Laserfiche WebLink
NEW United States Liability Insurance Company <br />Renewal of Number 1190 Devon Park Drive, Wayne, Pennsylvania 19087 <br />POLICY DECLARATIONS A Member Company of United States Liability Insurance Group <br />No. XL 1629428 <br />ACTIVE LEARNING BELIEVE AND INSPIRE <br />14 SURFSIDE CT <br />NEWPORT BEACH, CA 92663 <br />POLICY PERIOD: (MO. DAY YR.) From: 07/07/2022 To: 07/07/2023 <br />FORM OF BUSINESS: Non Profit Organization <br />12:01 A.M. STANDARD TIME AT YOUR <br />MAILING ADDRESS SHOWN ABOVE <br />IN RETURN FOR THE PAYMENT OF • SUBJECT TO ALL THE TERMS OF • <br />WITH YOU • PROVIDE <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. <br />THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br />PREMIUM <br />Excess Liability Coverage $1,060.00 <br />Wholesaler Broker Fee $175.00 <br />TOTAL: $1,235.00 <br />Coverage Form(s) and Endorsement(s) made a part of this policy at time of issue <br />See Endorsement EOD (1/95) <br />Agent: R.E. CHAIX & ASSOCIATES INSURANCE BROKERS (1786) Issued: 07/14/2022 11:58 AM <br />3200 El Camino Real, #290 <br />Irvine, CA 92602 <br />Broker: <br />By: Authorized Represe ati e <br />THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVER <br />UPD -- <br />( ) COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, IS 08-07 COMPLETE THE ABOVE NUMBERED POLICY. Reny &��„ <br />: A+& . Auvut• <br />_`. %z <br />Risk Management Sped Mis[ - <br />