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StNI HY: BMH; 17/48387568 SEP-24-03 11:39• Cnr~ a,.n <br />M iDTERM GRANDE DOCUMENT <br />POLICY NO. PHPK043151 <br />PHILADELPHIA INDEMNITX INSURANCE CO <br />NAMED INSURED THE CRM80DIAN FAMILY <br />MAILING ADDRESS 1111 EAST WAKEHAM AVENUE, SUITfl E <br />SANTA ANA, CA 92705 <br />POLICY PERIOD: From 03/09/2003 to 03/09/2004 _ at <br />12:01 A.M. $Wndard Time at your mailing aodross shown above, <br />CHANGE EFFECTIVE 09/OS/7~003 CMANGEw 00004 <br />DESCRIPTON <br />IN CONSIDERATION OF THE PREMIUM SHOWN, THE POLICY IS <br />AMENDED AS FOLLOWS: <br />CRIME COVERAGE <br />ADD <br />CLASS CODE 661, FORM A - EMPLOYEE DISHONESTY COVERAGE, <br />LIMIT $200,000, DEDUCTIBLE LIMIT $2,500 <br />~° <br />L''r'ttlty City /~Pi,-tn~V <br />P989286 <br />Total Annual <br />Addldonal/Retum Premium S 172 <br />Total Prorate <br />Addilionel/Return Promlum S B 8 <br />ADDSTIONAL <br />COUNTERSIGNED 0 23 2Q03 BY <br />(Date) (Authorised Reprssentative) <br />CLDGRv <br />