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Updates/Changes: <br />RENEWAL <br />INFORMATION FORM <br />This document does not provide insurance <br />Date: 05/24/2021 <br />Policy: 9048876-2020 <br />If you have already submitted your updates online, please disregard. <br />LOCATIONS & EXPOSURES <br />❑ No Permanent California Location <br />1801 E CHESTNUT AVE, SANTA ANA, CA 92701 (PRIMARY) <br />Classification <br /># of Full- <br />Time <br />Employees <br /># of Part <br />Time <br />Employees <br />Estimated Annual <br />Remuneration/Payroll <br />8017-1-STORES-RETAIL-N.O.C. <br />0 <br />20 <br />$244,394.00 <br />8810-1-CLERICAL OFFICE EMPLOYEES <br />3 <br />0 <br />$1,339.00 <br />8871-1-CLERICAL <br />TELECOM MUTER—N.O.C. <br />0 <br />0 <br />$0.00 <br />9016-1-AMUSEMENT OR REC. FACILITIES <br />0 <br />12 <br />$120,818.00 <br />9180-1-AMUSEMENT/REC. FACILITY <br />MAINT <br />T <br />3 <br />1$101,666.00 <br />Updates/Changes: <br />OWNERSHIP INFORMATION <br />Existing Owners, Officers & Partners <br />Intentionally Empty <br />Updates/Changes to Owners, Officers & Partners <br />Page 2 of 4 <br />SP <br />Policy Name: FRIENDS OF SANTA ANA Z <br />�oRaN Risk MmRgementDMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />