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PI-AI-SCH (08/20) <br /> Philadelphia Indemnity Insurance Company <br /> Additional Insured Schedule <br /> Policy Number: PHPK2716952-000 <br /> County of Los Angeles and it's agents <br /> Department of Health Services <br /> Contracts and Grants Division <br /> 313 N Figueroa St Ste 6E <br /> Los Angeles, CA 90012-2602 <br /> CG2026 - General Liability <br /> San Gabriel <br /> Pomona Regional Center <br /> 75 Rancho Camino Dr <br /> Pomona, CA 91766-4728 <br /> CG2026 - General Liability <br /> Funding source for the insured per contract <br /> The Corporation of the Presiding Bishop <br /> of The Church of Jesus Christ of Latter- <br /> Day Saints <br /> 50 E North Temple <br /> Salt Lake City, UT 84150-9700 <br /> CG2026 - General Liability <br /> Re: Contract Requirement <br /> Community Development Analyst <br /> Community Development Agency <br /> 20 Civic Center Plz <br /> Santa Ana, CA 92701-4058 <br /> CG2026 - General Liability <br /> Re: Funding Source <br /> PI-AI-SCH (08/20) <br /> Page 10 of 11 <br />