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POLICY CHANGE DOCUMENT <br />POLICY NO.: PHPK733498 <br />Philadelphia Indemnity Insurance Company 110917 Caiquo Insurance Agency <br />NAMED INSURED Arc Mid-Cities <br />MAILING ADDRESS 14208 Towne Ave <br />Los Angeles, CA 90061-2653 <br />POLICY PERIOD: FROM 07/19/2011 TO 07/19/2012 at <br />12.0 A.M. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 04/26/2012 CHANGE # 2 <br />DESCRIPTION <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Added: <br />Additional Insured <br />The City of Santa Ana <br />its officers, employees, agents <br />volunteers and representatives <br />20 Civic Center Plaza <br />Santa Ana, California 92701 <br />CG2026 Additional Insured-Designated Person or Organization <br />Only as respects the primary insured's operations <br />Per attached <br />Path ID 6185976 <br />Total Annual <br />Additional/Return Premium $ <br />0.00 <br />NO CHANGE <br />Total Prorate <br />Additional/Return Premium $ 0.00 <br />NO CHANGE <br />COUNTERSIGNED BY <br />(Date) <br />Insurance Policy <br />(Authorized Representative) <br />Page 1 of 1