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<br />~ <br /> <br />Philadelphia Insurance Companies <br />One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 <br /> <br />Philadelphia Indemnity Insurance Company <br /> <br />COMMON POLICY DECLARATIONS <br /> <br />Policy Number: PHPK141731 <br /> <br />Named Insured and Mailing Address: <br />HOTUNE OF SOUTHERN CAUFORNIA <br />PO# 32 <br />LOS ALAMITOS, CA 90720 <br /> <br />Producer: 17921 <br />S.D. HINES INSURANCE SERVICES, INC <br />3580 E. PACIFIC COAST HIGHWAY, #8 <br />LONG BEACH, CA, 90804 <br /> <br />Policy Period From: 11/26/2005 To: 11/26/2006 <br /> <br />at 12:01 A.M. Standard lime at your mailing <br />address shown above. <br /> <br />Business Description: Non Profit Organization <br /> <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, \f\IE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br /> <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS <br />INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br /> <br />Commercial Property Coverage Part <br />Commercial General Liability Coverage Part <br /> <br />Commercial Crime Coverage Part <br /> <br />Commercial Inland Marine Coverage Part <br /> <br />Commercial Auto Coverage Part <br /> <br />Businessowners <br /> <br />Workers Compensation <br /> <br />PREMIUM <br />121.00 <br />163.00 <br /> <br />2,395.00 <br /> <br />Total <br /> <br />$ 2,679.00 <br /> <br />Total Includes Federal Terrorism Risk Insurance Act Coverage <br /> <br />7.00 <br /> <br />FORM (5) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE <br />Refer To Forms Schedule <br /> <br />'Om;ts_~FO"'''''_'_''-'''-agep'~n <br /> <br /> <br />Countersignature Date Authorized Representative <br />