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Capitol Specialty Insurance Corp <br />P.O. Box 5900 Madison, WI 53705 <br />COMMERCIAL GENERAL LIABILITY <br />COVERAGE PART FORM SCHEDULE <br />POLICY NUMBER POLICY PERIOD AGENCY <br />BR01292559 <br />03/26/2009 03/26/2010 <br />04608 <br />NAMED INSURED AND ADDRESS AGENT <br />EARTHTECK IN'I.'ERNATIOusr• CORP <br />PO Box 48259 BASS UNDERWRITERS INC <br />Los Angeles, CA 90048-0259 <br />(Los Aaqeles CTY) <br />Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: <br />FORM3 APPLICABLE TO ALL PREt~3E3 ArID COVERAC}ES <br />Form Edition Description <br />CICL 042 0708 Cameral Liability Declarations <br />CICL 043 0608 C~eaeral Liability Schedule <br />CC3 03 00 0196 Deductible Liability 2asuraace <br />CCa 20 10 0704 Addl Ins-Owners, Lessees or Contractors - Scheduled <br />CC~L 344 0106 Amendment of Other 2asurance Coad Primary Add'1 Ias <br />Ca 00 O1 1207 Co~mmnercial Cleaeral Liability Coverage Form <br />Ca 21 50 0989 Amendment of Liquor Liability Exclusion <br />Ca 21 60 0998 Excl-Year 2000 Computer-Related and Other Elect Prob <br />Ca 21 70 0108 Cap on Losses frown Certified Acts of Terrorism <br />Ca 21 76 0108 Excl of Punitive Damages Certified Acts of Terrorism <br />CC3L 288 0803 Amendment - Contractual Liability <br />CCU 292 0306 Co®biaatioa Endorsement 1 <br />CC3L 322 0404 Limitation Classification <br />CICL 044 (10-93) Insured Copy <br />