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* S9 * 06/11/2021 * GLP 3961460 00 GREAT AMERICAN ASSURANCE COMPANY <br />*D/B* 072977484 262428 <br />IL 70 01 (Ed. 10/07) <br />Policy No. GLP 3961460 00 <br />Renewal Of <br />POLICY COMMON DECLARATIONS <br />VAMED INSURED BACKHAUS DANCE <br />%ND ADDRESS: P.O. BOX 5890 <br />ORANGE, CA 92863 <br />IN RETURN FOR PAYMENT OF THE PREMIUM, AGENT'S NAME AND ADDRESS: <br />AND SUBJECT TO ALL TERMS OF THIS POLICY, MAURY DONNELLY & PARR INC <br />WE AGREE WITH YOU TO PROVIDE THE 24 COMMERCE ST <br />INSURANCE AS STATED IN THIS POLICY. BALTIMORE, MD 21202 3208 <br />Insurance is afforded by the Company named below, a Capital Stock Corporation: <br />GREAT AMERICAN ASSURANCE COMPANY <br />'OLICY PERIOD: From 06/03/2021 To 06/03/2022 <br />12:01 A.M. Standard Time at the address of the Named Insured <br />This policy consists of the following Coverage Parts for which a premium is indicated. This premium may be subject to <br />adjustment. <br />Premium <br />Commercial Property <br />Commercial General Liability $ 3,625.00 <br />Commercial Crime and Fidelity <br />Commercial Inland Marine <br />Commercial Equipment Breakdown <br />Commercial Auto <br />Commercial Umbrella <br />FORMS AND ENDORSEMENTS applicable to <br />all Coverage Parts and made part of this <br />Policy at time of issue are listed on the <br />attached Forms and Endorsements Schedule <br />IL 88 01(11/85). <br />TOTAL $ 3,625.00 <br />POLICY ALTERNATE MAILING ADDRESS: <br />IL 70 01 (Ed. 10/07) (Page 1 of 1) <br />�oRaN <br />} z <br />a <br />RAMwaganadDMsiun <br />REVIEWED & APPROVED BY.- <br />p R. W&Wd <br />Risk Management Analyst <br />