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POLICY NUMBER INSURED NAME AND ADDRESS <br />B 6011108314 HOLISTIC YOGA & HEALTH LW <br />10015 GARDEN GROVE BLVD <br />GARDEN GROVE, CA 92844 <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 />Sri V I =30 k <br />The following forms have been added to your policy, effective 04/21/2016 <br />FORM NUMBER FORM TITLE <br />G56015B 11/1991 ENDORSEMENT EFFECTIVE 04/21/2016 <br />COMMERCIAL GENERAL LIABILITY <br />The following forms have been added to your policy, effective 04/21/2016 <br />FORM NUMBER FORM TITLE <br />SB300113C 06/2011 Additional Insured - Designated Person <br />Countersignature <br />V Secretary <br />Chairman of we ward <br />SB-14095-A 0& 01/06) WSURED Page 3 of 31 <br />