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PF-15245a (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 />Retroactive Date(s) <br />Designated Individual(s) or Entity(ies) <br />It is agreed that, in consideration of the premium charged, and solely with respect to the following designated individual(s) <br />or entity(ies), Item 4. of the Declarations, Retroactive Date, is deleted with respect to such designated individual(s) or <br />entity(ies) and replaced with the Retroactive Date for such designated individual(s) or entity(ies) listed in below. <br />Designated Individual(s) or Entity(ies)Retroactive Date(s) <br />Katrina Kuzyszyn-Jones 05/02/2007 <br />Katrina Kuzyszyn-Jones 05/02/2007 <br />Mackenzie Howard 07/01/2021 <br />Julianne Ludlam 06/01/2022 <br />Kaytie Mero 06/01/2022 <br />Lisa Foss 06/01/2022 <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