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07/28/2009 16:31 71A5278898 STATE 1=AF2M PACaE 02 <br />pECLARATIpN5 PAGE covERAGE suAAMARY , <br />Policy Number JUL 2d 2009 <br />82-t~A 8i33-8 STATE FAaM GENERAL INSURANCE COMPANY ""`" <br />900 OLD RIVER RD. BAKERSFtELD CA 93311.6044 <br />ASTOCK COMPANY Wli'H HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />Named Insured and Meiting23d8d82f F790 S <br />QEOFiQE, MARIE <br />D8A ACT ONE ACADEMY Of DANCE <br />1186 N TUSTIN AVE <br />ORANGE CA 92867-6006 <br />~2 00l - OGO, <br />~/t 0,2~ - C~ 3 <br />Cov A -Inflation Coveragge Index: NIA . <br />BU91NE95 POLICY - SPECIAL PORM S Cov B - Consumer Pricelndex: 220.0 <br />AUT4MATtC RENEWAI. - If the POLICY P1=R O~~fl Is showwnn as i2 ~nba~N~o~I! S, th s o 1 will be renewed aufomatical~Y <br />s b ect to the remtoms, ruled and fa rnwri~te ~notlcerln comS~i~@ce Iwmt the p~lia~ pro~is(onspo°rla r qu~rlej~~y~awe w tl <br />g~v~ you and tie [wortgapee~IL~enhatde P <br />Policy Period:, 12 Months em~sesYocat onbegtns and ends at 121 am standard time attlte <br />Effective Date. JUN z3 2009 P <br />Expiration Date: JUN 23 2010 <br />Named Insured: (ndiv uet Requested i3y: Actd$fonel Insured <br />Location of Covered Premis®a: <br />11$6 N TIJSTiN AVE <br />ORANGE GA 92867.6008 <br />Coverages & Properly <br />Section l <br />A Buildings <br />H Business Personal Property <br />C LOSS Of lnoorrr9 - 12 MOrtthS <br />Seotion If <br />L 8uslness Ltabllily <br />M Medical Payments <br />Products-Completed Operetians <br />(PCO) Aggregate <br />General Aqgg regate (Other <br />7nan PCi:?~) <br />Limits of Insaranoe <br />Ex~Olu300 <br />Actual doss <br />1,D0~~~~~ <br />2,000, <br />2,000,OOQ <br />Forms options, and Endorsementg <br />Sp®cia~ Form 3 <br />FP-6143 <br />Amendatory Endorsemr~nt FE-8205 <br />Debris Removal Endorsement FE-6451 <br />Policy Endorsement FE-6508.2 <br />Business Policy Endorsement FE-64fi4 <br />glass Deductible - S9ctfon [ FE-6638.1 <br />Terrorism Insurance Cov Notice i=E-6999.1 <br />Deductibles - 9eotioe r <br />600 Basic <br />In case of toss under this policy the deductible will be <br />applied to each occurrenoe and will be deducted from the <br />amount of the Ioes. Outer deduotlbies may apply -refer to <br />policy Premium <br />Discounts ApAlted: <br />Renewal Year <br />Years in Business <br />Cfalrtl Reoord <br />Continued en Reverse Side of Page i <br />Prepared OTHER LIMITS AtdO 1:xCLi1810NS MAY APPLY- RHEA <br />JUL 20ggpp2008 Count atgned <br />0~8~93.2C CU7Q BY <br />Your afroy eonststs of this page,any ehdorsemanta CHARLENE HATAKEYAi <br />ahd the papcy torm. Pi.tcASfi KEEP THE.4E TOGIETNICR. (714) 827-8897 <br />,09D.0 <br />p0~ .~0 /~ <br />,~ <br />~_ Aaent <br />(0112 t7Rb} <br />