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��A <br />H I SCOX <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 <br />City of Santa Ana, Its employees, and council members while <br />acting under the direction of the City of Santa Ana <br />Certificate Holder <br />� ���� <br />Authorized Representative <br />December 19, 2012 <br />Date <br />December 19, 2012 <br />Date <br />CG DS 01 01 1 O Includes copyrighted material of Insurance Services Office, Inc., with Page 5 <br />its permission. ©ISO Properties, Inc., 2000 <br />