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POLICY AMOUNT AND PREMIUM ADJUSTMENT <br /> Limits Of Insurance Premiums <br /> Coverage Previous Limit New Limit Previous New ❑ Add'I Premium <br /> Description Of Insurance Of Insurance Premium Premium 0 Return Premium <br /> $ $ $ <br /> TOTAL PREMIUM ADJUSTMENTS <br /> PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE <br /> ADDITIONAL RETURN <br /> $ 0.00 $0.00 <br /> REMOVAL If Covered Property is removed to a new location that is described on this Policy Change, you may <br /> PERMIT extend this insurance to include that Covered Property at each location during the removal. Cov- <br /> erage at each location will apply in the proportion that the value at each location bears to the value <br /> of all Covered Property being removed. This permit applies up to 10 days after the effective date <br /> of this Policy Change: after that, this insurance does not apply at the previous location. <br /> BP 12 01 07 02 ©ISO Properties, Inc., 2001 Page 3 of 3 <br />