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<br />SENT BV,'.VAN DUZER INSURANCE; <br /> <br />310~~~e1e; <br /> <br />MAR.10-04 5:28PM; <br /> <br />PAGE 2 <br /> <br />--,.-.. <br /> <br />.. "."fl~1'!ftít!i ;>f'#':;j , <br /> <br /> <br />.. <br /> <br />. <br /> <br />THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ rr CAREFULLY. <br /> <br />POLICY CHANGE <br /> <br />This endol8emenl changee !he poley eIIecIIve "" the Inœplion 0... cllh8 poIjçy yn1e88 .nOllle, - Iso !ndÍ<:a!1l(l below: <br /> <br />Peller N_ber: 72 alA t.G5574 <br /> <br />8C <br /> <br />COpy <br /> <br />.., <br />'" <br />.. <br />.. <br />.. <br /> <br />N81n1d tneure4 .nd IIIoUIIIg Add- <br /> <br />BIW\lII DALY DBA. HYGIBNB <br />Tll:CJIIIOLOa3:J:S 3:_T3:ORAL. 3:IIC. <br />3625 om. AMO BLVD #180 <br />TORAAIICII CA 90503 <br /> <br />.. <br />.. <br />.. <br />.. <br />... <br />.. <br />'" <br />g <br />... <br />.. <br />.. <br />.. <br />.. <br />... <br />... <br />. <br /> <br />Pelley C...,. Etf8cIIft D8Ie: 091 15/0 3 <br /> <br />Eff8ttIV8 ho..11 thl ..- IIIIId8d in the <br />DeclarltÎOllll P8¡ 1 Dl'th. Pallcy. <br /> <br />PalIqr C"np Number: 006 <br /> <br />- <br /> <br />AganI ""me: <br />Code: <br /> <br />D3:C1C VAN Wla . ASSOCJ:ATll:S, IJIC <br />2501179 <br /> <br />¡¡¡ POUCY CHANGES: <br />iii 110 PIWI3:UM DUE AS <br />.. <br />¡¡ <br />- <br />--= <br />!!! <br />- <br />¡¡¡ <br />¡; <br />i! <br />- <br />¡¡¡ <br />- <br />- <br />- <br />- <br />- <br />ii <br />- <br />- <br />;¡¡;;; <br />Iii <br />¡¡¡ <br />;¡¡ <br />¡¡¡ <br />- <br />- rllo IlATA rAC'lQl\I 1.000 <br />- <br />- THIS DDOIISIMIm' DOES 1tOT CIIAIIC2 TIIB POLICY DCEPT AS SHOtIII. <br /> <br />or POL3:CY CIUUIGII: BFFBCTIVE DATIl: <br /> <br />l"ORM WIIBBIIS or IIIDORSIMIm'S UVISIID 10'1' I!IIIDOIISIMIm' ISSUE. <br /> <br />3:H12001185 ADDJ:'1'IOIIAL III8UUD - PIRSOII-QIIGAIIIZA'1'ION <br /> <br />['1'[' <br /> <br />~~ 2/t <br />Ii <br />v <br /> <br />FonnS81211 CDHT Plinœd ill U,S.A. <br />PIOMI8D81e: U/19/03 <br /> <br />Pqa 001 <br /> <br />Pellc:yE>lplmlDno.tl!: 09/15/04 <br /> <br />vw COpy <br />