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DESCRIPTIONS (Continued from Page 1 <br /> Form:200302A Edt.Date: 09/01/08 Form Description: MA ASSESSMENT CHARGE <br /> Form: 200601A Edt. Date: 07/01/08 Form Description: MA CANCELLATION END <br /> Form: 200303D Edt. Date: 08101/10 <br /> Form Description: MA NOTICE TO POLICYHOLDER <br /> Form: 000414 Edt.Date: 07/01/90 <br /> Form Description: NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT <br /> Form: 200405 Edt. ❑ate: 06/01/01 <br /> Form Description: MASSACHUSETTS PREMIUM DUE DATE ENDORSEMENT <br /> Form: 000422B Edt.Date: 01/01/15 <br /> Form Description:TRIPRA❑ISCLOSURE END <br /> Form: 200401 Edt.Date: 11/01/90 <br /> Form Description: MASSACHUSETTS PENDING PREMIUM CHANGE ENDT <br /> Form: L295 Edt.Date: 05/01103 <br /> Form Description: CHILD LABOR LAWS AND CONTRACTORS RESPONSIBILITY <br /> Form: OOOOOOC Edt.Date: 01/01/15 <br /> Form Description:WORKERS COMPENSATION AND EMPLOYERS LIABILITY INS P <br /> **Supplemental Name** <br /> First Supplemental Name applies to all policies-Sachs Jewelers of Mashpee, Inc. <br /> SAGITTA 25.3(2016/03) 2 of 2 <br /> #S3827311M382730 <br />