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Mutual of Enumclaw Insurance Company <br /> POLICY NUMBER: BOP 0017604 02 BUSINESSOWNERS <br /> EB 12 01 12 99 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> BUSINESSOWNERS POLICY CHANGES <br /> THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. <br /> NAMED INSURED ;POLICY NUMBER POLICY CHANGES <br /> A0005198 C EFFECTIVE <br /> THAT CHICKEN PLACE LLC BOP 0017604 02 10/13/2020 <br /> 1907 HEWITT AVE STE A <br /> EVERETT WA 98201 AUTHORIZED REPRESENTATIVE <br /> CALROSE INSURANCE <br /> 0005198 <br /> CHANGES <br /> FORM BP 04 48 ADDITIONAL INSURED, DESIGNATED PERSON OR ORGANIZATION <br /> IS ADDED FOR CITY OF EVERETT PER ATTACHED. <br /> Transaction <br /> Type <br /> Previous <br /> A=Added Prem # Bldg # Coverage Description Limit New Limit <br /> D=Deleted Of Insurance Of Insurance <br /> C=Changed <br /> $ $ <br /> 0 <br /> N <br /> O <br /> O <br /> a TOTAL PRO-RATA PREMIUM ADJUSMENTS Additional(Return) <br /> $28 ADDITIONAL <br /> REMOVAL PERMIT <br /> rn If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered <br /> cap Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the <br /> 18 value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this <br /> Sinsurance does not apply at the previous location. <br /> EB 12 01 12 99 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 <br />