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PRODUCER'S FACT SHEET <br />NAMED INSURED: LABELLE-MARVIN INC <br />POL #: 72 SBA NU6283 SC <br />PRODUCER'S NAME: PRODUCER'S CODE: 251597 <br />CM MEIERS COMPANY INC <br />POL EFF DATE: 06/16/10 POL EXP DATE: 06/16/11 TRANS EFF DATE: 08/11/10 <br />TRANSACTION TYPE: ENDORSEMENT CHANGE NO.: 004 <br />ENDORSEMENT PREMIUM: $21.00 AP <br />ENDORSEMENT PREMIUM BREAKDOWN <br />PREMIUM COMMISSION PERCENTAGE <br />SPECTRUM $21.00 AP 15.0 <br />TOTAL $21.00 AP <br />FORM TITLE <br />SS 12 11 04 05 POLICY CHANGE <br />IH 12 00 11 85 WAIVER OF SUBROGATION <br />IH 12 00 11 85 ADDITIONAL INSURED - PERSON -ORGANIZATION <br />PRODUCER'S FACT SHEET PAGE 1 <br />08/17/10 72 SBA NU6283 SC (06/16/11) <br />