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Philadelphia Lndemnity Insurance Company <br />One Bala Ptaza. Suite 100, Bala Cynwyd, Pennsylvania 19004 <br />COMMON POLICY DECLARATIONS <br />Policy Numt�r: PHPK445ti57 <br />Named Insured and Maiiing Address: Producer: <br />Body by BootCamp Unassigned (SB), 6039 <br />99i2 Colony Grows Lane 26300 LA LALMEDA <br />Villa Park, CA, 02861 STE 480 <br />MISSION VIEJO, CA, 92891. <br />P41icy PerlDd Front: 70: at 721 A.M. Standard Tlma at your ma0ing address <br />09ro1 /loos 09ro'flzD10 °'1ON1n abOY�. <br />Business Description: Pansonai Training Studio <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, <br />WE AGREE WITH YOU TO PROVIDE THE. INSURA1VCi= AS STATED IN THIS POLICZ'- <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. <br />THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br />PREMIUM <br />__- .__.---- Gommerc:al -Pcoi : erty-- Coverage - Part _.-_._ -..._ _.._. -.._ ..___. -. —_- __.___..._ _.._._.._... <br />Commercial Genarel Llabiiity Coverage Part $385.00 <br />Commercial Crime Coverage Part <br />Commercial Inland Marine Coverage Part <br />COmmerClal Auto Coverage Part <br />BUSIRBSSOVYners <br />Workers Compensation <br />Stop Oap Coverage Part <br />Taxes! Feas/SUrcfiarges $100.00 <br />Total $495.00 <br />FORt111 (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF l8SUE <br />Rafar To Forms Schedule . <br />'Omits appiicebla Forma and Endoraemenia if atroWn In apedtb Coverage Par✓Covar+a9e Form Deefsratbna <br />Countersignature Date Authorized Representative <br />SOO /i001�i %V3 SS:Li BOOZ /C► /OT <br />