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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010699
Report Date: 07/28/2026
Date Signed: 07/28/2026 12:35:57 PM

Document Has Been Signed on 07/28/2026 12:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CREATIVE ANGELS PRESCHOOL & KINDERGARDENFACILITY NUMBER:
198010699
ADMINISTRATOR/
DIRECTOR:		GAYANE TAMAZIANFACILITY TYPE:
850
ADDRESS:1725 N. MARIPOSA AVENUETELEPHONE:
(323) 660-9934
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 32TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Suzana DemirchyanTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On July 28, 2026, at 9:00 am Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced annual inspection for the above facility. LPA was greeted by Teacher, S1, who explained that the licensee is on their way as the Director is not available. The Licensee, Suzana Demirchyan arrived shortly after and guided LPA on a tour of the facility. This is a preschool age program which operates Monday through Friday from 7:00 am to 6:00 pm. Per licensee, there are 8 children enrolled and LPA observed 5 children in care and 2 staff members.

At 9:30 am, LPA was guided on a tour of facility. Parents enter through the front door of the facility and sign their child in. This Preschool program consists of 4 classrooms: Class 1: 5 children and 2 staff, Classroom 2: 0 children, 0 staff, Classroom 3: 0 children and 0 staff, and Classroom 4: 0 children and 0 staff. Upon LPA’s arrival at the facility, LPA observed 1 child that appeared to be an infant in classroom 1. LPA asked S1 how old is Child 1 (C1), and they stated almost 2 years old. Once the licensee arrived at the facility, LPA questioned the age of the C1 and licensee confirmed that C1 is under 2 years old. LPA asked to see C1’s file and a file was unavailable. Licensee expressed that C1 is on a trial at the facility and has attended on 7/27/26 for one hour. LPA observed the sign-in sheet for the this week and did not observe C1 to be listed as a child attending the facility on 7/27/27 and 7/28/2026. LPA explained to the licensee that they are operating beyond the limitations and conditions of their license as they are a preschool program and are not licensed to care for infants, which is an immediate risk to the health and safety. LPA explained that the C1 needs to be picked up immediately and cannot continue to attend the facility. C1 was picked up from the facility at 10:02 am. LPA verified with the parent of C1 that C1 is an infant.

Page 1 of 5

Ana Chico
Priscilla Ochoa
DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 10
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/28/2026 12:35 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 07/28/2026 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101161(a)
Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out 5 children did not meet the age requirement to attend the facility as they are an infant which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2026
Plan of Correction
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LPA observed C1 be picked up by their parent. Licensee will write a declaration stating that they will follow the limitations of their preschool licensee. Licensee will send declaration to LPA by POC date 07/29/26
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2026


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 07/28/2026 12:35 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 07/28/2026 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in1 out of 3 staff did not obtain childcare mandated reporter training for LPA to review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2026
Plan of Correction
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Licensee will ensure that S3 completes childcare mandated reporter training and send LPA proof of completed certificate by POC date of 08/07/26
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 3 staff did not obtain proof of measles and pertussis immunization for LPA to review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/28/2026
Plan of Correction
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Licensee will ensure S1 and S3 obtain proof of measles and pertussis immunization. Licensee will send proof to LPA by POC date of 08/28/26
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/28/2026 12:35 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 07/28/2026 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 5 children did not have a file for LPA to review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2026
Plan of Correction
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Licensee will write a declaration explaining that they will always have a file for each child that attends the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699
VISIT DATE: 07/28/2026
NARRATIVE
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Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision. LPA observed all children to have their own cubby to store personal belongings. Napping equipment was observed in the form of cots. Bedding was inspected for good condition, appropriate storage, and cleanliness. Per licensee, bedding is taken home every Friday for washing purposes. There are age-appropriate toys and supplies for children in each classroom and are in good repair.

All toilets and hand washing facilities are in safe and sanitary operating condition. LPA observed a mounted changing table in the bathroom near the kitchen, which was in good and sanitary condition. Drinking water is available in form of personal water bottles that are also taken outside when needed. The facility provides additional water which is dispensed in each classroom for children in care.

The classroom furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free.

Outdoor playground was observed to be fenced and was inspected. Outdoor equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade in the play yard.

At this time, classroom 3 is used as an isolation area. Parents are contacted immediately. There is also a cot available if needed.

The facility provides all meals for children in care. LPA inspected the kitchen area and verified that meals for children in care were stored properly. The kitchen area was observed to be clean, and the cleaning compounds/solutions were found to be away from the food. Storage areas are clean, free of litter, rubbish, and rodents/vermin. All storage containers for solid waste, including moveable bins, have tight fitting covers and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. The facility takes measures to keep the facility free of flies, other insects, and rodents.

Per licensee there are no weapons, firearms, or bodies of water on the premises.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
Page: 7 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699
VISIT DATE: 07/28/2026
NARRATIVE
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All areas were identified on the Facility Sketch were inspected. The following documents were posted: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), PUB 269 Child Passenger System Poster, Meal menu, Daily Schedule.

LPA observed a functioning smoke and carbon monoxide detector at the facility. LPA observed a fully charged 2A-10BC fire extinguisher. The valve on the fire extinguisher pointed to the fully charged green section. Fire extinguisher was serviced on 4/16/2026. Per Title 22 Emergency Disaster Drill must be conducted at least every 6 months. LPA observed the last Emergency Disaster Drill was conducted and documented on 06/03/2026.

LPA reviewed Sign in and out sheets to ensure each sign in and sign out are time stamped along with the person who sign in and out the child.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Child records were deemed not complete. 1 out of 5 children did not have a file for LPA to review.

Staff records were reviewed to ensure Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation. Staff records were deemed not complete. 2 out of 3 staff did not obtain proof of measles and pertussis immunization for LPA to review. 1 out of 3 staff did not obtain childcare mandated reporter training for LPA to review. LPA reviewed Staff 1 (S1)’s proof of education and observed that they have completed child development courses in a different county and have been translated to English. However, LPA could not identify how many units each course is counted for as they translated to hours served. Licensee will need to get S1’s courses evaluated to ensure S1 has the appropriate number of units to meet title 22 regulations. Facility will receive a technical violation.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699
VISIT DATE: 07/28/2026
NARRATIVE
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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA P. Ochoa informed licensee, Suzana Demirchyan that this report dated 07/28/2026 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA P. Ochoa informed the licensee, Suzana Demirchyan to provide a copy of this licensing report dated 07/28/2026 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CREATIVE ANGELS PRESCHOOL & KINDERGARDEN
FACILITY NUMBER: 198010699
VISIT DATE: 07/28/2026
NARRATIVE
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The following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Suzana Demirchyan.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
Page: 10 of 10