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/ <br />,Nc ~+~. <br />/ <br />/4l <br />r'f: <br />~i ENDORSEMENT <br />s <br />l <br />;. ~ <br />e <br />. <br />_=~' ^ The Western Cmualty and Surety C•,n q,an <br />Attached ro a mf n,ede a parr of Pol,cy No ............................. .................................................... .....of ^ The Western Firr: Insurance Company <br />of Furt Scurf, Kansas 66701, <br />^ <br />The West e,n In,lemniry Company, Inc. <br />ISfu L'd 10 ........ ..................................................................... .................................................... . <br />................ <br />............................................................................... <br /> Name of Insured City Srate and Zip Code <br /> ~(/ <br />('/~ n EndorsemeYf f-Effective.. ...~-~.._ ............................................... End. Nn...... <br /> / <br />~ ~ <br />tr . <br />....... <br />.......... <br />............ <br />.. <br />.: <br />.. <br />... <br /> Secretary ....... <br />.... <br />. .................. ........ <br />........... <br />..... <br />~ <br />...... <br />... <br />. <br />.. <br />Authored F~lpr entative <br />C. <br />Yt ie e~rced that the cnn2nny caill mail 30 rnye c~ritten notice to <br />~.olorrdo Fiinnd Iand R~claeatioa Division - 1313 Slieman at., room <br />42.3 - D^nvar, ('.olorado S~2Q2 in the event of crnccllation o£ this <br />policy. <br />All other terms, I,mils and pr visi~n~ of phis ~SOlicy remain unchanged. <br />n <br />FOgM 1011 <br />