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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />Policy Number. PHPK141731 <br />® See Supplemental Schedule Agent # 17921 <br />LIMITS OF INSURANCE <br />$ 1, 0 00 , 0 0 o Genera! Aggregate Limit (Other Than Products -Completed Operations) <br />$ 1, ooo, ooo products/Completed Operations Aggregate Limit (Any One Person Or Organization) <br />$ z, 0 0 0, 0 0 o Personal and Advertising Injury Limit <br />$ z, o0 0 , o 0 o Each Occurrence Limit <br />$ zoo, ooo Damage To Premises Rented To You Limit (Any One Premises) <br />$ 5 , 0 0 o Medical nse Limit An One Person) <br />FORM OF BUSINESS: NON PROFIT ORGANIZA`fION <br />Business Description: Non Profit Organization <br />Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED <br />AUDIT PERIOD, ANNUAL, UNLESS OTHERWISE STATED: N/A <br />Rates Advance Premiums <br />'~~~~ Code No. P ~~ PremJ Prod./ PremJ Prod) <br />Com . O Com O <br />' 3's ~~,:;TJs;;...: ~ s~;c~%~ <br />SEE SCHEDULE ATTACHED > > <br />t,aL.t. <br />As~ista . ~i, <br />TOTAL PREMIUM FOR TH13 COVERAGE PART• <br />S 163 00 s <br />RETROACTIVE DATE (CG 00 02 ONLY) <br />This insurance does not apply to "Bodily Injury", "properly pamage", or "Personal and Advertising Injury" which <br />occurs before the retroactive date, if any, shown below. <br />Retroactive Date: <br />FORM (S)AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule <br />coura~ ~~ a,irw~zed Representative <br />