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MIMIC <br />10/16/2008 10:57:02 AM PAGE 4/006 Eastern Time Zone <br />IMPORTANT <br />If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement <br />on this certificate does not confer rights to the certificate holder in lieu of such endorsement(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 certificate does not confer rights to the certificate <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 insurers), 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 />Reverse of I 1 <br />Fax From : 10/16/00 07:57 Pg: 4 <br />