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POLICY AMOUNT AND <br />PREMIUM ADJUSTMENT <br />Limits Of Insurance <br />Premiums <br />Coverage <br />Description <br />Previous Limit <br />Of Insurance <br />New Limit <br />Of Insurance <br />Previous <br />Premium <br />New <br />Premium <br />❑ Add'] Premium <br />❑ Return Premium- <br />1 <br />1 <br />$ <br />$ <br />$ <br />TOTAL PREMIUM ADJUSTMENTS <br />PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE <br />ADDITIONAL RETURN <br />$ 0.00 $ 0.00 <br />REMOVAL If Covered Property is removed to a new location that is described on this Policy Change, you may <br />PERMIT extend this insurance to include that Covered Property at each location during the removal. Cov- <br />erage at each location will apply in the proportion that the value at each location bears to the value <br />of all Covered Property being removed. This permit applies up to 10 days after the effective date <br />of this Policy Change: after that, this insurance does not apply at the previous location. <br />R ek Beni Drvisim <br />R"EwED 6 APPROVED BY: <br />will, <br />laze ;De <br />Rislc Management Cierir lAide <br />Page 2 of 2 © ISO Properties, Inc., 2001 W I W1 W, <br />