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Policy Change <br />Number 1 <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />IL 12 01 11 85 <br />PAC7098932 <br />laolit <br />POLICY CH <br />EFFECTIVE <br />8/30/2016 <br />COMPANY <br />w 0 ILI ' ♦I, <br />NAMED INSURED AUTHORIZED REPRESENTATIVE <br />SECURITY SOLUTIONS INTERNATIONAL, INC. Morstan General Agency of <br />Florida Il, a Division of Hull & <br />Comoanv <br />COVERAGE PARTS AFFECTED <br />General Liability <br />ADDITIONAL PREMIUM: $50.00+ STATE TAX $2.50 + FSLSO FEE $0.09 <br />IN CONSIDERATION OF THE ADDITIONAL PREMIUM SHOWN ABOVE, IT IS HEREBY UNDERSTOOD AND AGREED THAT: <br />ADDITIONAL INSURED (CITY OF SANTA ANA) IS ADDED TO THE POLICY PER FORM CG2012 (04/13) ADDITIONAL INSURED -- <br />STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS PER THE <br />ATTACHED. <br />ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. <br />09/0612016 SU <br />BRK'. COMBINED UNDERWRITERS OF MIAMI INC. <br />Suplus Lines Agent's Name', <br />Gregg Kugler <br />6urplus Lines Agent'. Adds. <br />1835 Fankv R>ad <br />Merger., FL 33083 <br />Surplus Lines Agenr, Licensek <br />A142906 <br />In adLellp I Name: <br />DAVID R, RUGENS- A224386 <br />Prpdualpg eroksfe Addraaa: <br />6240 N. W. 52 Tereus, . Suite 408 <br />Sui plus Lines Agent's CounterslgnRund'., FL 33 166 8020 <br />IL 12 01 11 86 <br />Authorized Representative Si nature <br />INS i"sui ❑t o is ids'i.0 nnrsuauH to tP e I hxlulp stn'plus <br />linos laws. Persons Insured by surplus ilneu oardUS do <br />not have tha Moto rtlon of il'a Florida In a ui : e guaranty <br />rsci to .he fivte It or any rght of re,(overy for the obi iga Lion <br />of an InsoNent unifconsed Insurne'. <br />,: w r . • w is <br />to It <br />Copyright, Insurance Services Office, Inc., 1983 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />Page 1 of I {'2 <br />