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POLICY CHANGE (Continued) <br /> Policy Number: 72 SBM BD5162 <br /> Policy Change Number: 002 <br /> BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED <br /> ADDITIONAL INSURED(S) ARE ADDED <br /> THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN <br /> THIS POLICY. <br /> LOCATION 001 BUILDING 001 <br /> LEASED EQUIPMENT: SEE FORM IH 12 00 <br /> ADDITIONAL INSURED #1 - OWNERS, LESSEE OR CONTRACTORS IS ADDED <br /> FORM SS4170 <br /> NAME CITY OF ANTA ANA,ITS CITY COUNCIL,OFFICIALS,EMPLOYEES,AGENTS <br /> AND VOLUNTEERS <br /> ADDRESS 801 W CIVIC CENTER DR, STE 200,SANTA ANA,CA 92701 <br /> FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br /> SS 41 70 06 11 <br /> IH12001185 ADDITIONAL INSURED - LEASED EQUIPMENT <br /> Form SS 12 11 04 05 T Page 002 <br /> Process Date: 05/29/25 Policy Effective Date: 08/20/24 <br /> Policy Expiration Date: 08/20/25 <br />