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'O6/Ofl/2011 12:d8 FAX 71d2•i7'- - OH INS AGENCY-ALL9TATB @100 <br />ALLSTATE INSURANCE COMPANY <br />BUSINESS INSURANCE R999 ENDORSEMENTS <br />INSURED NAME: 450661033 <br />POLICY NUNf8[R 050661033 REQUESTED GATE: 05-09-11 11:33 AM <br />INSURANCE TYPE: 55 BbUND EFF DATE; 05-09-11 11:33 AM <br />** R999=- MTG/LPC/AI/ADDITIONALINTERESTS ** <br />ADD/ <br />DEL TYPE LOC? BLDG# REASON FOR ADDITIONAL INTERESTS <br />A A 000 001 EMPLOYMENT PLACEMENT <br />NAME1 : SANTA ANA k?ORK CENTER <br />NAt4E2 CITY OF SANTA ANA <br />ADDRESS 20 CIVIC CENTER PLAZA <br />CITY : SANTA ANA STATE: CA ZIP: 92702 <br />PROP COV: AIP TYPE OF ADDL INSURED: DP <br /> <br />APPROVED AS TQ FoRiVi <br />LISA E. STORCK <br />Assistant City Attorney <br />°?3 <br />Page 1 ofi 1