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ENGINEERING SOLUTIONS SERVICES-2015
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ENGINEERING SOLUTIONS SERVICES-2015
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Last modified
5/8/2020 10:17:52 AM
Creation date
12/16/2015 4:54:28 PM
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Template:
Contracts
Company Name
ENGINEERING SOLUTIONS SERVICES
Contract #
N-2015-183
Agency
PUBLIC WORKS
Expiration Date
9/30/2017
Insurance Exp Date
8/19/2016
Destruction Year
2022
Notes
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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 />Policy Number: 72 SBA IT9447 SC <br />Named Insured and Mailing Address; SUDABEH SHOJA DBA <br />ENGINEERING SOLUTIONS SERVICES <br />2182 DUPONT DR STE 201 <br />IRVINE CA 92612 <br />Policy Change Effective Date: 11/23/15 Effective hour is the same as stated in the <br />Declarations Page of the Policy. <br />Policy Change Number: 002 <br />Agent Name: PRIME INSURANCE SERVICES INC <br />Code: 186083 <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 />FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: <br />I1112001185 ADDITIONAL INSURED - PERSON -ORGANIZATION <br />PRO DATA FACTOR: 0.751 <br />THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. <br />Form SS 1211 04 05 T Page on <br />Process Date: 11/23/15 Policy Effective Date: 08/19/15 <br />/ Policy Expiration Date: 08/19/16 <br />REVIEWEDBY: "ry `` EUNICEVIEREDIA(fir'DOF b) <br />
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