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Coverage Is Provided In: <br /> �� . � Liberty Policy Number: <br /> Ohio Security Insurance Company BKS (21) 61 51 17 54 <br /> Mutual. Policy Period: <br /> INSURANCE From 07/01/2020 To 07/01/2021 <br /> Endorsement Period: <br /> From 07/09/2020 to 07/01/2021 <br /> Policy Change Endorsement 12:01 am Standard Time <br /> at Insured Mailing Location <br /> Named Insured &Mailing Address Agent Mailing Address&Phone No. <br /> SB SUSHI INC (425) 741-3600 <br /> DBA TOKYO HOUSE SEATTLE BEST INSURANCE INC <br /> 500 SE EVERETT MALL WAY STE B100 18623 HIGHWAY 99 STE 240 <br /> EVERETT, WA 98208 LYNNWOOD, WA 98037-4552 <br /> CHANGES TO POLICY - TRANSACTION # 2 <br /> This Policy Change Endorsement Results In A Change In The Charges As Follows: <br /> No Change in Premium <br /> Description of Change(s) <br /> ADDED CG2012 IN FAVOR OF: CITY OF EVERETT, ITS <br /> OFFICERS, EMPLOYEES AND AGENTS, 2930 WETMORE <br /> AVENUE STE 8-A, EVERETT, WA 98201 <br /> See The Revised Declarations and Declarations Schedule <br /> Issue Date 07/27/20 Authorized Representative <br /> To report a claim, call your Agent or 1-844-325-2467 <br /> DS 70 27 01 08 <br /> 07/27/20 61511754 N0179270 230 NCXHPPNO INSURED COPY 002601 PAGE 1 OF 18 <br />