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Policy Number <br />DECLARATIONS PAGE AMENDED JUN 23 2007 <br />92-GA-8133-8 STATE FARM GENERAL INSURANCE COMPANY O <br />9000LD RIVER RD, BAKERSFIELD CA 93311-6000 <br />A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />23-8821-F790 S <br />BUSINESS POLICY - SPECIAL FORM 3 <br />Named Insured and Mailing Address <br />GEORGE, MARIE <br />DBA ACT ONE ACADEMY OF DANCE <br />1186 N TUSTIN AVE <br />ORANGE CA 92867-6006 <br />Cov A: Inflation Coverage index: NIA <br />Cov B - Consumer Price -Index: 203.9 <br />AUTOMATIC RENEWAL -If the POLICY PERIOD is shown as 12 MONTHS, this pol' will be renewed automatically <br />subject to the remiums, rules and forms in effect for each P ceeding_policy pew In . If, t!1is P requlreld by law. a will <br />give you and tie Mortgagee/Lienhol er written notice in com Nance wi the Pa <br />Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the <br />Effective Date: JUN 23 2007 premises location. <br />Expiration Date: JUN 23 2008 <br />Location of Covered Premises: <br />1186 N TUSTIN AVE <br />ORANGE CA 92867-6006 <br />Coverages & Property <br />Section I <br />A Buildings <br />B Business Personal Property <br />C Loss of Income - 12 Months <br />Section II <br />L Business Liability <br />M Medical Payments <br />Products -Completed Operations <br />(PCO) Aggregate <br />General Aggregate (Other <br />Than PCO) <br />and Endorsements <br />Special Form 3 <br />'Section II Additional Insured <br />Amendatory Endorsement <br />Debris Removal Endorsement <br />Policy Endorsement <br />Business Policy Endorsement <br />Glass Deductible - Section I <br />New Form Attached <br />Limits of Insurance <br />Excluded <br />$ 5 800 <br />$ Actual Iloss <br />1,000,000 <br />5,000 <br />2,000,000 <br />2,000,000 <br />FP-6143 <br />FE-6609 <br />FE-6205 <br />FE-6451 <br />FE-6506.2 <br />FE-6464 <br />FE-6538.1 <br />Your policy is amended JUN 23 2007 <br />ADDL INSURED NAME & ADDRESS ADDED <br />ENDORSEMENT FE-6609 ADDED <br />Deductibles - Section I <br />500 Basic <br />In case of loss under this policy, the deductible will be <br />applied to each occurrence and will be deducted from the <br />amount of the loss. Other deductibles may apply - refer to <br />Endorsement Premium <br />Increase $ 120.00 <br />Discounts Applied:,' <br />Renewal Year <br />Years in Business l <br />Claim Record <br />Continued on Reverse Side of Page <br />OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY <br />Prepared Countelsigned_ <br />JUL 06 2007 <br />FP-8030.2C A3TN By. <br />06/1993 CHARLENE HATAKEYAMA <br />Your policy consists of this page, any endorsements (714) 527.8897 <br />and the policy form. PLEASE KEEP THESE TOGETHER. <br />d a7 <br />Agent <br />(0112172b) <br />