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POLICY NUMBER: - INSURED NAME AND ADDRESS - - <br />B 6025612892 Gruen Associates <br />6330 SAN VICENTE BLVD STE 200 <br />LOS ANGELES, CA 90048 <br />.. <br />FORMS AND <br />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 06/16/2021 <br />FORM NUMBER FORM TITLE <br />G56015B 11/1991 ENDORSEMENT EFFECTIVE 06/16/2021 <br />Countersignature <br />w�M.aq�rx,i <br />Chairman of the Board A lr ' f0':vlenID 6 TArexw® Or. <br />nek Wu —t ClmufAde <br />SB-146895-A (Ed. 01/06) INSURED - -- - <br />