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:Z <br />S T I L LWAwT E R <br />INSURANCE COMPANY <br />NEW <br />NE W <br />BUSINESS OWNER POLICY DECLARATIONS <br />Named Insured and Mailing Address Policy Number BP2002952 <br />Stillwater Insurance Group <br />PO Box 45126 <br />Jacksonville, FL 32232 <br />855-712-4114 <br />VIETNAMESE LANGUAGE ACCESS/ASSISTANCE (VIE' <br />1056 CABRILLO PARK DR #B Agency —and Service Contact <br />SANTA ANA CA 92701 ARC 23 INSURANCE SERVICES <br />(949) 484-7500 <br />Policy Period 09/28/2022 to 09/28/2023 12:01AM Standard Time at the Premises location <br />** THIS POLICY DOES NOT COVER EARTHQUAKE OR FLOOD DAMAGE ** <br />In return for timely payment and subject to all policy terms and conditions, we agree with you to provide insurance as <br />stated in this policy, declarations, and every applicable form and endorsement. Also: <br />Amount of insurance limits shown are not stackable across locations or buildings; <br />With respect to Business Liability and Medical Expenses — each claim paid reduces the amount of insurance <br />provided during the applicable annual period; and, <br />If coverage limits or deductibles are indicated as "included" refer to policy provisions for coverage, <br />conditions, and amount of insurance details. <br />PREMIUM AND FEES <br />Annual Premium $ 400.05 <br />Terrorism - Certified Acts $ 3.80 <br />Policy Fee - New Business $ 50.00 <br />Total Annual Premium & Charges $ 453.85 <br />�Ao�nH Risk <br />REVIEWED & APPROVED Or <br />�— Risk Management Analyst <br />