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Capitol specialty Insurance Corp <br />P.O: Box 5900, Madison, WI 53705 <br />POLICY CHANGE ENDORSEMENT <br />POLICY NUMBER POLICY PERIOD AGENCY <br />BR01292559 03/26/2009 03/26/2010 04608 <br />12:01 A.M. Standard Time at the address of the insured stated herein <br />NAMED INSURED AND ADDRESS AGENT <br />EARTHTECK II~1'PERNATIONAL CORD BASS UNDERWRITERS INC <br />PO Sox 48259 20350 VENTURA BLVD, SUITE 120 <br />Los Aaqeles, CA 90048-0259 Woodlaad Hls, CA 91364 <br />{Los Aaqeles CTYy <br />CHANGE # 1 <br />EFFECTIVE DATE OF CHANGE: 03/26/2009 <br />Annual Additional Premium <br />Annual Retum Premium <br />1.0000 <br />Additional Premium Due <br />Retum Premium Due <br />Pro Rate Factor <br />Short Rate Factor <br />X <br />Annual No Change In Premium <br />BELOW IS A DESCRIPTION OF THE CHANGES: <br />ADDED ADDITIONAL INSVRLrD <br />THIS CHANGE ENDORSEMENT WILL NOT BE USED TO AMEND POLICY CONDITIONS. <br />Authorized Representative <br />Date Issued 04/21/2009 siv <br />CICG 349-PCE (06-08) <br />