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PRODUCER'S FACT SHEET <br />NAMED INSURED: SUDABEH SHOJA DBA <br />ENGINEERING SOLUTIONS SERVICES <br />POL #: 72 SBA IT9447 SC <br />PRODUCER'S NAME: PRODUCER'S CODE: 186063 <br />PRIME INSURANCE SERVICES INC <br />POL EFF DATE: 08/19/15 POL EXP DATE: 08/19/16 <br />DIRECT ACCOUNT BILL NUMBER - 14206054 <br />TRANSACTION TYPE: ENDORSEMENT <br />ENDORSEMENT PREMIUM: $0.00 <br />NON -PREMIUM BEARING <br />FORM <br />SS 12 11 04 05 <br />IH 12 00 11 85 <br />TRANS EFF DATE: 11/23/15 <br />CHANGE NO.: 002 <br />TITLE <br />POLICY CHANGE <br />ADDITIONAL INSURED - PERSON -ORGANIZATION <br />PRODUCER'S FACT SHEET PAGE 1 <br />11/23/15 72 SBA IT9447 SC (08/19/16) <br />REVIEWED BY: I/m/ (/1 /,. L • EUNICE FIEREDIA (PG _60F 5) <br />