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Renewal of <br />CLS12B5938 <br />V VI~~1•IVI. 1 VL~V ~ /LV V/~~v~~~v~•v <br />~~ SCOTTSDALE INSURANCE COMPANY® <br />Home Office: <br />One Nationwide Plaza Columbus, Ohio 43215 <br />Administrative Office: <br />8877 North Gainey Center Drive - Scottsdale, Arizona 85258 <br />1-800-423-7675 <br />A STOCK COMPANY <br />ITEM 1. Named Insured and Mailing Address <br />MATTIE D WHITE <br />DBA: TINY TOT PRESCHOOL <br />3201 S. DEEGAN DRIVE <br />SANTA ANA, CA 92704 <br />Policy Number <br />CLS1365346 <br />Agent Name and Address <br />ACCORD INSURANCE SERVICES <br />BOX 4485 <br />THOUSAND OAKS CA 91359-1485 Agent No.: 04 OAG Pfogram NO.: NONE <br />OE77960 <br />I _ _icy erlod 2/28/2007 To: 12/28/2008 Tenn: 366 DAYS <br />12:01 A.M., Standard Time at your mailing address. <br />J <br />J <br />Business Description: DAY CARE <br />In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the <br />insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. <br />Where no premium is shown, there is no coverage. This premium may be subject to adjustment. <br />Coverage Part(s) <br />Commercial General Liability Coverage Part <br />Commercial Property Coverage Part <br />Commercial Crime Coverage Part <br />Commercial Inland Marine Coverage Part <br />Commercial Auto {business Auto or Truckers} Coverage Part <br />Commercial Garage Coverage Part <br />Professional Liability Coverage Part <br /> <br />$ Premium <br />1,300 <br />$ _ <br />NOT COVERED <br />$ NOT COVERED <br />$ NOT COVERED <br />$ NOT COVERED <br />$ NOT COVERED <br />$ NOT COVERED <br /> <br />Total Policy Premium: $ 1, 300.00 <br />3.125% TAX & FEES $ 40.63 <br />NO FLAT CANCELLATION $ __ <br />25~ MINIMUM EARNED $ <br />PREMIUM $ <br />GRAND TOTAL $ _ 1,340.63 <br />Form(s) and Endorsement(s) made a part of this policy at time of issue: I <br />SEE SCHEDULE OF FORMS AND ENDORSEMENTS <br />T.CASTANEDA/MK <br />01.18.08 <br />THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH <br />THE COMMON POLICY CONDITIONS, COVERAGE PART{S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, <br />'• COMPLETE THE ABOVE NUMBERED POLICY. <br />INSURED opsdl i . f ap <br />- OPS-D-1 (12-00) <br />