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HISCOX <br />Policy Number: P102.732.064.3 <br />Named Insured: Swim Brayv <br />Endorsement Number: 22 <br />Endorsement Effective: 05/10/2024 <br />Hiscox Insurance Company Inc. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />This endorsement will not be used to decrease coverage, increase rates or deductibles or alter any terms or con- <br />ditions of coverage unless at the sole request of the insured. <br />The following item(s): <br />❑ <br />Insured's Name <br />® <br />Insured's Mailing Address <br />❑ <br />Policy Number <br />❑ <br />Company <br />❑ <br />Effective/Expiration Date <br />❑ <br />Insured's Legal Status/Business of Insured <br />❑ <br />Payment Plan <br />❑ <br />Premium Determination <br />❑ <br />Additional Interested Parties <br />I@ <br />Coverage Forms and Endorsements <br />❑ <br />Limits/Exposures <br />❑ <br />Deductibles <br />❑ <br />Covered Property/Located Description <br />❑ <br />Classification/Class Codes <br />❑ <br />Rates <br />❑ <br />Underlying Insurance <br />is (are) changed to read (See Additional Page(s)): <br />The above amendments result in a change in the premium as follows: <br />® <br />NO CHANGES <br />❑ <br />TO BE ADJUSTED <br />ADDITIONAL PREMIUM <br />RETURN PREMIUM <br />AT AUDIT <br />CGL E5410 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc. <br />with its permission. <br />wekMnnxgetnmtlxtietan <br />REVIEWED & APPRDV®BY: <br />A- fe A� <br />`�' Risk Management SpedAut <br />