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®Allied <br />AMCO INSURANCE COMPANY <br />Insurance <br />a Nationwide Insuranc company <br />CHANGE OF DECLARATIONS ENDORSEMENT - PLEASE READ CAREFULLY, <br />POLICY NUMBER ACP BPR 3006525207 PREMIER BUSINESSOWNERS POLICY <br />NAMED INSURED: B&R BIRCHLER INVESTMENT, CORP - DBA <br />EDINGER 76 <br />MAILING ADDRESS: 1502 E EDINGER AVE <br />SANTA ANA, CA 92705.4908 <br />AGENT NAME: ROGER STONE INSURANCE AGENCY 84 22292 NO CHARGE <br />$ .00 <br />AGENT ADDRESS: NEWPORT BEACH CA 92660 002 <br />POLICY PERIOD: FROM 04.16.15 TO 04.16-16 12:D1 A.M. Standard Time <br />EFFECTIVE DATE OF CHANGE: 12-24-15 12:61 A.M. Standard Time <br />NOT A STATEMENT- YOUR BILLING WILL FOLLOW TOTAL PREMIUM <br />5 .00 <br />LOCATION i BUILDING 3E3E1E3L3F3E3F31F3E3E3EifiOE3L1L7E NO. 001000 <br />$ ,00 <br />LOC/BLDG DESCRIBED PREMISES <br />01 01 1502 E EDINGER AVE SANTA ANA CA <br />GAS STATION --BUILDING, PUMPS, AND CANOPY <br />SIC CODE CHANGE <br />NAICS CODE CHANGE <br />1E*ILS**3f3E3ELL3E3E*iE3t*Ilii**1E ADDITIONAL INSURED NO. 002000 <br />$ .00 <br />CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY <br />ADDED NAME <br />CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY <br />ADDED OLD ADDRESS <br />ECONOMIC DEVELOPMENT DIVISION <br />ADDED ADDRESS <br />1000 E SANTA ANA BLVD #200 <br />ADDED CITY <br />SANTA ANA <br />ADDED STATE <br />CA <br />ADDED ZIP CODE <br />927013900 <br />ADDED FORM NUMBER <br />PB6003 <br />MUNICIPALITY CHANGE <br />***R*iliEi4MM**■R5*AIIiLiLR3E*iEMiLS ENDORSEMENT a�SM1Elr>E�r11AN�r*3�3rx*�11r1E*�tr�*11*11t1�* <br />ADDED ENDORSEMENT FORM <br />FORM PE6003 EDITION DATE 0411 <br />A COPY OF THIS FORM IS ATTACHED <br />in <br />0 <br />ry <br />DIRECT BILL LBAJ 16006 ENSURED COPY 937404493 <br />o <br />u, <br />78 04526 <br />Exhibit C <br />�vi�waA � �° <br />,'d LOl l L99 b6L 9Lae15UIP3 <br />dt79 Zt 9t 9, Uhf '� ` <br />