|
<br />Nov 13 06 06:02p
<br />
<br />Tllar;1
<br />
<br />p.1
<br />
<br />
<br />p.3
<br />
<br />VI ; i:l4~ '~to':b IIr;:J
<br />,
<br />:!
<br />
<br />~1 005/ 0 O~
<br />.. j r- .IQ~
<br />I, p.l
<br />
<br />THts:sH!ET MvaT IE COMPLETeb ANI) A COMPANY
<br />THE CeRTIFICATE OF INSUMNCE
<br />
<br />ADDITIONAL IN'VASD ENDOR.aMEN
<br />
<br />Insv'Mc" comptlny
<br />
<br />Go14." Elil.
<br />
<br />Tnl' ondo,...m;nt modlne, .uc~ In8Ura"0lI a.l. eIIordo.1:ly ilia pre! 1.lon. 0:>1
<br />polICy ",0. Cln072946 reltolil1ll10 tIIo follaw;n;: '
<br />. ," I
<br />1, TIll City 01' Bania Ana, 20 CIVic Cln\lI' !'Iua, Senta AnA, ct If,,,"la 92701. II.
<br />afllag". .."",,101'..', Igtntl. an" I'9pr_nll1iVtla .",namedl t additional
<br />Il1&ur.d. ('ad<l~tontll"aulld8'1 with rogerg to Uabll~y And d na. of ,"'"allslng
<br />!r~rn Ilia Ofl'I",'lana and u_ perfonmod by 0' on boh.~ eI I\ll",..d In",,,,d,
<br />
<br />With r..p8CllO c:Ilim' arising oul o! tile opa,..nonSllllrl use iP.rforrre<l by or.n I'
<br />~lil\al! ollhe nll""a inauNd. svch 1_"'_ ..1. allomlld ~ IlIls policy I' '-d I
<br />primary ~lnd '0 ne'addlllonallO ar contrlllUllng wil\'l any !)It> linaUlancu OlIrr..
<br />by or lar tho b~nellt (If tile Id<lttlonallnsurlldl, '
<br />
<br />2,
<br />
<br />4,
<br />
<br />Thial~IUl&nOll applillt IlIPIllle1y 10 eacl1lneured GOt/lllt om clAim is madl or
<br />aultlS brought "'''pi with -1l81l110 Ihe company'll timila lI.bllily 'the
<br />i....lu.l.n .f onv pe",," or OIge.nlzallon U In insurad .hall ! aflecllny right , ,
<br />which sllCh p.rl~n or orSlnltaUOn would havI.. a elsima ,I: II nOI so Include\!. [' i
<br />
<br />With r"peelto 1M Sddlllonlllln.urt"". tIIlllnlurlnw .hall' at bA cancellld or '
<br />ml'lrlallyrtdu.oclln .""e,.g; or limilt I.elpt aftor tMilIY (, ) doyl wrillln nollce'
<br />I\lll blan given 10 thl Oily '" senl.Anl. 20 Oivie center P 'no Sa:nla "'nl, '
<br />Co; Itorni. 1I~70 1 ' Iii'
<br />
<br />
<br />(Complllion ollhg !.Hewlng, InCludlng counllralgnlturo, 1,"qU'r~ te rnakllhi5 " 1)1
<br />""dora.mlnleH..tlve.) .., ,
<br />II
<br />,I
<br />I
<br />I
<br />
<br />Effaclive
<br />
<br />10/Ol/ZOO6
<br />
<br />I
<br />. thil Indorsom, ',fe,,,, is . P"~ 01
<br />I
<br />
<br />3.
<br />
<br />Poiey No,
<br />
<br />CBP807Z946
<br />
<br />"
<br />
<br />
<br />e1.al IJlter:S.
<br />
<br />R..ourc.C$
<br />
<br />luueo. ~g
<br />
<br />IU...~Of ~.D~ro.8 IDe dba
<br />
<br />Named Inl\lred
<br />
<br />. II
<br />I)'
<br />,I
<br />
<br />OQun'-tligno<f by
<br />
<br />lol. ",IM:c..:e",L(ltIlltQr IPIIllI'\~~t *1l\QII~' ~"'C~ltlll
<br />
<br />I:
<br />{\~:'.rRO\/li...-:.' ('.' ,': Iii ,j
<br />
<br />--'tf5 y~.-
<br />
<br />II
<br />i
<br />.. TOT~l ~~,I"E. 0'3 ..
<br /> I
<br />
<br />A"~;;:LI! '-
<br />
|