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Coverage Is Provided In: <br />1-,1beTty West American Insurance Company - a stock company <br />- Mutual. <br />INSURANCE <br />Policy Change Endorsement <br />Named Insured <br />Policy Number: <br />BHW (21 ) 60 62 24 86 <br />Policy Period: <br />From 01/01/2020 To 01/01/2021 <br />Endorsement Period: <br />From 01/01/2020 to 01/01/2021 <br />12:01 am Standard Time <br />at Insured Mailing Location <br />GERALDINE VALENCIA (714) 288-8000 <br />DBA: G STARS DANCE AND GYMNASTICS AA LAKES INSURANCE SERVICES INC <br />POLICY FORMS AND ENDORSEMENTS - CONTINUED <br />This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed <br />information concerning your coverage. <br />FORM NUMBER <br />TITLE <br />CG 22 71 04 13 <br />Colleges or Schools (Limited Form) <br />CG 24 26 04 13 <br />Amendment of Insured Contract Definition <br />*CG 80 61 05 11 <br />Amendment of Cancellation Provisions <br />CG 84 99 01 12 <br />Non -Cumulation Of Liability Limits Same Occurrence <br />CG 88 1004 13 <br />Commercial General Liability Extension <br />CG 88 60 12 08 <br />Each Location General Aggregate Limit <br />CG 88 77 12 08 <br />Medical Expense At Your Request Endorsement <br />CG 88 86 12 08 <br />Exclusion - Asbestos Liability <br />CG 88 87 12 08 <br />Exclusion - Lead Liability <br />CG 90 41 01 13 <br />Amendment Of Coverage B Personal And Advertising Injury <br />CP 00 10 04 02 <br />Building and Personal Property Coverage Form <br />CP 00 90 07 88 <br />Commercial Property Conditions <br />CP 01 40 07 06 <br />Exclusion of Loss Due to Virus or Bacteria <br />CP 04 49 12 05 <br />California Changes - Replacement Cost <br />CP 10 30 04 02 <br />Causes of Loss - Special Form <br />CP 10 32 08 08 <br />Water Exclusion Endorsement <br />Issue Date 01/23/20 <br />To report a claim, call your Agent or 1-844-325.2467 <br />R� SW & Mpp SED ByMADI <br />MAR 1 <br />Authorized Representative <br />IDS 70 27 01 08 <br />ntnvnn FM77aRn w Ricin 7911 NrArPPNn INSIIRPn en Pv nn7775 Pats n nP 17 <br />