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<br />IMPORTANT – ATTACH TO YOUR POLICY <br /> <br /> <br />CHURCH MUTUAL INSURANCE COMPANY <br />CHANGE ENDORSEMENT <br /> <br /> <br />THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW: <br /> <br />ENDORSEMENT EFFECTIVE DATE: 05/21/2019 POLICY NO.: 0261856-02-145609 <br />POLICY EFFECTIVE DATE: 09/01/2018 <br /> <br />FELLOWSHIP OF CHRISTIAN ATHLETES <br />OKLAHOMA CHAPTER OF FELLOWSHIP OF CHRISTIAN <br />ATHLETES; GREATER DALLAS FELLOWSHIP OF <br />CHRISTIAN ATHLETES INC <br />8701 LEEDS RD <br />KANSAS CITY MO 64129 <br /> <br /> <br />SUMMARY CHANGES TO YOUR POLICY <br /> <br />FORM A 220(01-98) ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION ENDORSEMENT. <br />SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS IS ADDED FOR KITTITAS COUNTY. <br /> <br /> <br /> <br />PREMIUM: <br />NO ADDITIONAL PREMIUM DUE <br />AGENT: 35-345 <br />TRUSS LLC <br />4551 W 107TH ST 3RD FL <br />OVERLAND PARK KS 66207 <br />(913) 341-8998 <br /> <br /> <br /> <br />UN 412(06-86) CHANGE ENDORSEMENT PAGE 1 ISSUED DATE: 12/07/2018 <br />