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NAUTILUS INSURANCE COMPANY <br />POLICY NUMBER: NN1285075 ENDORSEMENT # 02 <br />Named Insured: STUART NAKAMURA Agency # 04611 00 <br />DBA S NAKAMURA STUDIO, LLC <br />NIF Insurance Services of California <br />30 Park Avenue <br />Manhasset, NY 11030 <br />Endorsement Effective Date: 01 / 12 / 2 02 2 <br />GENERAL CHANGE ENDORSEMENT <br />IN CONSIDERATION OF THE ADDITIONAL PREMIUM OF $286.00, IT IS UNDERSTOOD AND AGREED THAT <br />THE FOLLOWING CHANGES HAVE BEEN MADE: <br />FORM L815 HAS BEEN HEREBY REPLACED BY FORM L818, ATTACHED HERETO. <br />THE EXPOSURE FOR CLASS CODE 91581 HAS BEEN INCREASED TO $14,600 WITH A PREMISES/OPERATIONS <br />RATE OF $0.780, A PRODUCTS/COMPLETED OPERATIONS RATE OF $3.228, AND AN ANNUAL PREMIUM OF <br />$58.00. <br />ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME. <br />ADDITIONAL PREMIUM OF $286.00. <br />Tax & Fee Schedule <br />SURPLUS LINES TAX $ 5 72 PREMIUM: ❑ None ❑x AP ❑ RP $ <br />STAMPING FEE .29 Total Taxes & Fees $ <br />TOTAL PREMIUM DUE $ <br />All other terms and conditions remain unchanged. <br />PRODUCER: KING INSURANCE ASSOCIATES, INC <br />VZ <br />Manhasset, NY <br />02/16/22 RP Date Issued: 02 /17/2022 Authorized Representative <br />S901 (07/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />286.00 <br />6.01 <br />292.01 <br />