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<br />. , <br /> <br />POLICY CHANGE ENDORSEMENT <br /> <br />lheStRlul <br /> <br />This endorsement summarizes the changes to <br />your policy. All other terms of your policy not <br />affected by these changes remain the same. <br /> <br />How Your Policy Is Changed <br /> <br />GENERAL RULES <br /> <br />Adding form D0084 1000- Notice to Described Persons or Organizations of <br />Material Change Or Policy Cancellation Endorsement <br /> <br />GENERAL LIABILITY <br /> <br />Adding form G0435 0400-Non-Contributory Other Insurance Endorsement - <br />For Described Additional Protected Persons <br /> <br />Adding form 40502 0180- Additional Insured Endorsement <br /> <br />Forms added for: <br /> <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br /> <br />AdROVED AS TO FORM <br /> <br /> <br />'2.15 <br /> <br />1 r:~ Sheedy <br />)'.]l\':V City Attor <br /> <br /> <br />Premium Change Which Is Due Now <br />Additional premium -0- <br /> <br />Returned Premium <br /> <br />-0- <br /> <br />If issued after the date your policy <br />begins, these spaces must be completed <br />and our representative must sign below. <br /> <br />Policy issued to <br />NEW HORIZONS WORLDWIDE, INC. <br /> <br />Endorsement takes effect <br />01/14/03 <br />Processing Date: 01/17/03 <br /> <br />Policy Number <br />TE06101269 <br />15:26 004 <br /> <br />Authorized representative <br /> <br />40704 Ed.5-84 Printed in U.S.A. Endorsement <br />oSt.Paul Fire and Marine Insurance Co.1984 All Rights Reserved <br /> <br />Page <br /> <br />1 <br />