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p O ENDORSEMENT
Effective from 8/8/68 at the time of day the policy becomes effective. Amending Policy No. Nail- 2251201
Inued to THE ROA Rr� F COUNTY COMMI SSI ONFFR$ OF T UN F COTY OF WO
Date of Issue: 9/27/66 LT Additional Premium$ 659 Return Premium $
OFFICE PROD FPO°.
FOR .DD°EDFNV-0 �DE1�.1707 HOPK I NS LIMY I.NSRS INC
W. Pot- +j /� MODE F LOC.OF
MBE EXPIRES F�/ y MUST. A RISK
It is agreed that as of the effective date hereof the policy is amended in the following particulars:
AS RESPECT$ THE FOLLOWING AUTOMOBILES: TO INCLUDE COVERAGES AS STATED
BELOW:
FIRE, THEFT: ACV
COLL: $500 DED
ANNUAL RATES
AUTOMOBILE FIRE & THEFT COLL
1967 CHEV DUMP TRK #JM71790102508 CN: 15,500 30 193
1967 INTIL 3T TANDEM TRK #2419226238952 CN: 17 ,000 30 129
1966 FORD #T85KU78299 CN: 16,600 27 90
1962 TRK TRACTOR S#625611 CN: 18,500 22 145
1966 CHEV TANDEM DUMP TRK #M8536-P105612 CN : 15,000 27 135
1965 DODGE TRK #S-5881-521-498 CN: 17,000 19 90
W/GALUON DUMP 8#85432
1966 FORDTRK DUMP BODY #485L0849701 CN: 15,500 27 135
1957 GMC JM8670AD2361K CN: 17,900 35 138
1968 IHC 7579216310626 CN: 18,000 47 138
If any additional premium is noted above, this endorsement is issued in consideration thereof. If any return premium is noted above, the receipt
thereof is acknowledged upon acceptance of this endorsement.
THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY SYMBOL No.
8010
//
Secretary Secretary //Sec
FJCIO0 _ /i' 148
C-10748 2-BS PRINT CO IN U.S.A. Countersigned by a` _ / --^'-c ' "�
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