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COMMON POLICY DECLARATIONS <br />Policy Number <br />Renewal of SCOTTSDALE INSURANCE COMPANY" CLS1365346 <br />CLS12BS938 Home Office: <br />One Nationwide Plaza • Columbus, Ohio 43215 <br />Administrative Office: <br />8877 North Gainey Center Drive • Scottsdale, Arizona 85258 <br />1-8001123-7675 <br />A STOCK COMPANY <br />ITEM 1. Named Insured and Mailing Address _ <br />MATT -'E D WHITE <br />DBA: TINY TOT PRESCHOOL <br />3201 S. DEEGAN DRIVE <br />SANTA ANA, CA 92704 <br />Agent Name and Address <br />---CORD INSURANCE SERVICES <br />BOX 4485 <br />THOUSAND OAKS CA 91359.1485 Agent No.: 04 OAG Program No.: NONE <br />OE77960 <br />I ICy er10d 2/28/2007 To: 12/28/2008 Tenn: 366 DAYS <br />12:01 A.M., Standard Time at your mailing address. <br />o..�:...,« nnernnrinn nLV TARE <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) Premium <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 />$ NOT COVERED <br />$ NOT <br />COVERED <br />$ NOT <br />COVERED <br />$ NOT <br />COVERED <br />$ NOT <br />COVERED <br />$ NOT <br />COVERED <br />Total Policy Premium: $ 1 300,00 <br />3.125 TAX & FEES $ 40.63 <br />NO FLAT CANCELLATION <br />254 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: <br />SEE SCHEDULE OF FORMS AND ENDORSEMENTS <br />T <br />1 01.la.Ob <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 />opsdll. fap <br />- OPS -D-1 (12.00) INSURED <br />