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IL12011185 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />Policy Change <br />Numher 1 <br />POLICY NUMBER <br />POLICY CHANGES <br />COMPANY <br />L201619110 <br />EFFECTIVE <br />Certain Underwriter's at Lloyd's, London <br />June 29, 2017 <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />1st Pennsylvania Light Artillery, Battery "B" Division of Union <br />Lockton Affinity, LLC <br />Army of the West (UAOW) <br />P.O. Box 410679 <br />Kansas City, MO 64141-0679 <br />COVERAGE PARTS AFFECTED <br />ReEnactor's Policy <br />CHANGES <br />Endorsement IL9990 12 10 — "Notice Of Cancellation To Designated Person Or Organization" is added per <br />the attached. <br />Amend Additional Insured as follows: <br />City of Santa Ana, its officers, employees, agents and volunteers <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />No change in premium <br />,dG^�,Pdfi�� <br />i <br />\\J <br />S CJ <br />Policy Term: From: 11/02/2016 To: 11/02/2017 <br />�G <br />Authorized Representative Signature <br />IL 12 01 1185 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 ❑ <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />polcychg Acct#940960 <br />