Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGE <br />This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated <br />below: <br />Policy Number: 76 SBU UQS313 76 <br />Named Insured and Mailing Address; PROUDCITY <br />DBA PROUDCITY <br />2219 DAMUTH ST <br />OAKLAND CA 94602 <br />Policy Change Effective Date: 07/05/22 Effective hour is the same as stated in the <br />Declarations Page of the Policy. <br />Policy Change Number: 002 <br />Agent Name; PAYCHEX INSURANCE AGENCY INC/PHS <br />Code: 210690 <br />POLICY CHANGES: <br />SENTINEL INSURANCE COMPANY, LIMITED <br />ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING <br />STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK <br />ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. <br />THIS IS NOT A BILL. <br />NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE <br />BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED <br />ADDITIONAL INSURED IS CHANGED TO READ <br />LOCATION 002 BUILDING 001 <br />ADDITIONAL INSURED #3 - OWNERS, LESSEE OR CONTRACTORS IS REVISED <br />FORM SS4170 <br />NAME THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES & VOL <br />UNTEERS <br />ADDRESS 20 CIVIC CENTER PLAZA, SANTA ANA, CA 92701 <br />PRO RATA FACTOR: 1.000 <br />THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. <br />Form SS 12 110405 T Page 001 (CONTINUED ON NEXT PAGE) <br />Process Date: 06/24/22 Policy Effective Date: 07/05/22 <br />Policy Expiration Date: 07/05/23 <br />