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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> CHANGE IN INFORMATION PAGE <br /> INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY <br /> NCCI Company Number: 10456 AUDIT PERIOD: ANNUAL <br /> POLICY EFFECTIVE DATE: 05/03/17 POLICY EXPIRATION DATE: 05/03/18 <br /> Policy Number: 21 WEC GD7700 Endorsement Number: 01 HOUSING CODE: DV <br /> co <br /> Effective Date: 07/01/17 Effective hour is the same as stated in the Information Page of the policy. <br /> H Named Insured and Address: INDIAN RIVER COUNTY HEALTHY <br /> 1555 INDIAN RIVER BLVD. SUITE B241 <br /> co <br /> VERO BEACH, FL 32960 <br /> N <br /> o FEIN Number: 650363222 PRO RATA FACTOR: . 838 <br /> N PRODUCER NAME: USI INSURANCE SERVICES LLC/PHS PRODUCER CODE: 227667 <br /> Q It is agreed that the policy is amended as follows: <br /> H ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING <br /> (NI <br /> STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR <br /> o BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. <br /> THIS IS NOT A BILL. <br /> N <br /> IN CONSIDERATION OF NO CHANGE IN PREMIUM IT IS AGREED THAT: <br /> TTT MAILING ADDRESS IS AMENDED TO READ: <br /> 1555 INDIAN RIVER BLVD. SUITE B241 <br /> mmm VERO BEACH, FL 32960 <br /> MTT POLICY IS AMENDED TO DELETE LOCATION 02 FOR INSD 01 FOR ST 09 <br /> mmm LOC READS: 333 17TH ST STE 2R <br /> VERO BEACH, FL 32960 <br /> (A) POLICY IS AMENDED TO ADD LOCATION 03 FOR INSD 01 ST 09 <br /> LOC READS: 1555 INDIAN RIVER BLVD. SUITE 8241 <br /> VERO BEACH, FL 32960 <br /> Countersigned by 61e-e)�" CQ4�%ze � <br /> Authorized Representative <br /> Form WC 99 00 06 A (1) Printed in U.S.A. Page 1 (CONTINUED ON NEXT PAGE) <br /> Process Date: 09/14/17 Policy Expiration Date: 05/03/18 <br /> ORIGINAL <br />