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POLICY CHANGE (Continued) <br />Policy Number: a1 SBA IR4222 <br />Policy Change Number: 001 <br />FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: <br />SS 04 22 07 OS <br />IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION <br />Form SS 12 11 04 05 T Page o o z <br />Process Date: 0 5 / o ? / 12 Policy Effective Date: 0 2 / 1 s / 12 <br />Policy Expiration Date: 0 2 / 15 / 13