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000uoign Envelope ID: 000F8247-90eF-423A-AB78-8E5e800e81EE <br /> POLICY CHANGE DOCUMENT <br /> POLICY NO: CNANGE # 2 CHANGE EFFECTIVE: 06/27/2014 <br /> PHPK539280-004 <br /> Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. <br /> NAMED INSURED: Steve Kim <br /> MAILING ADDRESS 441O Sun Valley Or <br /> Durham, NC277O7'588S <br /> POLICY PERIOD: FROM 03105/2014 TO 03/0512015 at <br /> 12:OiA.h1. Standard Time at your mailing address shown above. <br /> In consideration of the premium reflected, the policy is amended as indicated below: <br /> Added 1 Additional Insured. <br /> Total Annual Total Prorate <br /> Addi800aVRotu/nPmm|um $0.00 AddM|ono|/RetumPremium $0.00 <br /> Total Annual Total Prorate <br /> Additional/Return Additional/Return <br /> Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $D.UO <br /> Page 1 of 1 <br />