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,�' <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 another date is indicated <br />below: <br />Policy Number: 72S13MIA4897 SC ORIGINAL <br />0 <br />Named Insured and Mailing Address; JOHNSON & VERCLIFF, LLC <br />0 120 THIRD ST <br />m SEAL BEACH CA 90740 <br />m <br />Policy Change Effective Date: 09/18/13 Effective hour is the same as stated in the <br />Declarations Page of the Policy. <br />N <br />Policy Change Number: 001 <br />Q <br />Ci <br />Agent Name: PRIME INSURANCE SERVICES INC <br />Code: 186083 <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 />ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. <br />THIS IS NOT A BILL. <br />NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE <br />RATES AND PREMIUMS ARE CHANGED. <br />FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: <br />IH12001185 ADDITIONAL INSURED - PERSON -ORGANIZATION <br />PRO RATA FACTOR: 0.652 <br />THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. <br />Form SS 12 111 04 05 T <br />Process Date: 09/20/13 <br />INSURED COPY <br />Page 001 <br />Policy Effective Date: 05 /14/13 <br />Policy Expiration Date: 05/14/14 <br />