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/?flJs o:2- 3872299 <br /> F&M BANK LINDEN PAGE 04/64 <br /> NAUTILUS INSURANCE COMPANY <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> LICY NUMBER: NC852849, <br /> Extension of Declarations is attached. Effective Date: A.M.Standard Time <br /> LIMITS Of f INSURANCE D If box is checked,refer to form S132 for Limits of Insurance. <br /> (;neral Aggregate Limit(Other Than Products/Completed Operations) $ 2,0 c 4,0 40 <br /> Products/Completed Operations Aggregate Limit $ INCLUDED <br /> I Personal and Advertising Injury Limit $ _1,co0,0 0_ Any One Person Of Qrganlzation <br /> EachOccurrence Limn $ W,0 0 C,DOG 1 <br /> Damage To Premises Rented To You Limit $ 100,00C Any One Premises s <br /> Medical Expense Urnit 5,000 Arty One Person <br /> RETROACTIVE DATE(CG OD 42 ONLY) <br /> This insurance does not apply to'bodilly Injury","property damage"or"personal and advertising injury'which occurs <br /> before the Retroactive Date, if any,shown here: (Enter Date or"NORSE'if no Retroactive Date applies) <br /> BUSINESS DESCRIPTION AND LOCATION OF PREMISES <br /> BUSINESS DESCRIPTION: CHERRY F$.sTZVAL IN MAY & TREE LIGHTING IN DEC.EMBI R <br /> LOCATION OF ALL PREMISES YOU OWN,RENT,OR OCCUPY: EX Location address Is same as retailing address. <br /> 4. r.0. BCx 557 <br /> Y�VDr^1T CA 55236- <br /> Additional locations(if any)will be shown on form S170. <br /> LOCATiON OF JOB SITE (If Designated Projects are to be Scheduled): <br /> PREMIUM I RATE ADVANCE <br /> CODE - CLASSIFICATIONi BASIS I PR/CO All Other i PREMIUM <br /> 4157 0 - Clubs-civic, service or social-no buildings 'x1 1.34 INCf�UD£^ i INCLUDED ML <br /> or premises owned or leased except for 2,9 s s j ;s=MD <br /> office purposes-NFP i <br /> Rate is Eacb-Member <br /> 90556 - Special Events-Group I-Ute to 500 i T. I 2 � INCLUDED Gi *7C ,L'DED ND f <br /> average daily attendance i E 1 <br /> Hate Is Attendance Per Day-Loc Sonharn& f I ; 's.Gs i 15I MD <br /> Hwy-215,$ 18524 E. Main St,;LINDEN,CA i ff I <br /> Christmas Tres Lighting$Jr-Mis Pagent <br /> i <br /> �C55" - Special Events-Group!-Sot-3,5W - TNCLJDEZ) IT <br /> i average daily attendance { <br /> Rate is Attendance Per Day-Loc:Linden ( ! 12 0.2 5° 120 :c <br /> Elementary Schad,Linder,,CA <br /> CHERRY FESTIVAL j <br /> 167c-_,3 - INCIDENTAL PAGENT REHEARSALS I 13 LUDED MD <br /> a Loc:1 B527 E.Main St.,Linden,CA ' <br /> jr.Miss Pagent :NCLi17ED <br /> f i <br /> t <br /> • PREMILM BASIS SYMBOLS + - Products/Completed Operations,are subject to the General Aggregate Limit <br /> a = Area ;,per'.,wo sq.ft.of area) o = Total Operating Expenses s Gross Sales <br /> c =Totai Cosi c (Per$1,000 of Gross Srslea, <br /> ;pet l'a1,000 of Total Cost) (pe $1,000 Total Operating Expenditures} t - See Classftatton <br /> m-Admissions (per 1,000 Admissions) p = Payroll (per si,000 of Payroll) u = Units (per unit} t <br /> i <br /> PREMIUM FOR THIS PAGE $ 750 MPI <br /> FO 4.5 AND ENDORSEMENT'S (other than applicable Forms and Endorsements shown elsewhere in the poficy) <br /> Forms and Endorsements appiYing to this Coverage Part and made part of#his poticy at time of issue. —� <br /> Refer to SW2 Schedule of Forms and Endorsements <br /> TNESS DECLARATIONS ARE?Aft TtiE POLICY t?ECLARATK7NS COtYrAIlVItVG THF NAME OF THE IhISIJFaEO AM1ID THE POLICY PEfiIOD. <br /> S150 00/04) Incluaes copyrigittaq materiel of Insurance Services OFfice.Inc.urrth its parmission. <br /> Copyright i$(3 Prop9Rie3.Inc.,2004 <br />