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FILE No .135 10/08 '02 14:55 I A: ALLSTATE <br />UPA11state. <br />161' fret In rlyA Imilds. <br />ALLSTATE INSURANCE COMPANY <br />Home Office Northbrook, 11linois <br />Calendar, 10/080001 <br />FLORIDA <br />FAX :3058548442 PAGE 1 <br />CU STOMEft SL RV I CE REQUES1 <br />COMMERCIAL AI11 U POLICY <br />Policy Nurrbet,: 041319/1165 09/14 <br />BU('iNESS NAME PROFESSIONAL 111 .TNG INC <br />I;USN ADDRESS 6/5 NW Ii STREET <br />CJTY MIAMI ST: Fl. 7.,111: 33128 <br />IIOI^1F PhONE ; ( 305 ) 986 - 4039 BUSINESS PHONE ( 305) 314 0101. <br />CHANGE COVLRA(1FS These are the Coverages Lhat apply to your, -.. -- <br />vehic'P(s) after your, reqursted change h;►s been made. <br />ITEM 001 ITEM 00? <br />Ali Combined Ii I & PO 500000 500000 <br />VA Basic_ NIP (Ded) 111 0 <br />PIP Plan 01. 01 <br />--- - -.... ...- ..------ - - - -._ . ... - ------- ........ <br />CHANGE POLICY ADDIIIONAL INSURCD <br />Uir, .,ode: 000000 <br />Nam: C11'Y OF MIAMI BEACH <br />C i ly: MIAMI BEACH <br />-------- - - - - --- <br />THIS LIIJORSF.MI:NT HAS AI-'FECTED THE FOLLOWING POLICY FORMS: <br />Fonts OPIet,ed:CA9927 Old/ SPLIT LIA011.11Y <br />.. . - - - . - - . -. .. . -.. - -- - - -- - - -.. ... P.. - -- - "--- .. -.. -.. ... . ... - - - . - -- - -..... ... <br />THIS REQUEST IS SIJrQFCT TQ POLICY TERMS AND IS GFFFCTIVE ONLY IF- <br />THE POLICY NOTED IS CURRENTLY IN FOIZCL-- <br />EF FF1, I) VE 12:01 AM 1.010912002 <br />Notice: il: is a Crime Im knowingly pruvi(l(, false, incomplete cr <br />misleachny information I,o an insurance (:ampany for the Inarper.;r of <br />def,auding Lhe cornpany. Penalties include imprisonment, Dines' and <br />denial of insurdrtCe benefits. <br />P' 1'CYhOLDI:R��gnature <br />/ _ .r <br />i N0: 016727 LOC: 749 305.851 1884 <br />Agent's Phone# <br />nm1, -► I r Page I of' 01 <br />