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40 <br />H I SCOX <br />The City of Santa Ana <br />Certificate Holder <br />14J_ <br />Authorized Representative <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 <br />August 01, 2015 <br />Date <br />August 01, 2015 <br />Date <br />CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 3 <br />its permission. © ISO Properties, Inc., 2000 <br />