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COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> POLICY NUMBER: NNS02306 <br /> N]Extension of Declarations is attached. Effective Date: 11/01/2014 12:01 A.M. Standard Time <br /> LIMITS OF INSURANCE 0 If box is checked refer to form S132 Amendment of 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 $ 1,000,000 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 $ 5,00o 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: Chamber of Commerce <br /> LOCATION OF ALS. PREMISES YOU OWN, RENT, OR OCCUPY. ❑Location address is same as mailing address. <br /> Various, Linden, CA 95236 <br /> 1 <br /> Additional locations (if any)will be shown on form S170, Commercial General Liability Coverage Part Declarations <br /> Extension. <br /> LOCATION OF JOB SITE (If Designated Projects are to be Scheduled): <br /> PREMIUM RATE ADVANCE <br /> CODE#- CLASSIFICATION * 13ASIS Prem/Ops Prod/Comp PREMIUM <br /> Ops <br /> clubs - civic, service, social - no t+ 161 3 .891 626 <br /> 41670 - building or premise owned/leased <br /> except office purposes - Not-For- Included Included <br /> Profit only <br /> Special Event Group I - Up to 500 t+ 1 84.969 85 <br /> 90555 - attendance per day (Nautilus/GD <br /> Surplus only) Included Included <br /> Special Event - Group I - 1501-3000 t+ 1 238.298 238 <br /> 90558 - attendance per day (Nautilus/GD <br /> Surplus only) Included Included <br /> 49950 - Additional Interest - Per Form t+ 1 Included Included <br /> CC2002 <br /> Excluded Excluded <br /> * PREMIUM BASIS SYMBOLS + =Products/Completed Operations are subject to the General Aggregate Limit <br /> a =Area (per 1,000 sq.ft.of area) o =Total 0erating 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) 2 = Payroll (per$1,000 of F3ayroll) u =Units (per unit) <br /> PREMIUM FOR THIS PAGE $ 949 <br /> FORMS AND ENDORSEMENTS other than applicable Forms and =ndorsements shown elsewhere in thepolicy) <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 /> S150(07/09) Includes copyrighted material of Insurance Services Office,Inc.with its permission. <br />