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DocuSlgn Envelope l D: 111C4FE8 -F974- 4816- BC9A- 67E51D5FD6C4 <br />/4w <br />TRAVELERS J One Tower Square, Hartford, Connecticut 06183 <br />OTHERINTEREST CHANGE ENDORSEMENT <br />INSURING COMPANY: <br />TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA <br />Named Insured: CSG ADVISORS INC <br />Policy Number: <br />Policy Effective Date: <br />Policy Expiration Date: <br />Issue Date: <br />ADDITIONAL Premium $ <br />680- 5F243125 -15 -42 <br />01/01/2015 <br />01/01/2016 <br />01/23/2015 <br />99.00 <br />Effective from 01/23/15 at the time of day the policy becomes effective. <br />THIS INSURANCE IS AMENDED AS FOLLOWS: <br />Under the Commercial General Liability Coverage Part, Who Is An <br />Insured is changed to include Blanket Additional Insured - Owners, <br />Lessees or Contractors as provided under endorsement CG D1 05. <br />The following forms and /or endorsements is /are included with this change. <br />These forms are added to the policy or replace forms already existing <br />on the policy: <br />CG D1 05 04 94 <br />IL TO 07 09 87 <br />MP TO 27 04 07 <br />NAME AND ADDRESS OF AGENT OR BROKER <br />PAYCHEX INS AGENCY INC <br />150 SAWGRASS DR <br />ROCHESTER <br />igyled by <br />( <br />7`Hut orized Representative <br />NY 14620 DATE: 01 /23/2015 <br />IL TO 07 09 87 (Page 1 Of 1 ) Office: PAYROLL <br />