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THIS ENDORSEMENT ORANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />PollcyPovl*& Fmm09/27/2019 To 09/2,7/2020 <br />This endorsomeat mod(fies Insuponce iNtmd" mfujef tfm MeMog: <br />Cuuurler'--idl a�ne"J r'Uv�raf4e <br />Endomemunt Number I <br />Policy Number WS3 89882 <br />changes Effactivo <br />Chang" <br />In comaido--altian OF no charIQA !.f% premium, i L [VI linrmby <br />a41'f-ocld thlt- ",h�l rollowinq add-,'"ona.. in,14kirorl !.a act-aed t'n tiln policy <br />vine forma CO201.2 and SPM,(;-C�'� <br />C'My of 8-anta j'wo <br />Rink xanw3nmnt vjvtnion <br />20 Cotntor plaz�' <br />Sazit—t Ana, C4 927')2 <br />All. terma and anndtinns rLiraiu uncliiniftd. <br />The fellwMnil fono(a) is ADDED to tho poiley: <br />62'71t�-CC '4/lh) Amenielmo,i,', OF Other Tlnsurinsn Primary <br />rviquranc" f,,�r Add-,'tion,�l r "aured <br />Cc, '-,0 1."dos{:}3r Additional TnmurAd - Si,ata nr Governuvimal Agency <br />yr Subdiviull.on or Polit,Lo-al- sabdjvjgjczs - porjr,1t_- <br />AuthorizationA <br />The follwM09 RMSED fom(s) 4m ATTACHUM <br />r2q4D-01 ?9/'W7j ("vmAevciall GTJ CDVc"r::tq': 0eclarationg <br />NEW TERM PREMIUM <br />5ltn-k <br />two <br />Nc chancit- <br />REVIEW ED & APPROVED <br />By %kMANACfEMENTt)tVjSj0N <br />5 202p <br />A,4qiE AcFvFdo <br />2 <br />