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2010-10-2Q 12:12 7145581960 7145581980 » 714 5714266 p ?4 <br />POLICY GFIANGE vOCUMENT <br />POLICY NO.: PNPKS23t367 <br />Phrledelphfe tnderernity Insurance Company Uaraselgned jsB) <br />NAMED Mt3URED Hearin Torras <br />MAILING ADORE3S _ 12692 tianctrero Way <br />_ Garden Csrove. t.A, 92643 <br />POLICY pER10D_ FROM 01/24/2040 TO 01!24/2091 <br />? 2:07 A.M. tatanaard Tarr M Y? rmMni add?oas ahOVMf above <br />at <br />CHANGE EFFECTIVE 09/2d/2010 CiiANGE e 7 <br />DESCRIPTIOT{ <br />Add Addttiortel Msured: The City W septa Ana 1626 W Chia Center Dr 3enta Ana .CA 92703 <br />APPF20VEp S TO <br />JOSEPH LET ER <br />ITV TT EY <br />Path ID: 4831067 <br />Tafil Mmd <br />AdOMlonwVReprn PrarM?an <br />COUNTERSIGNED <br />10.00 <br />Tom! Rorrls SO.00 <br />A4dJYensYReWnt P?amium <br />BY <br />(Data) <br />Pag9 109 1 <br />(Authorized Representative) <br />