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1'IIE Policy Number: BPP5654N <br /> MAIN <br /> STREET THIS ENDORSEMENT CHANGES THE POLICY <br /> AMERICA PLEASE READ IT CAREFULLY <br /> GROUP BUSINESSOWNERS POLICY CHANGE ENDORSEMENT <br /> AUSTIN MUTUAL INSURANCE COMPANY <br /> Endorsement No. 0 01 <br /> Named Insured: THE CERAMIC PLACE LLC Endorsement Effective Date: 09-17-2C <br /> Agent Name: SILVER LAKE INSURANCE Agent No. 461035 <br /> This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions of <br /> coverage unless at the sole request of the insured. <br /> BUSINESSOWNERS POLICY CHANGE DESCRIPTIONS <br /> THE POLICY IS AMENDED AS FOLLOWS : <br /> THE FOLLOWING ADDITIONAL INTEREST (LIAB-DESIGNATED PERSON OR <br /> ORGANIZATION) HAS BEEN ADDED TO THE POLICY: <br /> EVERETT CARES GRANT PROGRAM <br /> 2930 WETMORE AVE STE 8A <br /> EVERETT, WA 98201-4067 <br /> ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME <br /> The changes described result in a change in premium as follows: <br /> n No Changes - To be Adjusted at Audit Additional $ 2 7 . 0 0 Return <br /> Changes in Taxes, Fees and Surcharges <br /> Additional Return <br /> Countersigned By: <br /> `�- AUTHOR! AGENT <br /> BPM CHANGE 0197 <br /> INSURED COPY <br />