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GENERAL CHANGE ENDORSEMENT <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: <br />Name of Insurance Company(ies) <br />200.00 <br />FEES ......... :$ <br />0.00 <br />TAX .......... :$ <br />6.00 <br />FILING FEE ... :$ <br />0.36 <br />FIRE MARSHALL:$ <br />Atain <br />Specialty <br />Insurance <br />Company <br />Atain <br />Spec <br />Insurance <br />Company <br />100.0% <br />GenLiab <br />Atain <br />Specialty <br />Insurance <br />Company <br />Atain <br />Spec <br />Insurance <br />Company <br />100.0% <br />CommPkge <br />Atain <br />Specialty <br />Insurance <br />Company <br />Atain <br />Spec <br />Insurance <br />Company <br />100.0% <br />Property <br />Atain <br />Specialty <br />Insurance <br />Company <br />Atain <br />Spec <br />Insurance <br />Company <br />100.0% <br />LIQLI <br />Endorsement Effective <br />7/3/2024 <br />Named Insured <br />Sakura Sakura 52 DBA <br />Inception Date <br />5/8/2024 <br />Policy Number <br />CIP471258 <br />Expiration Date <br />5/8/2025 <br />Endorsement # <br />3 <br />Samuee &mon <br />Countersigned By <br />(Authorized Representative) <br />IN CONSIDERATION OF THE ADDITIONAL PREMIUM SHOWN BELOW, IT IS HEREBY UNDERSTOOD AND <br />AGREED THAT THE POLICY IS AMENDED AS FOLLOWS: <br />THE FOLLOWING ENTITY IS HEREBY ADDED ONTO THE POLICY AS A/I ON CG2010 FORM & WAIVER OF <br />SUBROGATION ON FORM CG2404 <br />City of Redwood City <br />1017 Middlefield Rd <br />Redwood City, CA 94063 <br />All other terms and conditions remain unchanged. <br />PREMIUM ...... :$ <br />200.00 <br />FEES ......... :$ <br />0.00 <br />TAX .......... :$ <br />6.00 <br />FILING FEE ... :$ <br />0.36 <br />FIRE MARSHALL:$ <br />0.00 <br />STAMPING FEE.:$ <br />0.00 <br />TOTAL ........ :$ <br />206.36 <br />7/3/2024 emd <br />