Orange County NC Website
PF-15234a (05/07)© 2007 The Trust Page 1 of 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Named Insured <br />Katrina Kuzyszyn-Jones <br />Endorsement Number <br />Policy Symbol <br />CRL <br />Policy Number <br />78G27815467 <br />Policy Period <br />05/02/2023 to 05/02/2024 <br />Effective Date <br />05/02/2023 <br />Issued By (Name of Insurance Company) <br />ACE American Insurance Company <br />Vicarious Liability Extension for the Named Insured <br />for Excluded Individual(s) or Entity(ies) <br />It is agreed that Section VII. DEFINITIONS, is amended at the definition of Insured,by adding the following: <br />ο‚·The individual(s) or entity(ies) listed in the Schedule below is/are not (an) Insured(s)under this policy and shall <br />not qualify as (an) Insured(s)under Section III. PERSONS INSURED. <br />Schedule of Individual(s) or Entity(ies) <br />Michelle Chase 05/02/2023 <br />Whitney Wall 05/02/2017 <br />Stephanie Skibba 09/19/2022 <br />The premium for this endorsement is included in the <br />premium shown on the Declarations unless a <br />specific amount is shown here: <br />Additional Premium: <br />Return Premium: <br />All other terms and conditions of this policy remain unchanged. <br />________________________ <br />Authorized Agent <br />DocuSign Envelope ID: ACEF8EF9-2EFA-4F7D-B215-CAC4F234E1F6