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'0� <br />MutualLiberty <br />. <br />INSURANCE <br />Coverage Is Provided In: <br />West American Insurance Company - a stock company <br />Policy Change Endorsement <br />Named Insured Agent <br />GERALDINE VALENCIA <br />DBA: G STARS DANCE AND GYMNASTICS <br />Policy Number: <br />BKW (21) 60 62 24 86 <br />Policy Period: <br />From 01/01/2020 To 01/01/2021 <br />Endorsement Period: <br />From 01/01/2020 to 01/01/2021 <br />12:01 am Standard Time <br />at Insured Mailing Location <br />(714) 288-8000 <br />AA LARES INSURANCE SERVICES INC <br />POLICY FORMS AND ENDORSEMENTS - CONTINUED <br />This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed <br />information concerning your coverage. <br />FORM NUMBER TITLE <br />J.NP 74 26 04 13 Notice to Policyholder Fully Earned Minimum Premium Endorsements <br />EVREWisk M� & pRpOVED <br />By M 110 <br />Issue Date 01/23/20 Authorized Representative <br />To report a claim, call your Agent or 1.844-325.2467 <br />DS 70 27 01 08 <br />mninn Sna994Pn Nnmi RR 9Rn NraFPPNn INsunrn rnpv nn9799 Parr 5 nr 19 <br />