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Common Policy Declarations <br />AgentNamed Insured <br />SUMMARY OF LOCATIONS - CONTINUED <br />POLICY FORMS AND ENDORSEMENTS <br />co <br />CM <br />To report a claim, call your Agent or 1-844-325-2467 <br />000487INSURED COPYACXFPPNOPOLSVCS34004/17/23 <br />CG 00 01 04 13 <br />CG 04 36 04 13 <br />CG 21 06 05 14 <br />CG 24 26 04 13 <br />CG 84 99 01 12 <br />CG 88 10 04 13 <br />CG 88 60 12 08 <br />CG 88 61 12 08 <br />CG 88 66 12 08 <br />CG 88 77 12 08 <br />CG 88 86 12 08 <br />CG 90 41 01 13 <br />CL 01 00 03 99 <br />CL 01 62 01 19 <br />15 <br />15 <br />15 <br />Coverage Is Provided In: <br />Ohio Security Insurance Company - a stock company <br />(952) 545-1230 <br />NORTH RISK PARTNERS LLC <br />2048 SUPERIOR DR NW STE 100 <br />ROCHESTER, MN 55901-5028 <br />DERFS HOT DOGS AND MORE LLC <br />1469 Freestone Rd <br />Manteca, CA 95337 <br />DS 70 21 11 16 <br />56800183 <br />■s <br />Commercial General Liability Coverage Form - Occurrence <br />Limited Product Withdrawal Expense Endorsement <br />Exclusion - Access Or Disclosure Of Confidential Or Personal Information And <br />Data-Related Liability - With Limited Bodily Injury Exception <br />Employment-Related Practices Exclusion <br />Fungi or Bacteria Exclusion <br />Cap on Losses from Certified Acts of Terrorism <br />Exclusion of Punitive Damages Related to a Certified Act of Terrorism <br />Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical <br />Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) <br />Amendment of Insured Contract Definition <br />Non-Cumulation Of Liability Limits Same Occurrence <br />Commercial General Liability Extension <br />Each Location General Aggregate Limit <br />Property Damage - Customers’ Goods <br />Property Damage - Borrowed Equipment <br />Medical Expense At Your Request Endorsement <br />Exclusion - Asbestos Liability <br />Amendment Of Coverage B Personal And Advertising Injury <br />Common Policy Conditions <br />Amendatory Endorsement - California <br />This section lists the Forms and Endorsements for your policy. Refer to these documents <br />information concerning your coverage. <br />FORM NUMBER TITLE ______ <br />Liberty <br />Mutual. <br />INSURANCE <br />as needed for detailed <br />CG 21 47 12 07 <br />CG 21 67 12 04 <br />CG 21 70 01 <br />CG 21 76 01 <br />CG 21 88 01 <br />This policy provides coverage for the following under one or more coverage parts. Please refer to the individual <br />Coverage Declarations Schedules, or, the individual Coverage Forms for locations or territory definition for that <br />specific Coverage Part. <br />0001 1469 Freestone Rd, Manteca, CA 95337-9675 <br />Policy Number <br />BKS (24) 56 80 01 83 <br />Policy Period: <br />From 06/01/2023 To 06/01/2024 <br />12:01 am Standard Time <br />at Insured Mailing Location <br />PAGE 26 OF 110