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SEP 30 '04 09:44 FROM: <br />T-234 P.02/03 F-248 <br />\; <br />POLICY NUMBER: <br />NAMED INSURED: <br />INSURANCE COMPANY: <br />PRODUCER: <br />i ENDORSEMENT IJ:1 <br />Se5B0o0530 <br />Civic Collection Corporation <br />Trie Burlington Insurance Company EFFECTIVE DATE: 07 /20/2004 <br />arakers, Inc. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR IT CAREFULLY. <br />I~ENERAL CHANGE ENDORSEMENT <br />This endorsement modifies ina~~rence provided under the following: <br />Commercial General Liability Policy <br />Zn consideration of an additional premium of 5106.00, it is understood and agreed that <br />the following form is added eo the goiicy: <br />86-4-370 0503 <br />The additional premium i.s a flat charge and fully earned even if chic policy is <br />cancelled <br />~/~ <br />for <br />S 100 Uu numu~ <br />$ 3 .23 Tax, if <br />3 103.23 Tocall <br />ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. <br /> <br />