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PROOF OF INSURANCE (2009) CLOSEDF,A* THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effeclive on the inception Date of the policy unless another date is indicated below: o Policy Number: 42 SBABU2483 SA COPY Ln W CD 0 Named Insured and Mailing Address; MAYER HOFFMAN MCCANN P. C. o, MAYER HOFFMAN MCCANN P.C. 6050 OAK TREE BLVD STE 500 ° CLEVELAND OR 44131 M CD Policy Change Effective Date: 02/02/09 Effective hour is the same as stated In the Declarations Page of the Policy. N d Policy Change Number: 043 Agent Name: CBIZ INSURANCE SERVICES INC Code: 640001 POLICY CHANGES: HARTFORD CASUALTY INSURANCE COMPANY e� ! ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE', DATE a� FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - PERSON - ORGANIZATION FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SX22100300 PRO RATA FACTOR: 0.578 I� THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page 001 Process Date: 03/06/09 Policy Effective Date: 02/02/09 Policy Expiration Date: 09/01/09 UW COPY POLICY NUMBER: 42 SBA BU2483 I nv-� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION CI'T'Y OF RANCHO SANTA MARGARITA 22112 EL PASEO RANCHO SANTA MARGARITA, CA 92688 CITY OF LAKE FOREST THE CITY, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 25550 COMMERCECENTRE DRIVE, SUITS 100 LAKE FOREST, CA 92630 BELLAGIO LLC MGM MIRAGE ITS SUBSIDIARIES AFFILIATES, DIRECTORS, OFFICERS AND EMPLOYEES 3600 LAS VEGAS BOULEVARD SOUTH LAS VEGAS NV 89109 ALAMEDA CORRIDOR TRANSPORTATION AUTHORITY ITS OFFICERS EMPLOYEES AND AGENTS ONE CIVIS PLAZA SUITE 350 CARSON CA 90745 Form iH 12 001185 T SEQ. NO. 009 Printed in U.S.A. Page 003 (CONTINUED ON NEXT PAGE) proC&gg Date: 03/06/09 EXpiration mate: 09/01/09 UW COPY POLICY NUMBER: 42 SBA BU2483 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - PERSON - ORGANIZATION CITY OF EL CA30N DEDE PORTER 200 H MAIN STREET EL CANON, CA 92020 CITY OF EL CANON, ITS ELECTED AND APPOINTED OFFICIALS, OFFICERS, EMPLOYEES AND VOLUNTEERS OMNITRANS 1700 WEST FIFTH STREET SAN BERNARDINO CA 92411 CITY OF BURBANK DINO BALOS 275 EAST OLIVE AVENUE BURBANK, CA 91502 SAN DIEGO U14IFIED PORT DISTRICT PO BOX 120488 SAN DIEGO, CA 92112 -0488 ATTN: ALEXANDER, RISK MANAGEMENT DISTRICT, ITS AGENTS, OFFICERS AND EMPLOYEES AS ADDITIONAL INSURED CUCAMONGA VALLEY WATER DISTRICT, ITS DIRECTORS, OFFICIALS, EMPLOYEES AGENTS AND COLUNTEERS ATTN: CHAD BRANTLEY, CAP FINANCE DEPARTMENT 10330 ASHFORD STREET RANCHO CUCAMONGA, CA 91730 CITY OF HUNTINGTON BEACH, ITS AGENTS, OFFICERS AND EMPLOYEES ATTN: CHRIS MENDOZA 2000 MAIN STREET HUNTINGTON BEACH, CA 92648 CITY OF MORENO VALLEY MORENO VALLEY COMMUNITY SERVICES DISTRICT REDEVELOPMENT AGENCY OF THE CITY OF MORENO VALLEY 14177 FREDERICK STREET Form IH 12 00 1185 T SECL NO. 009 Printed in U.SA. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 03/06/09 Expiration Date: 09/01/09 UW COPY POLICY NUMBER: 42 SBA SU2483 F THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION ,4 MORENO VALLEY, CA 92553 N ao o CITY OF EL SEGUNDO 330 MAIN STREET EL SEGUNDO, CA. 90245 0 rn 0 ro Go Ir C14 CITY OF ORANGE, ITS OFFICERS, AGENTS AND EMPLOYEES N 300 E CHAPMAN AVE o ORANGE, CA 92866 p JEANNE AREHART, INTERNAL AUDITOR N M CITY OF MONTEREY PARK 320 W NEWMARK AVE MONTEREY PARK CA 91754 CITY OF STOCKTON ITS OFFICERS, AGENTS, AND EMPLOYEES 425 N EL DORADO STREET mum STOCKTON CA 95202 CITY OF ALHAMBRA 111 S FIRST ST. ALHAMBRA, CA 91801 CITY OF OXNARD RISK MANAGER 300 WEST THIRD STREET, SUITE 302 OXNARD, CA 93030 �Q CITY OF ANAHEIM lam 200 S ANAHEIM BLVD ANAHEIM, CA 92805 Form IH 12 00 1185 T SEQ. NO. 009 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 03/06/09 Expiration Date: 09/01/09 UW COPY POLICY NUMBER: 42 SBA BU2483 E THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION MORENO VALLEY, CA 92553 kn o o CITY OF EL SEGUNDO 330 MAIN STREET m EL SEGUNDO, CA. 90245 0 rn 0 rn m `~ CITY OF ORANGE, ITS OFFICERS, AGENTS AND EMPLOYEES M N 300 E CHAPMAN AVE N o ORANGE, CA 92866 o JEANNE AREHART, INTERNAL AUDITOR N CITY OF MONTEREY PARK 320 W NEWMARK AVE MONTEREY PARK CA 91754 CITY OF STOCKTON t� ITS OFFICERS, AGENTS, AND EMPLOYEES s 425 N EL DORADO STREET STOCKTON CA 95202 CITY OF ALHAMBRA 111 S FIRST ST. ALHAMBRA, CA 91801 CITY OF OXNARD RISK MANAGER 300 WEST THIRD STREET, SUITE 302 OXNARD, CA 93030 CITY OF ANAHEIM 200 S ANAHEIM BLVD ANAHEIM, CA 92805 Form IH 12 8011 85 T SEQ. NO. 009 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 03/06/09 Expiration bate: 09/01/09 UW COPY POLICY NUMBER: 42 SBA BU2483 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON- ORGANIZATION CITY OF RANCHO SANTA MARGARITA 22112 EL PASEO RANCHO SANTA MARGARITA, CA 92688 CITY OF LAKE FOREST THE CITY, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 25550 COMMERCECENTRE DRIVE, SUITE 100 LAKE FOREST, CA 92630 BELLAGIO LLC MGM MIRAGE ITS SUBSIDIARIES AFFILLATES, DIRECTORS, OFFICERS AND EMPLOYEES 3600 LAS VEGAS BOULEVARD SOUTH LAS VEGAS NV 89109 ALAMEDA CORRIDOR TRANSPORTATION AUTHORITY ITS OFFICERS EMPLOYEES AND AGENTS ONE CIVIS PLAZA SUITE 350 CARSON CA 90745 Form IH 12 0011 85 T SEQ. ISO. 009 Printed in U.S.A. Page 003 (CONTINUED ON NEXT PAGE) Process Date 03/06/09 Expiration Date: 09/01/09 • Uw COPY