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06/03/2004 11:03 949-833-0127 IDHN BURNHAM PAGE 03/04 <br />IMPORTANT <br />If the cert'dicate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, A statement <br />on this certfcate does not confer rights to the certificate holder in Ilan of aurh Pndnrsamant(s). <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may <br />require an endorsement. A statement on this cersicate does not confer rights to the certlfcate <br />holder In lieu of such endorsement(s). <br />DISCLAIMER <br />The Certificate of Insurance on the reverse side of this form does not constitute a contract between <br />the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it <br />affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. <br />2 of 2 ffS15967lM16666 <br />