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C * S1*07/30/13*PACO330978-00 574353436 *D/B <br />ORIG <br />IMAGE COPY <br />• AMENDED <br />07/25/2013 0694804 <br />GREAT AMERICAN <br />IyEUgA0Nff <br />CO 10107 <br />�iRBA'P <br />fi[3' ,IUCAN, <br />Administrative Offices <br />3014tStreet <br />301E Stra <br />Cincinnati OH 45202-4201 <br />513 359 5000 ph <br />policy No. <br />E f f e c t i v e Date <br />PAC 033-09-78 <br />o f Change <br />- 00 <br />0 7/ 2 5/ 2 0 13 <br />INSURANCE GROUP <br />BUSINESSPRO <br />POLICY CHANGES <br />NAMED INSURED ORANGE COUNTY ASIAN & PACIFIC <br />ISLANDER COMMUNITY ALLIANCE <br />AND ADDRESS: 12900 GARDEN GROVE BLVD„#214A <br />GARDEN GROVE, CA 92843 <br />THIS ENDORSEMENT AGENT'S NAME AND ADDRESS: <br />CHANGES THE POLICY. CHAPMAN INSURANCE <br />PLEASE READ IT PO BOX 5455 <br />CAREFULLY. PASADENA, CA 91117 0455 <br />nsurance is afforded by the Company named below, a Capital Stock Corporation: <br />GREAT AMERICAN INSURANCE COMPANY <br />POLICY PERIOD: From 10/15/2012 To 10/15/2013 <br />1 2 : 0 1 A.M. Standard Time at the address of the Named Insured <br />IT IS HEREBY UNDERSTOOD AND AGREED THAT THE POLICY IS AMENDED AS FOLLOWS: <br />\DDING FORM CG2026-ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION <br />f0 THE POLICY AS RESPECTS TO: <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, <br />\GENTS, VOLUNTEERS, AND REPRESENTATIVES <br />CITY OF SANTA ANA <br />1000 E. SANTA ANA BLVD. SUITE 200 <br />SANTA ANA, CA 92701 <br />DORSEMENT 4 <br />\NY AMENDED FORMS ATTACHED TO THIS CHANGE DISPLAY PREMIUMS FOR A FULL <br />POLICY TERM. <br />Forms and Endorsement Activity <br />CG2026 07/04 ADDL INS -DESIGNATED PERSON/ORGANI ADDED <br />Agent Signature Date <br />IL 70 02 10/07 (Page 1 of 1 )TOAMM� <br />OY 5 <br />t Gity pttorneY <br />psi;tan qyX-11 <br />