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a <br /> NAUTILUS INSURANCE COMPANY <br /> COMMERCIAL. GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> POLICY NUMBER: NC738713 <br /> ® Extension of Declarations is attached. Effective Date: 11/o1/2oo7 12:01 A.M. Standard Time <br /> LIMITS OF INSURANCE 0 If box is checked, refer to form$132 for Limits of Insurance. <br /> General Aggregate Limit(Other Than Products/Completed Operations) $ 2,000,000 <br /> Products/Completed Operations Aggregate Limit $ INCLUDED <br /> Personal and Advertising Injury Limit $ 1, 0 0 0,00 0 Any One Person Or Organization <br /> Each Occurrence Limit $ 1,000,000 <br /> Damage To Premises Rented To You Limit $ 100, 000 AuiyOne Premises <br /> Medical Expense Limit $ 5,000 Any One Person <br /> RETROACTIVE DATE(CG 00 02 ONLY) <br /> This insurance does not apply to"bodily injury", "property damage"or"personal and advertising injury"which occurs <br /> before the Retroactive Date, if any,shown here: (Enter Date or"NONE"if no Retroactive Date applies) <br /> BUSINESS DESCRIPTION AND LOCATION OF PREMISES <br /> BUSINESS DESCRIPTION: CHERRY FE$TIVP.L IN MAY & TREE LIGHTING IN DECEMBER <br /> LOCATION OF ALL PREMISES YOU OWN, RENT,OR OCCUPY: L2S� Location address is same as mailing address. <br /> 1. P.O. BOX 557 <br /> LINDEN CA 95236- <br /> 2. <br /> Additional locations(if any)will be shown on form 8170. <br /> LOCATION OF JOB SITE (if Designated Projects are to be Scheduled): <br /> PREMIUM RATE ADVANCE <br /> CODE#- CLASSIFICATION * BASIS PR/CO All Other PREMIUM <br /> 416670 - Clubs-civic,service or social-no buildings T 130 INCLUDED INCLUDED MP <br /> or premises owned or leased except for 2.959 750 MP <br /> office purposes- NFP <br /> Rate is Each Member <br /> 9055,s - CHRISTMAS TREE LIGHTING&JR.MISS T 2 INCLUDED INCLUDED <br /> PAGENT-Special Events-Group I-Up to <br /> 500 average daily attendance-Rate is 72.000 <br /> Attendance Per Day-LOC: BONHAM& <br /> HWY 26& 18524 E. MAIN ST., LINDEN CA <br /> DATE: 12/01/07&03/01/07 <br /> 90557 - CHEERY FESTIVAL-Special Events- T 1 INCLUDED INCLUDED <br /> Group I-501-1,500 average daily <br /> attendance-Rate is Attendance Per DaY 14.567 <br /> DATE: 05/17/2008 <br /> LOC:LINDEN ELEMENTARY SCHOOL, <br /> LINDEN <br /> 67013 - INCIDENT PAGENT REHEARSALS T 13 INCLUDED INCLUDED <br /> EVENT:JR.MISS PAGENT <br /> DATE: 03/01/2008 <br /> INCLUDED <br /> LOC; 18527 E. MAIN STREET, LINDEN CA <br /> x PREMIUM BASIS SYMBOLS =Products/Completed Operations are subject to the General Aggregate Limit <br /> a =Area (per 1.0oo sq.ft;of area) o =Total Operating Expenses s =Gross Sales (per$1,000 of Gross Sales) <br /> c =Total Cost (per$1,000 of Total Cost) (per$1,000 Total Operating Expenditures) t =See Classification <br /> m=Admissions (per 1,000 Admissions) p =Payroll (per$1,000 of Payroll) u =Units (per unit) <br /> PREMIUM FOR THIS PAGE $ 750 MP <br /> FORMS AND ENDORSEMENTS (other than applicable Forms and Endorsements shown elsewhere in the policy) <br /> Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue: <br /> Refer to$902 Schedule of Forms and Endorsements <br /> THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. <br /> Includes copyrighted material of insurance Services Office Inc.with its permission. <br /> S150 (10104) Copyright ISO Properties,Inc.,200b <br /> i CC/ ZCO'3 CLL£# SNI ACini 89059£602 Zb OT 80CZ'5C'2idd <br />