Laserfiche WebLink
POLICY CHANGE DOCUMENT <br />POLICY NO.: PFIPK1297595 <br />Philadelphia Indemnity Insurance Companyl 101950 McNamara Insurance Services, Inc <br />NAMED INSURED Tim Bowen dba Play Well TEKnologies <br />MAILING ADDRESS 224 Greenfield Ave Ste B <br />San Anselmo, CA 94960-2471 <br />POLICY PERIOD: FROM 03/05/2015 TO 10/01/2016 at <br />12:01 A.M. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 04/15/2015 CHANGE # 7 <br />DESCRIPTION <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Added: <br />Additional Insured <br />City of Santa Ana it officers, employees, agents and representatives <br />Form CG2026-Addl Insured -Designated Person or Organization applies <br />With respect to Use of facilities to conduct classes <br />Per attached schedule <br />Path ID 8837301 <br />Total Annual <br />Additional/Return Premium $ 0.00 <br />NO CHANGE <br />COUNTERSIGNED <br />(Date) <br />05/27/2015 <br />Issue Date <br />m <br />Reviewed by <br />ft- 2'er� <br />Carmen Acosta <br />PRCSA/Recreation <br />Total Prorate <br />Additional/Return Premium $ 0.00 <br />NO CHANGE <br />(Authorized Representative) <br />Insurance Policy Page 1 of 1 <br />