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43 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any <br />21 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock <br />IS insurance company of The Hartford Insurance Group shown below. <br />SBM <br />INSURER: SENTINEL INSURANCE COMPANY, LIMITED tuy <br />ONE HARTFORD PLAZA, HARTFORD, CT 06155 <br />COMPANY CODE: A <br />Policy Number: 72 SBM IB2143 SC <br />SPECTRUM POLICY DECLARATIONS <br />Named Insured and Mailing Address: DICK COOK INSURANCE SERVICES <br />(No., Street, Town, State, Zip Code) <br />814 HIBISCUS WAY <br />PLACENTIA CA 92870 <br />Policy Period: From 05/18/16 To 05/18/17 365 DAYS <br />12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. <br />Name of Agent /Broker: BEARBOWER INSURANCE SERVICES LLC <br />Code: 186795 <br />Previous Policy Number: NEW <br />Named Insured is: INDIVIDUAL <br />Audit Period: NON - AUDITABLE <br />Type of Property Coverage: NONE <br />Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we <br />agree with you to provide insurance as stated in this policy. <br />TOTAL ANNUAL PREMIUM IS: <br />Countersigned by <br />425 MP <br />dle n f 6�alfzt zaLa ' <br />Authorized Representative <br />05/18/16 <br />Date <br />Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) <br />Process Date: 05/18/16 Policy Expiration Date: 05118117 <br />