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<br />FFB 07 2002 10:10AM HP LASERJET 3200 <br /> <br />1".3 <br /> <br />'-' ::'~ 'wi -.. <br /> <br />" ;' ""," : <br />~ ~. <br />MIDTERM CHANGE DOCUMI:NT <br /> <br />POLICY NO. PHPK015656 <br />PHILADELPHIA INDEMNITY IN"~ICE ~2::I:_ <br /> <br />NAMED INSURED HOTLINE OF SOUTHERN CltLIFORNIA <br /> <br />MAILING ADDRESSP. O. BOX 32 <br /> <br />LOS ALAMITOS, CA <br /> <br />90"120 <br /> <br />POLICY PERIOD: From 11/26/2001 1,.11/26/200.2 <br />12:01 A.M. Standard Time at your mailing address sl10wn above. <br /> <br />at <br /> <br />CHANGE EFFECTIVE 03/22/2002 <br /> <br />CHANG.EJL.J) 0 0 0 3 <br /> <br />----- <br /> <br />DESCRIPTION <br /> <br />IN CONSIDERATION OF THE PRElIlIUr-l REFLECTED, THE <br />FOLl,OHING CHANGES HAVE BEEN MADE: <br /> <br />THE CITY OF SAN"TA ANA IS INCL'JDED AS AN ADDITIONAL <br />INSURED AS RESPECTS THE ATTACHED .Ml\NUSCRIPT SPECIAL <br />ENDORSEMENT PERTAINING TO: <br />GENERAL LIABILITY <br /> <br />BUT ONLY IN CONNECTION WITH THE OPERATIONS OF THE <br />NAMED INSURED. <br /> <br />WITH REGARDS TO CASINO NIGHT BEING HEl,D 3/22/2002 <br />BY THE NAMED INSURED. THE CITY OF SANTA ANA WITH <br />RESPECTS TO THE SPECIAJJ EVENT, CASINO NIGHT TO BE <br />HELD 3/22/02, WILL BE HELD HARJl1LESS EXCEPT IN THE <br />CASE OF WILLFUL MISCONDUCT OR GROSS NEGLIGENCY BY THE <br />ADDITIONAlJ INSURED. <br /> <br />NOTICES TO BE SENT TO: <br />THE CITY OF SANTA ANA, COMMlJNITY DEVEl,OPM&'lT AGENCY <br />M-25 <br />P.O. BOX 19BB <br />SAN'l'^l\Nl\, ell. 92702~1988 <br /> <br />P#631708 <br /> <br />Total Annual <br />Addilional/Return Premium $ <br /> <br />-~t~I~~ ' <br />? I di~1~'Return Premium $ <br />BY ._l_.-Un i /J . <br /> <br />U~rize <br /> <br /> <br />COUNTERSIGNED 02/07/2002 <br />(Date) <br /> <br />REGGRY <br />