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10 <br />• <br />l/ 1J <br />u <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [T CAREFULLY, <br />POLICY CHANGES <br />Authofted Representative Signature <br />hi. imumnw Ser6m Oft% Inc, 1993 <br />fiz <br />Ar3186 (12 -U) pytigM, ISO Commerdal Risk SwO , Inc.. IM <br />v • aas}+v <br />PouCY NiIi� am <br />POLICY CHMOES IFFEC't' VE <br />r.��� <br />COMPANY <br />CPP 2013875 <br />10119167 <br />AMERISURE INSURANCE COMPANY <br />6 uva Bill No.: <br />group Ha,: <br />POLICY PERIOD <br />From 1()11107 To 101110$ <br />Account No- 1i3585i91 <br />KJAMW INSURED <br />AUTHORMED REPRESENTATIVE <br />RESOLLr 3; BUILDING COMPANY <br />WACHOVIA WS SEi2WRALEIGH <br />SEE ENDORSEMENT A <br />P 0 BOX 3656 <br />CHAPEL WLL NC 27615 <br />PRODUCERCODE: 615279 -1 <br />COVERAGE PART'S AFFECTED <br />ALL COVERAGE PARTS <br />CHANGES <br />IT IS AGREED THAT ENDORSEMENT C W CANCELLATM NOTIFICATION IS ADDED AND ATTACHED HERETO. <br />Authofted Representative Signature <br />hi. imumnw Ser6m Oft% Inc, 1993 <br />fiz <br />Ar3186 (12 -U) pytigM, ISO Commerdal Risk SwO , Inc.. IM <br />