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OCT-25-20012 16:29 From:2098872299 To:94689324 Pa9e:1/5 <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> POLICY NUMBER: NN188826 <br /> Extension of Declarations is attached. Effective Date: 11/01/2011 12:01 A.M.Standard Time <br /> LIMITS OF INSURANCE If box is checked,refer to form S132Amendment of Limits of Insurance. <br /> General Aggregate Limit(Other Than Products/Completed Operations) $ 21_goo,a 0 0 <br /> Products/Completed Operations Aggregate Limit $_INCLUDED <br /> Personal and Advertising Injury Limit $ 1,000,000 Any One Person Or Organization <br /> Each Occurrence Limit $ 1.000.000 <br /> Damage To Premises Rented To You Limit $—100,000 Any One Premises <br /> Medical Expense Limit $ 5,000 Anyone 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: CHAMBER OF COMMERCE <br /> LOCATION OF ALL PREMISES YOU OWN,RENT,OR OCCUPY: El Location address is same as mailing address. <br /> 1. VARIOUS <br /> LINDEN CA - <br /> 2. <br /> Additional locations(if any)will be shown on form 5170,Commercial General Liability Coverage Part Declarations <br /> Extension. <br /> LOCATION OF JOB SITE (If Designated Projects are to be Scheduled): <br /> * RATE <br /> CODE#- CLASSIFICATION PREMIUM ADVANCEBASIS Prem/Ops Prod/Comp PREMIUM <br /> Ops <br /> 41670 - Clubs-civic,service or social-no buildings T 161 3.310 533 <br /> or premises owned or leased except for <br /> office purposes-NFP INCLUDED INCLV6ED <br /> Rate Is Each Member <br /> 90556 - Special Events-Group I-Up to 500 T 1 72.251 72 <br /> average daily attendance INCLUDED <br /> Rate is Attendance Per Day INCLUDED <br /> CHRISTMAS TREE LIGHTING <br /> DATE TBD <br /> 90556 - Special Events-Group I-Up to 500 T 1 72.250 72 <br /> average daily attendance <br /> Rate is Attendance Per Day INCLUDED INCLUDED <br /> CHERRY FESTIVAL-DATE TBD <br /> 90557 -Special Events-Group I-501-1,500 T 1 114.989 115 <br /> average daily attendance <br /> Rate is Attendance Per Day INCLUDED. INCLUDED <br /> JR MISS COMPETION-DATE TBD <br /> PREMIUM BASIS SYMBOLS +=Products/Completed Operations are subject to the General Aggregate Limit <br /> a =Area (per 1,000 sq.rt.of area) o =Total Operating Expenditures 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 $ 792 <br /> FORMS AND ENDORSEMENTS (other then 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 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 /> 5150(07!09) Includes copyrighted material of Insurance Services Office,Inc.with its permission. <br />