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IM-M <br />I AOOV <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated <br />below: <br />Policy Number: 46SBMUM3801 DX <br />Named Insured and Mailing Address; HJELMSTROM & ASSOCIATES <br />28072 WILKES PL, <br />LAGUNA HILLS CA 92653 <br />Policy Change Effective Date: 10/23/15 Effective hour is the same as stated in the <br />Declarations Page of the Policy. <br />Policy Change Number: 003 <br />Agent Name: BIN INSURANCE HOLDINGS LLC/PHS <br />Code: 505500 <br />POLICY CHANGES: <br />SENTINEL INSURANCE COMPANY, LIMITED <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 />LOCATION 001 BUILDING 001 13 REVISED <br />PRO RATA FACTOR: 0.482 <br />THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. <br />Form SS 12 11 04 05 T Page 001 (CONTTNUFT) ON NEXT PAGE) <br />Process Date: 01/07/16 Policy Effective Date: 04/16/15 <br />Policy Expiration Date: 04/16/16 <br />REWEVVED Be BEIM E i iEREEHA (PG, )IJ <br />........... <br />