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POLICY NUMBER: BBP0001661-01 <br /> OPTIONAL COVERAGES Changes to Optional Coverages as shown above. <br /> The following optional coverages are added under this policy <br /> when designated by an "X" in the box(es) shown below. 0 Additional Premium <br /> Limits Of Insurance ❑ Returned Premium <br /> ❑ Outdoor Signs <br /> ❑ Burglary and Robbery <br /> (Named Peril Endorsement only) Inside the Premises <br /> or <br /> ❑ Money and Securities Outside the Premises <br /> ❑ Employee Dishonesty each occurrence <br /> Mechanical Breakdown <br /> ❑ Boiler and Pressure Vessels <br /> ❑ Air Conditioning Units <br /> ❑ Pressure Vessels Only <br /> TOTAL PREMIUM ADJUSTMENTS <br /> PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE <br /> ADDITIONAL RETURN <br /> Total Premium: $13.00 <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 /> Authorized Representative Signature <br /> Page 2 of 2 © ISO Properties, Inc., 2001 BP 12 01 07 02 0 <br />