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<br />Oct ~1 01 10:24. . C...ni. Smit.h <br />OCT-Jll-2llill 14'34 <br /> <br />615-673-0293 <br /> <br />p.e: <br /> <br />P. BJ/93 <br /> <br />AODI'M1)NAI.. 'NSURED iNDORSEMENT <br /> <br />Insu"nce Cornpf ny -- 11......11-4',.. ,.......n........... ~~...... <br /> <br />ThillllClOrnment rnodIIIa lNGh \nSUrIrlG8 .. III etIDrded II>>' till pIOVlIianS of PoIieY <br />j CAP-715709:t-M-U __totllafolcMlna: <br /> <br />1. The CitY ci l:anl8 AtrI. 2Q CIvIc CenaIr PIIza. s.nla "... CaIIamia <br />82701; ils .Af;....~. empIOVt.... IJOIIII. ~... '....U 4I.\lvelere IlIIlIlId · <br />uditionlll insuredS (Wld1Ik.... tnsu"'-' wIIll8IIIRI to /iabiIilr and dIII8IIlB ofl&li\S <br />erisWlg ffam the ._nllllld .... peffin.j. b'f cIr Oft IIeh8If cithe ~ N\Ir8d. <br />2. \Mth r,-cUII c:Il*nIlriIinD aut or... 41 ....... and .... _.......od by <br />Dr an IIIMIf of the MIIlIC inIUNld. .uCh InIur8IlC1 . Is ~ I:Iy tIIII polley is <br />primary _II nol.cldlllaM \Ill or GOnlIIlIullntI with "'If Cllher inallrlInCe Carried bY ar far <br />the blI/MIIIt crt the ."~1IoM' ,..... <br /> <br />3. TIlia Nur8IICI ..,pu.s ..reltlly to eech it\IUI8d ..eMlIt .nom .Im IS <br />made Of wit Is bnIlIght _. ~ ...-:t to thlI GCIlIII*'y'& IIrnb of 11bIIIly. 111. <br />inaluslan of arry pt(ICIft or .~ . an inued stili not atrect III'IY - wt\lGI1 <br />lucI\ 1I811011ot oigarizatIOn would haft as a .:IlI\nwnt \fIIot to ~. <br /> <br />4. WIth JMPlId to \lie 14.1l1un11l 1nIUNdI. Ilia ~ alien not be <br />cancellld, or nl8tcrillll)' reduClld '" ........111' IlmIIS ~... thbt' (30) days writIMI <br />nab hili o.n liNen to the Cilt ci hlltll "".., 20 eM; e.nw PIaa. s.ntII Ana. <br />CIIIIaINa 92701. <br /> <br />(Camplllllon of the followlll8. inlllllldl... caUMIl........ ill MlIuhd to mille tIIiI <br />8lldo1wemllllt .A.c:live.) <br /> <br />Ef(ective Ol/Z2!01 ~ ...........ment form .. · pert at <br /> <br />POlICY' W-7157093-D0-67 <br /> <br />IIIU8d to l"....~"v Mn..h.ad j "&Delat.. <br />Nmled IiIIlftII <br /> <br />1U4- ,.,. /21-I-L <br /> <br />courdllll8-1ty <br /> <br />AiIIt...dlod Rallo III l\A"" <br /> <br /> <br />TDTA.. P. e3 <br />