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A COMPANY
ENDORSEMENT NO. 11
A~-ACHED TO AND ENDORSEMENT EFFECTIVE
FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE
POLICY NUMBER MO. DAY YR. 12:01 NOON
A.M.
3XZ12057001 01 21 2003 X CiTY OF JEFFERSONVILLE 430034
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In consideration for the premium charged it is hereby understood and agreed the following change (s) are made to the
PROPERTY section (s) of this policy:
Amend form C24729b (5/99) Building and Personal Property Coverage Form Public Entity:
Section A Coverage, 5.I. Animal Mortality is increased to read $30,000.
DELETE from Canine:
Gero Nitro
Gero Z Milcina CS Chase Von Der Haus Gil
$10,000 $10,000
ADD to Canine:
Nick- 11/24/94 Nitro-8/3/95 Dutch- 10/5/98
Capt Ashabranner Cpl Hubbard Ptl Leverett
$10,000 $10,000 $10,000
ADDITIONAL PREMIUM DUE:
WAIVED
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
~'UTHORIZED REPRESeNTATIVe"
[~ATE'
Agent: Clark General
01/23/03
p.perry
zc 25166 (8/99)