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POLICY NUMBER: BBP0001661-01 <br /> Endorsements Applicable Per Policy <br /> Endorsement Number Endorsement Title <br /> See Schedule Of Forms And Endorsements <br /> Premium: <br /> TOTAL POLICY PREMIUM $4, 153.00 <br /> Policies Subject To Premium Audit: <br /> Audit Period: ❑ Annually ❑ Semi-annually ❑ Quarterly ❑ Monthly <br /> Countersignature Of Authorized Representative <br /> Name: <br /> Title: <br /> Signature: <br /> Date: <br /> Issued: 08/18/2020 <br /> BP DS 01 07 13 o Insurance Services Office, Inc., 2012 Page 5 of 5 ❑ <br />