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e <br />General Endorsement <br />POLICY NUMBER <br />BKA (15) 55 96 34 27 <br />Policy Period: <br />From 05/31/2014 To 05/31/2015 <br />12:01 am Standard Time <br />at Insured Mailing Location <br />This Endorsement Changes The Policy. Please Read it Carefully. <br />THE FOLLOWING APPLIES TO FORM CG8883 - AMENDMENT <br />OF OTHER INSURANCE - DESIGNATED PERSONS OR <br />ORGANIZATIONS: <br />COMPLETE ADDITIONAL INSURED: <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, <br />AGENTS, AND REPRESENTATIVE PARKS, RECREATION AND <br />COMMUNITY SERVICES AGENCY <br />26 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />To report a claim, call your Agent or 1-800-362-0000 <br />CID 70020101 <br />APPROViED AS TO FORM <br />9SAE. STORCK <br />Assistant City Attorney <br />3y 3 <br />Page 1 of 2 <br />