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D4tp: 11/21/2008 Time: 9:35 AM To: @ 17147313806 <br />Page: 001 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGE <br />This endorsement changes the policy effective on the Inception Date of the policy unless anothe date is indicated <br />below: <br />-^ Policy Number: 72 SBA AA1945 :.X <br />n <br />T <br />0 <br />r <br />O <br />O <br />7 <br />a <br />a <br />0 <br />O <br />0 <br />ilk <br />i <br />i_ <br />1! <br />s <br />i? <br />sa <br />as <br />!sue <br />;ems <br />in <br />i? <br />dill; <br />COPY <br />Named Insured and Mailing Address; --.u PETERSON GROUP. IUC. <br />16G ti>k?ORT CENTER 1R-VE f27C <br />N-@PORT BEACH C3 93660 <br />Policy Change Effective Date: 11; 141106 <br />Effective hour Is the same as :Mated in the <br />Declarations Page of the Policy. <br />Policy Change Number: O04 <br />Agent Name- SJPERIOR ACCESS I1IS S2VC 71[C.'PFS <br />Code: _alaao <br />POLICY CHANGES: <br />HARTFORD CASUALTY IIISURAITCE COMPANY <br />ANY CE .NOES :N YOUR PREMIUM WILL EE RcFLECTED IN YOUR [TEXT BI:LI11; <br />STA-EMEN'2. <br />TFIS IS NCT A BILL. <br />NO PREV.-'jm DUE! AS OF POLIC7 ::FANGE EF?ECTIVE DA-n <br />F^RM \'TS^RS OF EITDORSENEHTS REVISED AT ENDORSEMENT ISSUE: <br />13[12001155 ADDITIONAL INSURED - PEPSO1T-ORGA\=ZATi Ct1 <br />PFO RA?A FA-'OR: 1.000 <br />^!?IS -MORSEMENT DOSS NOT T?IA11GE THF. PCICY EXCEPT AS SHOWN. <br />Form SS 12 11 04 05 T Page 001 <br />Process Date: "- 120/2 Policy Effective Date: li .4 0s <br />Policy Expiration Date: 0:/25 09 <br />V1 COPY