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POLICY NUMBER: 6BRPGO000004934600 tNTE•8ZLINE <br />IL 12 01 11 85 <br />THIS ENDORSEMENT CHANGES THE POLICY_ PLEASE TREAD IT CAREFULLY. <br />POLICY CHANGES <br />Policy Change <br />POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY <br />6BRPG000000493,4600 04/2 111 1 Nationwide Mutual insurance Company <br />I <br />NAMED INSURED AUTHORIZED REPRESENTATIVE. <br />Maria R. Vigil K&K Insurance Group, Inc. j <br />DBA: Ria Vioil Group Fit <br />COVERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CHANGES <br />Form Number: CG201' "Additional Insured - Managers or Lessors of Premises" <br />] Add Form n Delete Form ,Xj Amend Form To Include Additional insured Below <br />City of Santa Ana, its officers, agents and employees <br />Paris, Recreation and Community Services Agency <br />Attn: Siivia Cuevas <br />26 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Ref: CP# 552 <br />The above amendments result in a change in the premium as fo€Iows: <br />NOCH <br />-O AT AUDIT <br />S <br />Authorized Representative Signature <br />€L 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983.Page 1 of 1 <br />Copyright, ISO Commercial Risk Services. Inc., 1983 <br />