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CT u. COMMERCIAL LINES COMBINATION POLICY DECLARATIONS <br />Lot, <br />/ Landmark American Insurance Company <br />(A New Hampshire Stock Co.) <br />(hereinafter called "the Company") <br />EXECUTIVE OFFICES: 945 East Paces Ferry Road, Suite 1800, Atlanta, GA 30326-1160 <br />Policy Number: LHC843766 <br />Named Insured and Mailing Address: <br />BAKER RESCUE SERVICES INC <br />19744 BEACH BLVD <br />SUITE 366 <br />HUNTINGTON BEACH, CA 92648 <br />RENEWAL OF: LHC840822 00 <br />Producer Name: <br />Policy Period: From: 8/3/2021 To: 8/3/2022 12:01 A.M. Standard Time at the Named Insured address as stated herein. <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 />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY <br />BE SUBJECT TO ADJUSTMENT. <br />Business Description: EMERGENCY FIRST AID RESCUE SERVICES <br />COVERAGE PARTS PREMIUM <br />Commercial General Liability <br />COMMERCIAL GENERAL LIABILITY COVERAGE FORM - $ Included <br />OCCURRENCE <br />Professional Liability <br />MEDICAL PROFESSIONAL LIABILITY COVERAGE PART CLAIMS $ Included <br />MADE AND REPORTED BASIS <br />Forms and Endorsements made a part of this policy at time of issue: Please see SCHEDULE OF ATTACHMENTS. <br />(Omits applicable forms and endorsements if shown in specific Coverage Form Declarations.) <br />THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS, IF <br />ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY <br />August 17, 2021 By: 4U <br />Date Authorized Representative <br />Declarations Page 1 of 2 SebldlD7k 235164 BlnderlDtt <br />RSG 50011 1020 w.tw tni. <br />°•tdD.ItJL Tau Pocumo <br />rusk M1laeu9eem+t Clmcal A l <br />