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POLICY CHANGE DOCUMENT <br />POLICYNO,: PHPK191129 <br />Phlladelphla Indemnity Insurance Company 18922 L Smith Lanier & Co, <br />NAMEDINSDRED BAY AREADRNINGSCHOOL <br />MAILINGADDRESS 1010ASt <br />Hayward, CA 945414106 <br />POLICY PERIOD <br />, FROM 11�01�2006 TO 11�01�2007 al <br />12,01 R.M. Staadartl Tlma elycur maillrg address shown above. <br />CHANGEEFFF.CTIVE 032912007 CHANGER 2 <br />DESCRIPTION <br />In coasiderellao of the premium reflected, the policy Is amended as iodicaletl below, <br />Added; <br />CG2010�Add' I Insured- Owners, Lessees, Or Contredors•Schaduled Parson or <br />Organiaaflon with respects to Lock1,1010 A St Hayward, CA: <br />The Clfy of Santa Ana <br />20 Chic Ceofer Plasa <br />Santa Ana, CA 92701 <br />Path ID 2240337 <br />total Moual Tatal PmraN <br />RddiliooauReWmPremium$ 0,00 � Addis`onaVReturaPiemlum$ 0,00 <br />ADDITIONAL ADDITI NAL <br />COUNTERSIGNED BY <br />(Dale) �Au�odted asenla <br />Insured Copy Page 1 of 1 <br />