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POLICY CHANGE DOCUMENT <br /> POLICY NO.: PH PK2641462-014 <br /> Philadelphia Indemnity Insurance Companyl 113857 The Liberty Company Insurance Brokers, <br /> I III IIIIIIIIII IIIIIIiYYillli�l��1 <br /> NAMED INSURED Templo Calvario Community <br /> Development Corporation <br /> MAILING ADDRESS 2501 W 5th St <br /> Santa Ana, CA 92703-1816 <br /> POLICY PERIOD: FROM 01/01/2025 TO 01/01/2026 at <br /> 12:01 A.M. Standard Time at your mailing address shown above. <br /> CHANGE EFFECTIVE 02/14/2025 CHANGE# 2 REVISION#3 <br /> DESCRIPTION <br /> In consideration of the premium reflected, the policy is amended as indicated below: <br /> Added: <br /> Additional Insured <br /> City of Santa Ana, its City Council, officers, officials, employee, agents, and <br /> volunteers <br /> Form CG2404 Waiver of Transfer Rights of Recovery against Others to US <br /> Per attached <br /> Path ID 18293533 <br /> Total Annual Total Prorate <br /> Additional/Return Premium$ 0.00 Additional/Return Premium$ 0.00 <br /> NO CHANGE NO CHANGE <br /> COUNTERSIGNED BY <br /> (Date) (Authorized Representative) <br /> 05/20/2025 <br /> Issue Date Insurance Policy Page 1 of 1 <br />