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�i <br />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: 76 SBU BC5868 DW <br />Named Insured and Mailing Address; ELISA STIPKOVICH <br />500 HIGH DR <br />LAGUNA BEACH CA 92651 <br />Policy Change Effective Date: 10/02/19 Effective hour is the same as stated in the <br />Declarations Page of the Policy. <br />Policy Change Number: 001 <br />Agent Name: NUTMEG INS AGENCY INC/PHS <br />Code: 210781 <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 />BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED <br />ADDITIONAL INSURED(S) ARE ADDED <br />THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN <br />THIS POLICY. <br />LOCATION 001 BUILDING 001 <br />PERSON/ORGANIZATION: SEE FORM IH 12 00 <br />FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />PRO RATA FACTOR: 1.000 <br />THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. <br />RgEVIEWM D & APPROVED <br />iVisoD <br />RiskForm SS 12 11 04 05 T Page 001 (CONTINUED ON NEXT PAGE) <br />Process Date: 10/02/19*FRAN'Cl <br />6EAVILLAREAL <br />19 Policy Effective Date: 08/14/19 <br />Policy Expiration Date: 08/14/20 <br />