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THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. POLICY CHANGE . rl N '" r-- rl Policy Number: 65 SBM PY2472 COpy This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: DX Named Insured and Mailing Address: CYNTHIA D VALLES Ll) <:> N <:> N r-- ~ N >< Po Ll) \0 <:> <:> <:> rl <:> oj< 9713 INDIAN CREEK WAY ESCONDIDO CA 92026 Policy Change Effective Date: 08/30/04 Effective hour is the same as stated in the Declsrations Page of the Policy. Policy Change Number: 001 Agent Name: Code: USAA INSURANCE AGENCY, INC/PHS 812846 - POLICY CHANGES: NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE - - == - - - = - - ¡;¡¡¡;;¡ BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED - - - ADDITIONAL INSURED(S) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 PERSON/ORGANIZATION: SEE FORM IH 12 00 - - - - - - = - ¡;¡¡¡;;¡ - - - FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION ¡;¡¡¡;;¡ ¡;¡¡¡;;¡ ¡;¡¡¡;;¡ - - - -- - ¡;¡¡¡;;¡ - PRO RATA FACTOR: 1. 000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form 55 121103 92T Printed in U.S.A. Process Date: 09/01/04 Page 001 Policy Expiration Date: 06/15/05 uw COpy ~0~.ttQ/ (':7/ ! 5/Y'