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POLICY CHANGE DOCUMENT <br />POLICY NO.: PHPK292306 <br />Philadelphia Indemnity Insurance Companyl 25917 Wigmore Insurance Agency, Inc. <br />NAMED INSURED Orange County Bar Foundation <br />MAILING ADDRESS PO BOX 986 <br />Santa Ana, CA 92702-0986 <br />POLICY PERIOD: FROM 03/15/2008 TO 03/15/2009 at <br />12:01 A.M. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 05/14/2008 CHANGE # 1 <br />DESCRIPTION <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Added: <br />Additional Insured Status is with Respects to the Funding Source <br />Relationship; Coverage is Primary and Non -Contributory. 30 Day Notice of <br />Cancellation to Additional Insured. Refer to Form CG2026 as per Attached. <br />The City of Santa Ana <br />It's Officers, Employees, Agents, Volunteers, and Representatives <br />20 Civic Center Plaza <br />Santa Ana, CA 92701-4058 <br />Path ID 2954088 <br />Total Annual <br />Additional/Return Premium $ <br />0.00 <br />NO CHANGE <br />COUNTERSIGNED BY <br />(Date) <br />Total Prorate <br />Additional/Return Premium $ 0.00 <br />NO CHANGE <br />(Authorized Representative) <br />Insured Copy Page 1 of 1 <br />