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Sep 23 04 10:43a Houston&HarrisPCS <br />ACP CERTIFICATES Fax:909-886-0053 <br />9094220841 <br />Sep 22 2004 15:13 <br />P.03 <br />p.3 <br />bbird <br />POLICY NT:,XM MZX 0829622 <br />.. <br />.. ... .. . <br />Piamed Tasorai Segomtl}t <br />� <br />001. <br />,8OU8TON i B�ART_4 PCS t„ � .. <br />.. ... <br />. <br />.. <br />CJ <br />rffectLI0 <br />Ef£e0tive <br />•12-01.ostandard <br />612 /04 .1SS+APT_ .. 7ather <br />me va4/Od <br />Time attha address of the insured <br />Thie is an Redoreement only. Other than chnngas ehoan, all <br />a <br />e41a4 <br />ocve.-'age re lmx in full force and affect. Prmium adjustments else <br />s ' <br />PRSHZfiM S97pd aAYa - . JIDDrTSoetAL PRMMCTr1t DG8 POR. <br />Tarrorism Vex *muraewe Ant -Certified Act. Coverage - <br />.. <br />. All CavermH-x &=I *0 -]Tat Oa mrad .. .. <br />- ' <br />Iatlude:r CALIPORMIA Surcharge of <br />.. <br />The Premium shown,inciudae Adjustahle Premium(s) Refer to PremiLl. <br />Ads <br />meat <br />Information attaalied. .. <br />.. Tin folloriag other Gon. al Liability aadaroas@nt(ml„.ate added to <br />the p01i <br />cX_ ... <br />� xPP1T .e ebo.Tr<. <br />.... ADDITIMAL =SpR-1$D, cunnneMOIT <br />Isom - 0869 - <br />- - - <br />. <br />.. I990 MUM COKSMY: Nl.T--MML SDRSTIC CORPORATION <br />TAI9 E1®OR9L9 MODIPIS9 8UC8 IN9URAttCE as IS 71e"rownp SY TFM <br />PROVISICNS OF POLICYXZX40829,¢22 RRLi.TING To TSB FO7d.0'9S% <br />. <br />I. TB8 CYTV OF SANTA AM, 10 C7v C CEWlCA PLLZA,..&%W=. <br />WAI. <br />_ <br />CN.IFORKMA "701, ITS OXPICOLS, MWILCYEe3, AGMEWS <br />• RP.PRFSMMATIVES ARE »D AS ADDITIONAL IRHOAEDE("ADDITI <br />. INSOJUMM•) WITS 22mtAD TO IxAn7maTY'MID AEFSNSA OFTITS: <br />ARISING FROK "M OPVRATIONe AED USBS 'v3wxOBMED' BY OR <br />OW <br />REM" OF TO 1@XW ntsmm. <br />-. <br />2. WI= RESPECT TO CLAIMS ARISING 07Z OF TER OPERATIONS <br />AXD <br />. <br />USES MZGPJGM BY OR 08 &EEALP OF TEE MAO49 INSMD, <br />MCK <br />IXEMPAMS AS IS Ayr== SY -Tf{IS POLIOY IB MIMARY �= <br />I8. <br />mat-WDITIONAL To OR CMMrAOTINO NITR ANT OTXMt IN <br />E <br />.' <br />C!"21RD BY OA FM T_M BSN£PIT OP TBZ AWITIONAL <br />.S'. <br />.. <br />3. TJQS TRMMANCE APPLIES SEPARATELY TO RACK TN$V= <br />WOOK CLAIM IS MADR OR SUIT IS 370VO cr EXCEPT VITH - <br />CT <br />\� <br />of AS1dTvd:ad A <br />�2Cnumtewl8natmc Duc 9 <br />21 {04' <br />?rodnea AVSTIN COOPER & PRICE Va. AGENCY, INC. <br />_ <br />.. 2.0; BOr 3180 .: .. <br />'. <br />:.. <br />.... <br />•• 4EN WSRATDt1TMh 'f2 a]XaR <br />