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PQLICY NUMBER INSURED NAME AND ADDRESS <br />;ARDEN GROVE, CA ..1844 <br />POLICY CHANGES <br />ENDORSEMENT EFFECTIVE 04/21/2016 <br />This Change Endorsement changes the Policy. Please read it carefully. <br />This Change Endorsement is a part of your Policy and takes effect on the <br />effective date of your Policy, unless another effective date is shown. <br />The 'o_lowing Additional insured(s) ha3 _en ad=.1a1: <br />Form A S3300113C Title. ADDIrICAIAT. W3EC - <br />DES-SGNATED PERSQ: <br />`lane and Address: CITY OF SNATA AiA, HS EMPLOYEES, AGENTS, <br />PEPRES NTATIVE,i T VOL-UNTEERS <br />f <br />carmen Acosta <br />Wq" ,sA,'ReC, eaboo' <br />Chairman of the Board 9acaetnry <br />