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Policy Number'. 46 SBM UM3801 <br />Policy Change Number: 003 <br />BUSINESS LIABTLTTY OPTIONAL COVERAGES ARE REVISED <br />ADDITIONAL INSURED IS DELETED <br />LOCATION 001 BUILDING 001. <br />LEASED EQUIPMENT: SEE FORM IH 12 00 <br />FORM NUMBERS OF ENDORSEMENTS REVISED, AT RNDORSEMENT ISSUE: <br />IH12001185 ADDITIONAL INSURED - LEASED EQUIPMENT <br />IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION <br />TH12001185 WAIVER OF SUBROGATION <br />FORM N­JMBERS CF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />SS 12 23 06 11 <br />IH12001185 ENDORSEMENT #003 <br />EFFECTIVE DATE 10/23/2015 <br />Form SS 12 11 04 0,5 T Page 002 <br />ProcessDate: 01/07/16 Policy Effective Date: 04/16/15 <br />Policy Expiration Date: 04/16/16 <br />RRE10EVVE[) ffle -i E I flDUHAA <br />- -------- <br />. ........... . . .......... ........ <br />