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Coverage Is Provided In: <br /> Liberty Policy Number: <br /> U Ohio Security Insurance Company BKS (21) 61 51 17 54 <br /> rx Mutual. <br /> 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 Agent <br /> SB SUSHI INC (425) 741-3600 <br /> DBA TOKYO HOUSE SEATTLE BEST INSURANCE INC <br /> POLICY FORMS AND ENDORSEMENTS - CONTINUED <br /> This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed <br /> information concerning your coverage. <br /> FORM NUMBER TITLE <br /> CG 24 26 04 13 Amendment of Insured Contract Definition <br /> CG 26 77 12 04 Washington - Fungi or Bacteria Exclusion <br /> CG 32 21 01 15 Washington Conditional Exclusion of Terrorism Involving Nuclear, Biological or <br /> Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance <br /> Act) <br /> CG 84 99 08 09 Non-Cumulation Liability Limits Same Occurrence <br /> CG 88 10 04 13 Commercial General Liability Extension <br /> CG 88 60 12 08 Each Location General Aggregate Limit <br /> CG 88 61 12 08 Property Damage - Customers' Goods <br /> CG 88 63 12 08 Valet Parking Liability Endorsement <br /> CG 88 66 12 08 Property Damage - Borrowed Equipment <br /> CG 88 77 12 08 Medical Expense At Your Request Endorsement <br /> CG 89 01 12 08 Hired Auto And Non-Owned Auto Liability <br /> CG 89 27 10 09 Washington Exclusion - Asbestos <br /> CG 91 98 06 15 Disclosure and Notice Concerning Fully Earned and Minimun Premium Endorsements <br /> CP 00 10 10 12 Building and Personal Property Coverage Form <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 3 OF 18 <br />