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®Allstate <br />SPECIAL FORM CUSTOMIZER POLICY NO. 050 828050 <br />SUPPLEMENTAL DECLARATIONS <br />4. ADDITIONAL INTERESTS <br />This policy covers the interests of any of the following when named below. The Mortagee, under Coverage A - <br />Part One. the Loss Payee under Coverage A - Part Two, the Additional Insured under Coverage B - Part One, and <br />the Vendor, under Coverage B - Part One. <br />Loc. <br />No, <br />Bldg. <br />No. <br />Additional <br />Interest <br />Name A Address <br />001 <br />001 <br />ADDITIONAL INSURED <br />CAPISTRANO UNIFIED SCHOOL DISTRICT <br />31431 EL CAMINO REAL <br />SAN JUAN CAPISTRANO, CA 92675 <br />001 <br />001 <br />ADDITIONAL INSURED <br />ORANGE UNIFIED SCHOOL DISTRICT <br />ATTN: USE OF FACILITIES <br />1401 NORTH HANDY STREET <br />ORANGE, CA 92867-4434 <br />001 001 ADDITIONAL INSURED ST JOHN LUTHERAN SCHOOL <br />154 S SHAFFER ST <br />ORANGE, CA 92866 <br />001 001 ADDITIONAL INSURED TUSTIN UNIFIED <br />300 SOUTH C STREET <br />TUSTIN, CA 92780-3633 <br />001 001 ADDITIONAL INSURED ST NORBERT'S <br />300 TAFT AVE <br />ORANGE, CA 92865-4330 <br />001 001 ADDITIONAL INSURED IRVINE UNIFIED SCHOOL DISTRICT <br />IRVINE PUBLIC SCHOOLS FOUNDATION <br />18552 MACARTHUR BLVD #200 <br />IRVINE, CA 92612-1210 <br />001 001 ADDITIONAL INSURED NEWPORT -MESA UNIFIED SCHOOL DISTRICT <br />2985-A BEAR STREET <br />COSTA MESA, CA 92626-4300 <br />BU5575.3 <br />BLWaR I <br />Page 1. <br />O, <br />