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84 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any <br /> 69 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock <br /> 13A insurance company of The Hartford Insurance Group shown below. <br /> SBM <br /> INSURER: SENTINEL INSURANCE COMPANY, LIMITED <br /> ONE HARTFORD PLAZA, HARTFORD, CT 06155 <br /> COMPANY CODE: A <br /> Policy Number: 20 SHM BA6984 DV THE <br /> HARTFORD <br /> SPECTRUM POLICY DECLARATIONS <br /> Named Insured and Mailing Address: ANGELA D SHAW DRA THE ADR COACH, IN <br /> (No., Street, Town, State, Zip Code) C. <br /> 3782 WELLINGTON ROAD <br /> LOS ANGELES CA 90016 <br /> Policy Period: From 08/02/24 To 08/02/25 1 YEAR <br /> 12:01 a.m,, Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. <br /> Name of Agent/Broker: BURNETTE INSURANCE AGENCY INC/PKS <br /> Code: 262167 <br /> Previous Policy Number: 20 SBM 8A6984 <br /> Named Insured is: INDIVIDUAL <br /> Audit Period: NON-AUDITABLE <br /> Type of Property Coverage: NONE <br /> Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we <br /> agree with you to provide insurance as stated in this policy. <br /> TOTAL ANNUAL PREMIUM IS: $584 DISCOUNT APPLIED: PAID IN FULL <br /> Countersigned by 05/16/24 <br /> Authorized Representative Date <br /> Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) <br /> Process Date: 05/16/24 Policy Expiration Bate, 08/02/25 <br />