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City of Santa Ana /% CORE 360' <br /> err <br /> pum�li�U1N >YN�j1�1 OIIUJJUI➢°11IIIIICIIIIII ICOJ��UU uu��NNUI>�I��y�JNNR�� � !iq!!li�k>r�k_11i�fi VigU�>jIII�lUIIiI IIIi�IDU))1U11111UIIIlUIUJiD�U�UICII� <br /> Terrorism Subject to The Return of a Completed and Signed Surplus Lines Verification Form <br /> Lloyd's Syndicate 3623 (Beazley Must be Received in our Office Within Twenty(20) Days of Binding/California Surplus <br /> Furlonge Limited) Lines Disclosure Statement(Pre Bind) <br /> Subject to <br /> Terrorism <br /> Texas Insurance Company -The return of a completed and signed Surplus Lines Verification Form must be <br /> received in our office within twenty(20)days of binding <br /> 52 <br /> i <br /> �,�,� JJ II I�111<,<II1111�D���1�llll lUl�ll�>I�JJ III <br /> _ _ ,,,,,,,,,,,���,,,,����«�««���«������«����«����������«�IIIIIIIIIIIIiiloiii�illfIIIIIIIff0111111IIIIl011IIIIII��I�IOI � �� ����������� II III011lllf I���I���I�I��I�IIIIII�(O�I��I��IIIIIII��I���II�III��IIIIIIIIIIOII IIII��I�I��I�IIIIII�III������IIIII Il���l���f I���IIIII <br />