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®Allstate <br />. n¢ow nra <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. Bldg. Additional Name A Address <br />No. No. Interest <br />001 001 ADDITIONAL INSURED THE ROMAN CATHOLIC BISHOP OF ORANGE <br />A CORPORATION SOLE <br />2811 E VILLA REAL DR <br />ORANGE, CA 92867-1932 <br />BUSS75-3 <br />Page 1. <br />9 <br />