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POLICY CHANGE (Continued) <br />Policy Number: 46 SBM UQ8313 <br />Policy Change Number: 002 <br />BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED <br />ADDITIONAL INSURED(S) ARE ADDED <br />THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN <br />THIS POLICY. <br />LOCATION 002 BUILDING 001 <br />VENDOR: SEE FORM IH 12 00 <br />ADDITIONAL INSURED #3 - OWNERS, LESSEE OR CONTRACTORS IS ADDED <br />FORM SS4170 <br />NAME THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, & RE <br />PRESENTATIVES <br />ADDRESS 20 CIVIC CENTER PLAZA, SANTA ANA, CA 92701 <br />FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: <br />SS 41 70 06 11 <br />FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />SS 12 23 06 11 <br />IH12001185 ADDITIONAL INSURED - VENDOR <br />Form SS 12 1104 05 T <br />Process Date: 10/20/21 <br />Page 002 ate. "Mawgarnewkum" <br />Policy Effective REVIEWED&APPROVED Hr <br />Policy Expiratio � i ) �A %W G' ' <br />Rkk ManagementSupewum <br />