Firecat LLC dba Karl's Bakery & Cafe 11/4/2020

PolicyChange : THE Business Owner's PolicyHARTFORD The following Additional Insured has been added as an Additional Insured -Designated Person or Organization. Additional Insured Name City of Everett,its officers,employees and agents The following Additional Insured has been added as an Additional Insured -Owners, Lessees or Contractors -Completed Operations. Name of Additional Insured(s)Person or Organization Location Description of Completed Operations City of Everett,its officers,employees and agents 1 vendor The following Additional Insured has been added as an Additional Insured - Owners, Lessees or Contractors-Scheduled Person or Organization. Name of Additional Insured(s)Person or Organization City of Everett,its officers,employees and agents Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy. FORM NUMBER FORM NAME COVERAGE PART SC 00 06 10 18 POLICY CHANGE Common ADDITIONAL INSURED-OWNERS, SL 30 36 10 18 LESSEES OR CONTRACTORS- Liability COMPLETED OPERATIONS ADDITIONAL INSURED- SL 30 42 10 18 DESIGNATED PERSON OR Liability ORGANIZATION ADDITIONAL INSURED-OWNERS, SL 30 48 10 18 LESSEES OR CONTRACTORS- Liability SCHEDULED PERSON OR ORGANIZATION Premium associated with this Policy Change has pro rata factor 0.961. Form SC 00 06 10 18 Page 2 of 2 Process Date: 10/20/2020 ©2018,The Hartford Policy Expiration Date: 10/06/2021 (May include copyrighted material of Insurance Services Office, Inc., with its permission)