Laserfiche WebLink
/I- 2viS- L) 2 -q <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />Policy Change <br />Number 2 <br />POLICY NUMBER <br />POLICY CHANGES <br />COMPANY <br />EFFECTIVE <br />Mesa Underwriters Specialty <br />MP0004018002938 <br />03/23/2018 <br />Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRES////E''''NTATIVE <br />TR HOLLIMAN AS50CIATES, INC. <br />�JI� <br />04018 f! LU! <br />Monarch E-5 I surance Services, div <br />COVERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY <br />IN CONSIDERATION OF THE ADDITIONAL PREMIUM: <br />ADDITIONAL PREMIUM: $250.00 <br />STATE TAX: $ 7.50 <br />STAMPING FEE: $ .50 <br />TOTAL A/P: $258.00 <br />--FULLY EARNED-- <br />ARNED^IT <br />ITIS HEREBY UNDERSTOOD AND AGREED THAT BLANKET ADDITIONAL INSURED <br />HAS BEEN ADDED TO THE POLICY PER FORM KUS010120127 (03-16) ATTACHED. <br />ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. <br />03/29/2018 DM NL <br />IL 12 01 1185 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />.sion of ! <br />Inauxed Copy \� <br />vJISI <br />,�C. <br />