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POLICY NMEBER INSURED NAME AND ADDRBGS <br />P 2093563501 MGT OF AMERICA, INC. <br />2123 CENTRE POINT BLVD <br />TALLAHASSEE, FL 32308 -4930 <br />POLICY CHMONS <br />ENDORBEIMT E!Y'ECrx" 0/20/13 <br />This Change Endorsement changes the Policy. Please read it carefully. <br />This Change Endorsement is a part of your Policy and takes effect on the <br />effective date of your Policy, unless another effective date Is shown. <br />6.Lake County Purchasing Division <br />7.Siskiyou County, Auditor's Office <br />Em <br />M <br />10. <br />i <br />i• <br />SEEN <br />i <br />Chakm of the BWd <br />G- 56015 -8 (ED. 11/91) <br />18 North County Street <br />Waukegan, Illinois 600805 -4350 <br />311 Fourth St., RM 101 <br />Yreka, CA 96097 <br />9ecretery <br />— VA F. 3 10FtCKJ. <br />Assistant. City AtforneY <br />s--p/1j <br />