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BOLXCY NUMBER INSURED NAME AND ADDRESS <br />B 6024686380 Benevate, Inc <br />3423 PIEDMONT RD NE <br />Yy ATLANTA, GA 30305 <br />Y Mv, <br />FORMS AND ENDORSEMENTS SCHEDULE <br />The following list shows the Forms, Schedules and Endorsements by Line of Business that are <br />a part of this policy. <br />COMMON <br />The following forms have been added to your policy, effective 05/13/2020 <br />FORM NUMBER FORM TITLE <br />SB147052C 06/2016 Notice of Cancellation or Material Coverage Change <br />G56015B 11/1991 ENDORSEMENT EFFECTIVE 05/13/2020 <br />G56015B 11/1991 ENDORSEMENT EFFECTIVE 05/13/2020 <br />Che� <br />REVILWED & APPROVED <br />By Wisk RNACIFMFW DlVIS(ON <br />mym�� <br />Ar4gk Acurdo <br />countersignature <br />�Secreut <br />SB-146895-A (Ed. 01/06) AGENT Page 4 0£ 4 <br />