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AM <br />HISCOX <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 <br />City of Santa Ana, Its employees, and council members while <br />acting under the direction of the City o <br />Certificate Holder <br />Authorized Representative <br />April 13, 2015 <br />Date <br />April 13, 2015 <br />Date <br />CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 5 <br />its permission. © ISO Properties, Inc., 2000 <br />