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<br />To: 15624201022 Page: 2/11 Date 6/1120078:46:06 AM <br /> <br />CHANGE EFFECTIVE DATE: 05-24-07 <br />CHANGE ENDORSEMENT NUMBER: 0004 <br /> <br /> <br />e TRA V E LE RS One Tower Square, Hanford, Connecticut 061"" <br /> <br />CHANGE ENDORSEMENT <br /> <br />Named Insured: <br />DEKRA-LITE INDUSTRIS, INC. THE <br />JEFFREY LOPEZ REVOCABLE TRUST <br /> <br />Policy' Number: 1-660-0420L552-TIL-07 <br />Policy Effective Date: 04/08/07 <br />ISsue Date: 05/30/07 <br />Additional Premium $ 109 <br /> <br />INSURING COMPANY: <br />TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br /> <br />Effective from OS/24/07 at the time of day the policy becomes effective. <br /> <br />THIS INSURANCE IS AMENDED AS FOLLOWS: <br /> <br />ADDITIONAL INSURED (CONTRACTORS), CG D2 47, 08-05, <br />IS AMENDED AS FOLLOWS: <br /> <br />THE FOLLOWING HAS BEEN ADDED AS AN ADDITIONAL INSURED TO FORM <br />CG D2 47: <br /> <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA M-25 <br />POBOX 1988 <br />SANTA ANA CA 92701 <br /> <br />Stone Witter Insurance Services, Inc. <br />POBox 8035 <br />Long Beach, CA 90808-8035 <br />Ph: 562/420-3422 <br />CA Ins Lie OF15720 <br /> <br />~~ <br /> <br />- uthonzed Representat;ve;. <br />DATE: 66 It:' I () T <br />I / <br /> <br />NAME AND ADDRESS OF AGENT OR BROKER: <br /> <br />Cj.J <br /> <br />-\ i <br />1:: ~Ji <br /> <br />~2~ <br />'--"-.' '" . ,"' '--- - ~-~-.. ,_._--, ',-.- _7,.~.__,L_.'=__~~c._._,.__" <br />:".:,r i" St..Cd)' <br /> <br />L::j i~ l.--.LyAttcr:~<?v <br /> <br />