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11/13/2008 12:07 3872299 F&M BANK LINDEN PAGE 03/03 <br /> NAUTILUS INSURANCE COMPANY <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> IOLICY NUMBER: NGS62849 <br /> LN Extension of declarations is attached. Effective Date: 1.1/01/2008 12:01 A.M. Standard Time <br /> rGeneral <br /> SURANCE ❑ If box is checked refer to form 8132 for Limits of Insurance. <br /> gregate Limit(Other Than Products/Completed Operations) $ 2,000,Ooo <br /> ompleted Operations Aggregate Limit $ INCLUDED <br /> d Advertising Injury Limit $ 1,000,000 Any Dne Person Or Organizatlon <br /> rence Limit $ 1,000,000 <br /> Damage To Premises Rented To You Limit S 100,000 Any One Premises <br /> Medical Expense Limit $ ,DOa 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 Revoactive Date applies) <br /> BUSINESS DESCRIPTION AND LOCATION OF PREMISES <br /> BUSINESS DESCRIPTION: C13ERRY FESTIVAL IN MAY & TRES LIGHTING IN DECEMBER <br /> LOCATION OF ALL PREMISES YOU OWN,RENT,OR OCCUPY: R Location address is same as mailing address, <br /> 1. P.0- BOX 557 <br /> LINDEN CA 95236- <br /> 2. <br /> Additional locations(if any)will be shown on form St 70. <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 /> 41670 - Clubs-civic,service or social-no buildings i T 130 INCLUDED( INCLUDED MD <br /> or premises owned or leased except for I � 2.9 5 5 385 MD <br /> office purposes-NFP i <br /> Rate is Each Member If <br /> i <br /> i <br /> 90556 - Special Events-Group I-Up to 500 T 2 INCLUDED INCLUDED MD <br /> average daily attendance <br /> Rate is Attendance Per Day-Loc:Bonham& 79-557 151 MD <br /> Hwy.2a&18524 E. Main St.;LINDEN,CA <br /> Christmas Tree Lighting&Jr.Mis Pagent <br /> 90557 - Special Events-Group I-501-1,500 T 1. INCLUDED INCLUDED MD <br /> average daily attendance , } <br /> Rate is Attendance Per Day-Loc:Linden i 4.,0 ,in 0 120 MD <br /> Elementary School,Linden,CA i <br /> CHERRY FESTIVAL <br /> 67013 - INCIDENTAL PAGENT REHEARSALS T 13 INCLUDED i INCLUDED MD <br /> Loc: 18527 E.Main St., Linden.CA <br /> Jr. Miss Pagent INCLUDED <br /> I , f <br /> • PREMIUM 13ASIS SYMBOLS + - Products/Competed Operations are subject to the General Aggregate Limit <br /> .a = Area (per 1,000 sq.ft,of area) o = Total Operating Expenses s - Gross Sales (per 31,000 of Gross Sales) <br /> c = Total Cost (per 3!.000 of Total Cost) (per 31.000 Total Operating Expenditures) t = See Classification <br /> Inn-Admissions (per 1,000 Admissions) p = Payroll (Pei$1,000 of Payroll) u = Units (per unit) <br /> PREMIUM FOR THIS PAGE_$ 750 MP <br /> IF MS 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 5902 Schedule of Forms and Endorsements <br /> THESE DECLARATIONS ARF_PART OF THE POLICY OF-CLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. <br /> 5150 (10/D4) Includes copyrighted material of insurance Services Office,Inc,with its permission. <br /> Copyright ISO Properties,Inc.,2000 <br />