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Tapcv <br /> POLICY ENDORSEMENT <br /> Name of Assured Producer <br /> Moises Camacho Barco 517830 <br /> 2535 E Diana Dr Hector Gonzalez Insurance Agency Inc <br /> Anaheim, CA 92806 1850 E. 17th. St. <br /> Suite#219 <br /> Santa Ana, CA 92705 <br /> POLICY NUMBER: CPS4096515 ENDORSEMENT NUMBER: 001 <br /> COMPANY: Scottsdale Insurance Company <br /> POLICY EFF. DATE: 07/21/2025 POLICY EXP. DATE: 07/21/2026 <br /> ENDORSEMENT EFF. DATE: 07/21/2025 <br /> Endorsement 001 <br /> Form CG2010 (12/19)and Form CG2404(12/19) listing, The City of Santa Ana, its City Council, Officers, Officials, <br /> Employees, and Volunteers, are amended to change the address to read: <br /> The City of Santa Ana, its City Council, Officers, Officials, Employees, and Volunteers <br /> Attn: Executive Director, Community Development Agency <br /> 20 Civic Center Plaza <br /> Santa Ana, CA 92701 <br /> No change in premium. <br /> See revised forms attached. <br /> ALL OTHER PROVISIONS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. <br /> This Endorsement is issued by WICJ S_Q <br /> TAPCO Insurance Services <br /> Post Office Box 286 <br /> Burlington, NC 27216 <br /> 800-334-5579 Authorized Representative <br /> CA License Number: 0778135 <br /> Page 1 of 1 1002 <br />