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POLICY CHANGE 5 <br />GKe4tsve 03/16/2015 ,this endersament forms a pas of i No. 711- 01 -37 -43 -0001 <br />(At the time stated in the poiicy) <br />ismied to <br />SL'LEC RON TECHNOLQCIES, INC. <br />(See ASC. 00 11 01 96, Schedule 1) <br />12323 SW 66TI.1 AVE, <br />TIC;ARQ, OR 07223 -3568 <br />Prodac,ar: RISK PLr'i_:F..TAE1',1T SERVICES, ZNC. <br />ey Atla;ltic Speciell i-y Insurance Company <br />in ACcordanCe with this Falicy Change Your Premium is R:eviand an follows: <br />Additional <br />premium <br />$46 <br />This Policy Change Amends he Following Policy hrovisionn- <br />C ommon Policy Declarations, 4 VIL 100 10 98 <br />Add Notice of Cancellation Co Designated Certificate Holder, VIL 229 On 1.2: <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER FLAU2 <br />SANTA ANA, CA 92701-405a <br />Liability Schedule, VQG 100 10 58 <br />Add Ad :aoWCasal insured [Owners, Les ocs or Contractors, CG 20 10 04 13: <br />=NS CITY OF SANTA ANA <br />200 CIVIC CWTER PLAZA <br />SZ1NPIA AMA, CA 92101-4058 <br />Loc Bldg <br />I i <br />3 2- 15- W1 031/24/2C!5 i42L CPrii' Pt 0.579 <br />Aso 09"91 98 E- INSURED POLICY CHANCE <br />Page _ of 7 <br />