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* S9 * 06/11/2021 * GLP 3961460 00 GREAT AMERICAN ASSURANCE COMPANY <br />*D/B* 072977484 262428 <br />CG 74 00 (Ed. 07/01) <br />Policy No. GLP 3961460 00 <br />GENERAL LIABILITY COVERAGE PART <br />DECLARATION PAGE <br />NAMED INSURED: BACKHAUS DANCE POLICY PERIOD: <br />06/03/2021 to 06/03/2022 <br />LIMITS OF INSURANCE: <br />General Aggregate Limit <br />(Other Than Products - Completed Operations) <br />$ <br />2,000,000 <br />Products - Completed Operations Aggregate Limit <br />$ <br />2,000,000 <br />Personal and Advertising Injury Limit <br />$ <br />1,000,000 <br />Each Occurrence Limit <br />$ <br />1,000,000 <br />Damage to Premises Rented to You Limit <br />$ <br />100,000 Any One Premises <br />Medical Expense Limit <br />$ <br />5,000 Any One Person <br />FORM OF BUSINESS: NOT FOR PROFIT ORGANIZATION <br />TOTAL ESTIMATED PREMIUM: $ 2,837.00 <br />Products/Completed Operations All Other <br />$ $ 2,837.00 <br />SCHEDULE OF LOCATIONS <br />Location: 0001 Building: 0001 <br />P. 0. BOX 5890 <br />ORANGE, CA 92863 <br />CODE NUMBER: 01211 PREMIUM BASIS: MANUAL RATED - NON -AUDIT <br />Classification: SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT <br />Products/Completed Operations <br />EXPOSURE: <br />RATE: <br />PREMIUM: $0.00 <br />All Other <br />EXPOSURE: IF ANY <br />RATE: <br />PREMIUM: $165.00 <br />CG 74 00 (Ed. 07/01) (Page 1 of 2) <br />�oRaN <br />} z <br />a <br />RiskMmWmentDMsian <br />REVIEWED & APPROVED BY.- <br />p R. vj&wd <br />Risk Management Analyst <br />