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NEW HAMPSHIRE INSURANCE COMPANY <br />INSURED COPY <br />70 Pine Street. New York. NY 10270 <br />617 330-1100 <br />COMMERCIAL GENERAL LIABILITY CERTIFICATE-OCCURENCE FORM <br />) FEOTEDOTHOUGH R-PROFITACORPORATION,&LOCATEDSANDaDOMICILEDlIN1THElity STATEuOFhasing ILLINOISGroup <br />� N <br />Client#009585/PPA-G <br />Policy/Certificate No: O1 -LX -0964079/ RGL-7242632-03 New Renewal X <br />Issue Date: 08/13/09 <br />Named Insured: SPENCER GRANT <br />Address: C/O SPENCER GRANT CbSA <br />31512 FLYING CLOUD DRIVE <br />LAGUNA NIGUEL, CA 92677-2711 N-2009-148 <br />Business of Insured: PHOTOGRAPHY <br />Policy Period: From: 09/01/2009 To: 09/01/2010 12:01 a.m. Standard Time <br />COVERAGES AND LIMITS OF INSURANCE <br />IN RETURN FOR THE PAYMENT OF PREMIUM INDICATED BELOW, WE AGREE WITH YOU TO <br />PROVIDE THE FOLLOWING COVERAGES, AT THE LIMITS SHOWN. SUBJECT TO ALL THE TERMS <br />AND CONDITIONS OF THE POLICY. <br />COVERAGES <br />LIMITS <br />Commercial General Liability <br />General Aggregate (Other than Products/ <br />Completed Operations) <br />$ 2,000,000 <br />Products/Completed Operations Aggregate Limit <br />$ 1,000,000 <br />Each Occurrence Limit <br />$ 1,000,000 <br />Fire Damage Limit (Any one Fire) <br />$ 100,000 <br />Medical Expense Limit <br />$ 10,000 <br />$ 1,000,000 Each Accident <br />Non -Owned Auto Liability <br />$ 1,000,000 Each Accident <br />Rented Auto Liability <br />Premium $320.50 <br />Terrorism Included No charge <br />Total Advance Premium $320.50 <br />FORMS AND ENDORSEMENTS ATTACHED TO THE POLICY AT INCEPTION <br />CG00011001, IL00171198, CG20110196, CG214607981 CG21470798 <br />CG00570999, IL00210702, 68704(8/97), 96556(2/08) <br />IL0270702 <br />91222(7/06), 78711(02/09) ApPROV ED AS TO 'FORM <br />C- " - <br />MARSH Affinity Group Services _ Teresa d <br />` <br />a service of Seabury & Smith, Inc. Deputy City Attorney <br />12421 Meredith Dr <br />Urbandale, IA 50398 <br />1-800-588-7518 <br />