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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />PREMIUM DISCOUNT ENDORSEMENT <br />Policy Number: 72 WEC AMOKNA Endorsement Number: 003 <br />Effective Date: 07/18/24 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: Borrone Peter Inc <br />2022 BROADWAY ST <br />REDWOOD CITY CA 94063 <br />The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This <br />endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will <br />be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating <br />is not subject to premium discount. <br />SCHEDULE <br />1. Table of States <br />California <br />California <br />California <br />or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate <br />basis at the effective date of the policy. <br />2. Average percentage discount: 2.80 % <br />3. Other policies: <br />4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your <br />policy number: <br />Countersigned by <br />Form WC 00 04 06 Printed in U.S.A. <br />Process Date: 07/22/24 <br />ATTY/AGR.2024.136Nesta (2022 Broadway) (Page 29 of 31) <br />Authorized Representative <br />Policy Expiration Date: 06/07/25 <br />