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Sep 23 04 10:43a HOUstan6HarrisPCS <br />ACP CERTIFICATES Fax:909-886-0053 <br />9094220841 p.3 <br />Sep 22 2004 15:13 P.03 <br />I i <br />POLICY NU,"tM 'MZX90829622 <br />Named S ik Sogor-0Ha1 <br />aDDamoM y IIaflyTR PCS, ISPC 001 <br />Da]LTPCLZa L3ANr.B IImOA,aHM6E1T ,.. ;, .• ... , <br />Effe6!ioa " &E. 04'12a01. ao <br />standard Tinr2 at� the addreae of Lba laau7red <br />Tbia is an Rmdgraement only. Other than chaagam mhewn, all other e4 atlas <br />cove„-mge remains in lull force and of fazt. Premium ad�u tmeata ax'e <br />PRSYO:ID!S97618AYa ADPr7lIDaAL 11>rm1*= D98 PCIf .... <br />Te drjam Rtak Iyaurmn Act -Certified AOtm cot►erage - <br />AU. C... Ear asel fit Not Ce ared <br />-Includes culrowu S�Omrge of <br />The premium ahowa,+naludaa Adjuasabla ftsmium(s), Refer to Premim Adj m.nt <br />. .... Ia£o-r�eipn attadied. '.. .... • ..... � ... � .. <br />Tha follewiag other Genweal Liability mndora�t(w) a;m addwd'ce the ,p .cy <br />an4 spplr sa Oho .. .. .... .. ,_. ... <br />.. . 1N9aRANC6 cnwmy: b*a.TIMML smwzy COP.PORATIOM <br />MS SSMMUZM MT XMIPIR9 fit= =9=ANCB 'AS 3s A7002 O BY THE <br />FRcRaSICKS OF PaLICTMY%80829¢22 RStiTING tip TBB PCW,QIi:DTG: <br />. 1. MM CITY'CP BAUM AMA, 20 CSC CEWX= PLAZA, SANTL WhI' .. <br />CALIFORNIA 98701, ITS C7fI —9, ENPLODMO, AGOWTS <br />REP' RE98 WATIVE9 ARR 241 = AS AOOr=CNAL INSC=ff ("ADDITI <br />.MSOMMAm) WXTS PLMMAiO TO T; A =ST7C AbM S}EF== OF 8. <br />ARSSINO PBOK MM GPERATIONa 'A= DSIM 'RERY'ORM= BY OR <br />SLPiALS OP I= lf141'ddb. 11CSUREU. .. .. .. .. ... .. .. <br />2. WITS RSSPBCT TO CLAIMS ARI5TBG OUT OF TBa 02SRA2 cbT5 AM <br />MM PERPORMT5 BY OR ON W ALP OF THE NAME IXSQ=, <br />luffm ANC& AS is APPORDSD BY Tf(l! POLICY I9 PRH.yp%RY' IS. <br />MOT aDnITZONAL TO OR CONTRIbOTTN4 WITB An aTSEt= -S .. <br />C MIBD BY OR YM T_m BYBEFIT OP TBS AIIDITxcmt. S; . <br />3. THIS IBBDRA = APPLIES SEPARATELY TO PACs T <br />WSOK CLA7O6 Is IMaIDB Oa SUIT IS BROUGYT =CBPT vz' H CT <br />CG=LW=Jgmd— of Atu =lwd Ayrak F( _ �1!!d <br />PrO&OW AUSTIN COOPER 6 BAKE Vd. AaSN�CY, INC. <br />. P.O: Bar 33a0 .: .. <br />.. RAN BERiffiRDINO' 'cm 92513 .. .. <br />CBANGB MMOB.YEMLWT C"OD7TX-A=M ON PALM 2 <br />Dam 921/04.'.. <br />... _.PLO ... _.. ..,..... . <br />1 <br />