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Forms a part of Policy No.: FV20200 M-01 <br />Issuine Comoanv: Capitol Specialty Insurance <br />Additional Insured — Owners, Lessees or Contractors — Scheduled Person <br />Organization <br />Continued <br />If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and er <br />on the Declarations. <br />All other terms and conditions of this Policy remain unchanged. -• <br />f - , <br />Authorized Representative <br />ENV 167 (05-16) © 2016 CapSpecialty, Inc. All rights reserved. <br />•s den Risk MarugemndDlvisim <br />RE EwED 6 APPRMM By: <br />( <br />iuitua-/- r MxKM Z vw-' <br />®' Risk Management Malyst <br />