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Pof►ay Number <br />92 -YG- 4106 -2 <br />DECLARATIONS PAGE AMENDED MAY 7 2010 <br />STATE FARM GENERAL INSURANCE COMPANY <br />900 OLD RIVER RD, BAKERSFIELD CA 93311 -6000 <br />A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />Named Insured and Malling Address <br />23- 8906 -F418 U <br />BFSG LLC <br />2040 MAIN ST STE 150 <br />IRVINE CA 92614 -8207 <br />5�� --vl te.s G roc. p <br />BUSINESS POLICY - SPECIAL FORM 3 <br />�j�os O/o - O 7S <br />Cov A - Inflation Coverage Index- N/A <br />Cov B - Consumer Price - Index: 220.0 <br />.UTOMATIC RENEWAL - If the POLICY PERIOD is shown as 72 MONTHS, this policyy will be renewed automatically <br />ubject to the premiums, rules and forms in effect for each succeedinq policy perio If fhis olicy is terminated, we wi l <br />ive you and the Mortgagee /Lienholder written notice In compliance wRh the policy provision�or as required by law. <br />'oliCy Period: i 2 Months The policy period begins and ends at 1 2:01 am standard time at the <br />affective Date: JUL 8 2010 premises location. <br />axplration Date: JUL 8 2011 <br />am <br />mpany <br />.ocation of Covered Premises: <br />?040 MAIN ST STE 150 <br />RVINE CA 92614 -8207 <br />:overages &Property <br />Section I <br />� Buildings <br />3 Business Personal Property <br />Loss of Income - 12 Months <br />Section II <br />_ Business Liability <br />JI Medical Payments <br />products- Completed Operations <br />(PCO) Aggregate <br />general Agggregate (Other <br />Than PCO) <br />Limits of Insurance <br />Excluded <br />$ 116,100 <br />$ Actual Loss <br />2,000,000 <br />5,000 <br />4,000,000 <br />$ 4,000,000 <br />°orms Options, and Endorsements <br />Special Form 3 <br />FP -6143 <br />Section II Additional Insured <br />FE -6609 <br />Business Policy Endorsement <br />FE -6464 <br />Amendatory Endorsement <br />FE -6205 <br />Debris Removal Endorsement <br />FE -6451 <br />Policy Endorsement <br />FE- 6506.2 <br />Glass Deductible - Section I <br />FE- 6538.1 <br />New Form Attached <br />Your policy is amended MAY 7 201 O <br />ADDITIONAL INSURED ADDED <br />PREMIUM ADJUSTMENT <br />ENDORSEMENT FE -6609 ADDED <br />Other items shown are effective <br />ccupancy: urrice <br />Deductibles - Section 1 <br />$ 1 ,000 Basic <br />In case of loss under this policy; the deductible will b. <br />applied to each occurrence and well be deducted from the <br />amount of the loss. Other deductibles may apply -refer t. <br />policy. <br />Endorsement Premium <br />Increase <br />Discounts Applied: <br />Renewal Year <br />Years in Business <br />Enclosed Building <br />Protective Devices <br />Sprinkler <br />Continued on Reverse <br />$ 46.80 <br />L ura Stit[ Sliced <br />-.. ,..pant City Atu rncti <br />: ontinued on Reverse Side of Page I <br />OTHER LIMITS AND EXCLUSIONS MAY APPLY -REFER TO YOUR POLICY <br />� repared `�_ � <br />tAY 18 201 O Countersigned 7— �v <br />P- 8030.2C LOCK BY �rxir�� -7� %G <br />6/1 993 KEN L OURE E CLU, CHFC <br />our policy consists of this page, any endorsements (71q) 5qq -3779 <br />nd the policy form_ PLEASE KEEP THESE TOGETHER_ <br />(o N2�7F <br />