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POLICY NO: <br />PHPK1024916-000 <br />POLICY CHANGE DOCUMENT <br />CHANGE # 1 CHANGE EFFECTIVE: 08/12/2013 <br />Philadelphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. <br />NAMED INSURED: Marc Payan, dba, West Coast Community Development, LLC. <br />MAILING ADDRESS 59 Long Mdw <br />Irvine. CA 92620 - <br />POLICY PERIOD: FROM 05/23/2013 TO 05/23/2014 at <br />12:01 A.M. Standard Time at your mailing address shown above. <br />DESCRIPTION: <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Added 1 Additional Insured. <br />Total Annual Total Prorate <br />Additional/Return Premium $0.00 Additional/Return Premium $0.00 <br />Total Annual Total Prorate <br />Additional/Return Additional/Return <br />Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 <br />Apk'ROVED AS TO FOPM <br />Page 1 of 1 LISA E. STORCK <br />Assistant City Attornmi <br />