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Page 2 of 2 © Insurance Services Office, Inc., 2009 BP 12 01 08 10 <br />OPTIONAL COVERAGES <br />Add'l PremiumThe following optional coverages are added under this policy <br />when designated by an "X" in the box(es) shown below.Return Premium <br />Limits Of Insurance <br />Outdoor Signs $$ <br />Burglary and Robbery $ <br /> (Named Peril Endorsement only)$Inside the Premises <br />or <br />Money and Securities $Outside the Premises $ <br /> Employee Dishonesty $each occurrence $ <br />Equipment Breakdown $$ <br />TOTAL PREMIUM ADJUSTMENTS <br />PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE <br />ADDITIONAL RETURN <br />$$ <br />REMOVAL <br />PERMIT <br />If Covered Property is removed to a new location that is described on this Policy Change, you may <br />extend this insurance to include that Covered Property at each location during the removal. Cov- <br />erage at each location will apply in the proportion that the value at each location bears to the value <br />of all Covered Property being removed. This permit applies up to 10 days after the effective date <br />of this Policy Change; after that, this insurance does not apply at the previous location. <br /> <br />Authorized Representative Signature <br />Docusign Envelope ID: BAF64511-C271-4FC1-BBE9-5AF1BC605D95