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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SUPPLEMENTAL SCHEDULE <br />Policy Number: PHPK2635616 <br />Agent # 127479 <br />Rates <br />Advance Premiums <br />Premium <br />Prem./ Prod./ <br />Prem./ Prod./ <br />Classifications Code No. <br />Basis <br />O s. Comp. O s. <br />O s. Comp. O s. <br />CA PREM NO. 001 <br />HOTEL/MOTEL-W/POOL-<4 STORY 45190 <br />1 <br />5507.922 <br />INCL <br />5,618 <br />INCL <br />FLAT CHARGE <br />PROD/COMP OP SUBJ TO <br />GEN AGG LIMIT <br />CA PREM NO. 001 <br />HALL -FP 44276 <br />17,714 <br />319.346 <br />INCL <br />5,770 <br />INCL <br />AREA <br />PROD/COMP OP SUBJ TO <br />GEN AGG LIMIT <br />CA PREM NO. 001 <br />PARK/PLAYGROUND 46671 <br />5 <br />91.948 <br />INCL <br />469 <br />INCL <br />PARK/PLAYGR <br />PROD/COMP OP SUBJ TO <br />GEN AGG LIMIT <br />CA <br />COMMUNICABLE DISEASE EXCLUSION CREDIT 44444 <br />-10 <br />CA <br />LIMITATION OF COV DESIGNATED ACTIVITIES <br />INCL <br />CA 1 50 <br />ADDITIONAL INSURED 44444 1 FLAT CHARGE <br />Risk MougmumtDMsian <br />REVIEWED & APPROVED BY. <br />® Risk Management Specialist <br />