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07/28/2009 16:31 7145278898 STATE FARM PAGE 02 <br />DECLARATIONS PAGE COVERAGE SUMMARY <br />Policy Number JUL 20 2009 <br />82-CiA 8i33-8 WATE FARM GENERAL INSURANG6 COMPANY I ""4 <br />900 OLD RIVER RD, BAKERSFIELD CA 93311.6000 <br />ASTOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />Named Insured and Mailing23�ddrref F790 S <br />QEORGE, MARIE <br />DBA ACT ONE ACADEMY OF DANCE <br />1156 N TUSTIN AVE <br />ORANGE CA 92867-6006 <br />R 00l - OGO, <br />Cov A - Inflation Coveragge Index., N/A . <br />BUSINESS POLICY - SPECIAL FORM 3 Cov B - COASUMOt Prlcelndex: 220.0 <br />AUTOMATIC 14ENEWAL - If the POLICY PERIOD Is showwnn as 12 MON�I S, th s o iRWit be renewed autornaticall� <br />s b eat to the rem(urns, ruleq and fo rnwri�te noticerIn comS�i an @ce Iwmt the p�lia pro�is(ond or a10 r qu�rej y law. s w <br />give you and tie Mortgageell-ienholde P <br />Policy Period:12 Months The policy <br />pert onbegins and ends at 12�1 am standard time at the <br />Effective Date., JUN 23 2009 P <br />Expiration i?ate: JUN 23 2010 <br />Named Insured: Ind —Mal Requested By: Additional Insured <br />Location of Covered Premises: <br />1186 N TUSTIN AVE <br />ORANGE CA 92867.6006 <br />Coverages & Properly <br />Section I <br />A Buildings <br />H Business Personal Property <br />C Loss of income - 12 Months <br />Section II <br />L Business Liability <br />M Medical Payments <br />Produote-Completed Operations <br />(PCO) Aggregate <br />General Aqgg regate (Other <br />Than PCO3 <br />Limits of Insaranoe <br />Ex101u300 <br />Actual loss <br />1,9:��� <br />2,D0000, <br />2,000,000 <br />Forms Options, and Endorsements <br />Special Form 3 <br />FP-6143 <br />Amendatory Endorsement <br />F8-6205 <br />Debris Removal Endorsement <br />FE-6451 <br />Policy Endorsement <br />FE-6506.2 <br />Business Policy Endorsement <br />FE-6484 <br />Glass Deductible - Section I <br />FE-6638.1 <br />Terrorism insurance Cov Notice <br />FE-6999.1 <br />Deductibles - 9eo00111 I <br />600 Basic <br />in case of loss under this policy the deductible will be <br />applied to each occurrenoe and wfll be deducted from the <br />amount of the loss. Other deductibles may apply - refer to <br />Policy Premium <br />Discounts Applied: <br />Renewal Year <br />Years In Business <br />Claim Record <br />Continued on Reverse Side of Page i <br />Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY- REPER <br />JUL Prepared <br />Count signed <br />FP-8 <br />8j93.2C CUTO BY <br />Your oficyeonststs of this page, anyendomemants CHARLENE HATAKEYAi <br />and the policy form. PLEASIE KEEP THESE TOGETHER. (714) 827-8897 <br />,090.0 <br />p0 .X00 r <br />0-6- , Aaent <br />(0112 i7Rb) <br />