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HISCOX <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 <br />Commercial General Liability Declarations <br />In return for the payment of the premium, and subject to all the terms of this Policy, we agree with you to <br />provide the insurance as stated in this Policy. <br />Policy No.: <br />Named Insured: <br />Address: <br />Policy period: <br />Form of Business: <br />Each Occurrence Limit: <br />At 12:01 A.M. (Standard Time) at the address shown above. <br />Damage to Premises Rented to You Limit: <br />Medical Expense Limit: <br />Personal &Advertising Injury Limit: <br />General Aggregate Limit <br />Products/Completed Operations <br />Aggregate Limit: <br />Supplemental Business Personal Property <br />Floater Coverage Limit: <br />Supplemental Business Personal Property <br />Floater Coverage Deductible: <br />All Premises You Own, Rent or Occupy <br />Premises Number: <br />Individual/Sole Proprietor <br />Is 1,000,000 <br />$ 100,000 Any one premises <br />$ 5,000 Any one person <br />$ 1,000,000 Any one person or organization <br />$ 2,000,000 <br />Products -completed operations are subject to the General Aggregate <br />Limit <br />$ 5,000 <br />$ 500 <br />Address: 9519 W Olympic Blvd <br />Beverly Hills, CA 90212 <br />Total Premium: 1$470.00 <br />Attachments: I See attached Forms and Endorsements Schedule. <br />CGL D001 01 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 1 YI <br />its permission. © ISO Properties, Inc., 2000 <br />