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-, Me my I•I <br />CHANGE #4 CHANGE EFFECTIVE: 07/06/2016 <br />Philadeiphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. <br />NAMED INSURED: Illary Archilla <br />MAILING ADDRESS 1 Dover <br />Trabuco Canyon, CA 92679- <br />POLICY PERIOD: FROM 07/06/2016 TO 07/06/2017 at <br />12:01 A,M, Standard Time at your mailing address shown above. <br />DESCRIPTION: <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Endorse to add primary and non-contributory wording in favor of the following entity. The City of Santa <br />Ana, it's officers, employees, agents, and representative. <br />Total Annual Total Prorate <br />Additional/Return Premium $0.00 Additional/Return Premium $0.00 <br />Total Annual <br />Additional/Return <br />Tax/Surcharge/Fee <br />Total Prorate <br />Additional/Return <br />$0.00 Tax/Surcharge/Fee <br />Page 1 of 1 <br />ME <br />