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POLICY CHANGE (Continued) <br />Policy Number: 57 SBM BL2522 <br />Policy Change Number: 003 <br />BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED <br />ADDITIONAL INSUREDS) ARE ADDED <br />THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN <br />THIS POLICY. <br />LOCATION 001 BUILDING 001 <br />ADDITIONAL INSURED #1 - OWNERS, LESSEE OR CONTRACTORS IS ADDED <br />FORM SS4170 SS4171 <br />NAME THE CITY OF SANTA ANA <br />ADDRESS 20 CIVIC CENTER PLZSANTA ANA, CA 92701 <br />FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />SS 41 70 06 11 SS 41 71 06 11 <br />Form SS 12 11 04 05 T Page 002 <br />Process Date: 11/12/19 Policy Effective Date: 11/09/18 <br />Policy Expiration Date: 11/09/19 <br />