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,r <br /> `t Coverage Is Provided In: Policy Number: <br /> ' Liberty Ohio Security Insurance Company BKS (21) 61 51 17 54 <br /> 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 /> CP 91 42 01 15 Custom Protector Plus Endorsement <br /> IL 01 23 11 13 Washington Changes - Defense Costs <br /> IL 01 46 08 10 Washington Common Policy Conditions <br /> IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br /> IL 09 35 07 02 Exclusion of Certain Computer-Related Losses <br /> IL 09 52 01 15 Cap On Losses From Certified Acts Of Terrorism <br /> IL 09 96 01 07 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical <br /> Terrorism (Relating to Dispostion of Federal Terrorism Risk Insurance Act) <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 5 OF 18 <br />