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THE <br />HARTFORD <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />CHANGE IN INFORMATION PAGE <br />INSURER: Hartford Casualty Insurance Company <br />NCCI Company Number: 14397 <br />Policy Number: 57 WEC AU9LTU Endorsement Number: 001 <br />Effective Date: 08/19/25 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: <br />FEIN Number: 82-2936498 <br />ALIAHMAD <br />2053 BROADWAY ST STE B <br />REDWOOD CITY CA 94063 <br />It is agreed that the policy is amended as follows: <br />This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive <br />a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium <br />will change future draw amounts. <br />In consideration of an additional premium of $43, it is agreed that: <br />Policy is amended to add the following condition(s): <br />Waiver of Our Right to Recover from Others Endorsement <br />Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy. <br />WC040306 <br />WC990006B(.2) <br />WC990006B(.1 P) <br />Countersigned by <br />Authorized Representative <br />Form WC 99 00 06 B (1) Printed in U.S.A. Page 1 <br />Process Date: 08/19/25 Policy Expiration Date: 11/08/25 <br />