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40 <br />HISCOX <br />The City of Santa Ana <br />Certificate Holder <br />'. <br />Authorized Representative <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 <br />September 23, 2013 <br />Date <br />September 23, 2013 <br />Date <br />CG DS 0101 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 3 <br />Its permission. © ISO Properties, Inc., 2000 <br />