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Capitol Specialty Insurance Corporation ADDITIONAL INTEREST SCHEDULE <br /> P.O. Box 5900, Madison, WI 53705 <br /> POLICY NUMBER POLICY PERIOD AGENCY/PRODUCER CODE <br /> PR03027746-01 10/06/2020- 10/06/2021 4692P <br /> 12:01 A.M. Standard Time at the address <br /> of the insured stated herein. <br /> NAMED INSURED AND ADDRESS AGENCY/PRODUCER <br /> Aura Creative Inc Pacific International Underwriters, Inc. <br /> DBA Aura Art& Ink; DBA Clorae.Baca.Photography PO Box 2007 <br /> 14002 NE 181st PI Edmonds WA 98020-9507 <br /> Apt A302 <br /> Woodinville, WA 98072-8538 <br /> SCHEDULE <br /> Name of Person or Organization: Executive Beauty Suites Josh&Laycee Gwyther <br /> Address: 111 SE Everett Mall Way <br /> Bldg F <br /> Everett WA 98208-3236 <br /> Snohomish <br /> Insured Item: $50.00-Additional Insured <br /> Interest: CG 20 11 -Additional Insured Manager Or Lessors Of Premises <br /> Interest Type: Designation Of Premises(Part Leased To You) <br /> Description: <br /> Name of Person or Organization: the City of Everett, its officers, employees and agents <br /> Address: 2930 Wetmore Ave <br /> Everett WA 98201-4067 <br /> Snohomish <br /> Insured Item: $50.00-Additional Insured <br /> Interest: CG 20 26-Additional Insured Designated Person or Organization <br /> Interest Type: Name Of Additional Insured Persons Or Organizations <br /> Description: <br /> Countersigned 10/13/2020 By <br /> Authorized Representative <br /> CGE 067(08-03) Page 1 of 1 <br />