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SENT BY: LAKE INSURANCE AGENCY: <br />DD-li-01 10:36AM FR01h8 E Ch~ix <br />ADOft'IOMA{, ifVSUREQ ~ORSEMEfJ'T <br />T-TBB P.002/002 F-264 <br />l n,< ~U~.~n fir; l_,~~ ~,.,~,y <br />C-+.i~i~~b tom ~ is ~^~ by Ble pravlaions of Policy <br />a2701;t1ts o}Mp $~ °~ ~b ~ 20 Gvio Center ptate, 6ama Ana, Ca+eomia <br />agaMs, valutleata and rctitei~rdoMeL~ qra Hamad as <br />addgbnwl bfsuteds ('aedltlenal lneu <br />erisirq from the eperalbns and ~qst perfp2n~ py~ ~ ~th~nartns <br />2. ~h CesP1eCt b ahirne atlsinQ nut of ttas teperations and tteYe parfom~ad by <br />a on behaN pf tits rrolned irlstatad, each 61ett-afloe as 1s afforded t1y this ppby <br />thebengq of the aG®[lfpi-nb eyrp~y~j,~~~ ~ ~ !nom car(rd by or fa <br />3. 7hls,NquFarwa appfias separeONy to each Msuted ipainst whom dakn y <br />rtlade O< suit N twoupfN axca~pf wMN ropes b IFte <br />~ « ~0^ ~ Oh ss an irnwed~not afreE~ ai9ht which <br />o-ysrNaDKipn wtwid have at a Wimarrt 1-not so tnchedad. <br />catlcaled, or tNhh ~Q tD the addaional iresunads, this insurwka shell not be <br />notion has bp'Hend~'~r ~~Mta, 20 C~'Nio C~ettpBr ~ wtittert <br />Caii-omla 82707. . Santa Ana. <br />(~Con~pgtk-n of d1e b~ tnrJudin~ c~+l+terei0naturo, is -a9uked to make this <br />do-certte+rt MfacuSre.) <br />~~ thb endoFaemenf form as a rt of <br />PoGq N ~ <br />--r.~.,.~... <br />lasuedtp (tar v.1~ ~ n tw! tdw._ie --'._ _ <br />Ca+tebni8netl by `°~""' ~ +~`s~D~,., <br />ReDraselNallye <br />7148387566; SEP-17-04 S:39P~A; PAGE 313 <br />Z~Z <br />