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POLICY NUMER INSURED NAME AND ADDRESS <br />B 6011406514 HOLISTIC YOGA & HEALTH LLC <br />1.00115 GARDEN GROVE BLVD <br />GARDEN GROVE, CA 92844 <br />POLICY CHANGES <br />ENDORSEMENT EFFECTIVE 04/21/2016 <br />This Change Endorsement changes the Policy. Please read it carefully. <br />This Change Endorsement is a part of your Policy and takes effect on the <br />effective date of your Policy, unless another effective date is shown. <br />The following Additional. Insured(g) has (have) been added: <br />Form 1: SB300113C Title: ADDITIONAL INSURED - <br />DESIGNATED PERSON <br />Name and Address: CITY OF SNATA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, <br />REPRESENTATIVES & VOLUNTEERS <br />Revewed by <br />Chairman of the Board <br />V�4J4— <br />Seaeta,y <br />cl-56015-B (ED. 1191) <br />