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AGENCY ADDITIONAL INTEREST SCHEDULE CARRIER United States Fire Insurance Co POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S) SRPGP-101-0415/USP180232 1 05/15/2015 Walter Castillo DBA Olympic TKD Academy ADDITIONAL INTEREST (Not all fields apply to all scenarios — provide only the necessary data) DATE (MM/DD/YYYY) 05/15/2015 NAIC CODE 21113 INTEREST NAMEANDADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER City Riverside X ADDITIONAL INSURED LOSS PAYEE of LOCATION: BUILDING: BEACH OF WARRANTY MORTGAGEE 6927 Magnolia Ave. 2nd Floor VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER Riverside, CA 92506 EMPLOYEE AS LESSOR REGISTRANT ITEMITEM: CLASS: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAMEANDADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE AP Arlington LLC Insurance Compliance LOCATION: BUILDING: BEACH OF WARRANTY MORTGAGEE PO Box 12010 - AY VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER Hemet, CA 92546 EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FORINTEREST: E-MAIL ADDRESS: INTEREST NAMEANDADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/ LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAMEANDADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAMEANDADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: I E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD