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POLICY CHANGE DOCUMENT <br />POLICY NO.: PHPK438976 <br />Philad 1pl is Ind rnnity Insurance C mpan r 16012 Sherman Parent Prince & Fleming Insuran <br />NAMED INSURED East L.A. Classic Theatre Corp <br />MAILING ADDRESS 2168 S Atlantic Blvd <br />Monterey Park, , CA 91754-6839 <br />POLICY PERIOD: D: FROM 1 9 T 1 1 at <br />12:01 A. I. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 01/13/2010 CHANGE# 1 <br />DESCRIPTION <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />ADDED: <br />Additional Insured: <br />City of Santa Ana -PIA <br />Athena Martinez <br />PCB Box 19 M-75 PI <br />Santa Ana CA 92702 <br />P10 <br />FORM <br />With respects to performances at the city's schools SEPH 1I FT HE <br />Form: CG2005 Controlling Interest C1 TTORNEY <br />00 <br />Per attached schedule <br />Path ID 4200823 <br />Total Annual <br />Additional/return Premium <br />0.00 <br />NO CHANGE <br />COUNTERSIGNED BY <br />(Date) <br />Total Prorate <br />Addibonal/Return Premium0.00 <br />NO CHANGE <br />(Authorized Representative) <br />Insurance Policy Page I of I <br />