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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 another date Is indicated <br />below: <br />rn Policy Number. 46 SBM UV8485 DX COPY <br />6 <br />N <br />Named Insured and Mailing Address; SERVANDO VARELA <br />ro DBA XV SOLUTION <br />0 344 ORANGE BLOSSOM <br />IRVINE CA 92618 <br />w <br />Policy Change Effective Date: 1O/14/11 Effective hour Is the same as stated In the <br />e Declarations Page of the Policy. <br />oPolicy Change Number: 001 <br />Agent Name: TECHINSURANCE GROUP LLC/PHS <br />Code: 505301 <br />iL <br />POLICY CHANGES: <br />® HARTFORD CASUALTY INSURANCE COMPANY <br />�. ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING <br />STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK <br />s ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS_ <br />THIS IS NOT A BILL. <br />sc <br />NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE <br />!� <br />� .FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />1 <br />IH12001185 ADDITIONAL 2NSURED <br />PRO RATA FACTOR. O_959 <br />-- THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN_ <br />Form SS 12 11 04 05 T Page 001 <br />Process Date: 10/3-4/]Ll- Policy Effective Date: 09/28/11 <br />Policy Expiration Date: 09/28/3-2 <br />UW COPY <br />