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~ POLICY CHANGE DOCUMENT <br />POLICY NO.: PHPK162357 <br />Philadelphia Indemnity Insurance Company 18894 ASHBROOK-CLEVIDENCE, INC. <br />NAMED INSURED Orange County Bar foundation <br />MAILING ADDRI=SS PO Box 986 <br />Santa Ana, CA 92702-0986 <br />POLICY PERIOD: FROM 03/iS/2006 TO 03/1S/2007 at <br />12:01 A.M. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 03/15/2006 CHANGE # 4 <br />DESCRIPTION <br />1n consideration of the premium reflected, the policy is amended as indicated below: <br />AMENDING THE ADDITIONAL INSURED TO READ AS FOLLOWS: <br />CITY OF SANTA ANA <br />P. O. BOX 1988 <br />SANTA ANA, CA 92702 <br />3/s~ <br />Path ID 1964761 <br />Total Annual <br />AdditionaURetum Premium $ 0.00 <br />NO CHANGE <br />COUNTERSIGNED SY <br />(Date) <br />Total Prorate <br />AdditionaURetum Premium $ 0.00 <br />NO CHANGE <br />{Authorized Representative} <br />Page 1 of 1 <br />