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OCT-25-2012 16:31 Frorn:2098872299 To:94689324 Page:2.15 <br /> COMMERCIAL GENERAL LIABILITY <br /> COVERAGE PART DECLARATIONS EXTENSION <br /> POLICY NUMBER: NN188826 Effective Date: 11/01/2011 12:01 A.M.Standard Time <br /> LOCATION OF PREMISES <br /> Location of All Premises You Own, Rent or Occupy: <br /> PREMIUM <br /> CODE#- CLASSIFICATION * PREMIUM RATE ADVANCE <br /> BASIS Prem/Ops ProdOps mp PREMIUM <br /> 67013 - INCIDENTAL JR MISS COMPETITION T 1 INCLUDED INCLUDED <br /> REHERSALS INCLUDED INCLUDED <br /> 49950 -Additional Insured T 2 INCLUDED INCLUDED <br /> FORM CG2011 <br /> ❑ Additional page needed_ PREMIUM FOR THIS COVERAGE PART $ <br /> THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. <br /> S170(07109) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 <br />