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POLICY NUMBER:606749214 E4277 <br /> 2nd Edition <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> POLICY CHANGES <br /> Effective Date of Change: 12/13/2020 Expiration Date:06/17/2021 <br /> Change Endorsement No.: 1 Agent:79-26-36R <br /> Named Insured: 5 RIVERS LLC <br /> The following item(s): <br /> Insured's Name Insured's Mailing Address <br /> Policy Number Company <br /> Effective/Expiration Date Insured's Legal Status/Business of Insured <br /> Payment Plan Premium Determination <br /> Additional Interested Parties Coverage Forms and Endorsements <br /> Limits/Exposures Deductibles <br /> Covered Property/Location Description Classification/Class Codes <br /> Rates Underlying Insurance <br /> is(are)changed to read{See Additional Pages)}: <br /> The above amendments result in a change in the premium as follows: <br /> NO CHANGES TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM <br /> AT AUDIT <br /> $ $ <br /> Authorized Representative Signature: <br /> 91-4277,2nd Edition 09/02 Includes Copyright material,©ISO Properties, Inc.,with its Page 1 of 2 <br /> permission. <br />