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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />Policy Number:PHPK75��84 -00� <br />� See Supplemental Schedule <br />Agent #:6039 <br />LIMITS OF INSURANCE <br />G <br />$3,000,000 <br />General Aggregate Limit (Other Than Products — Completed Operation) <br />$3,000,000 <br />Products /Completed Operations Aggregate Limit (Any One Person Or Organization) <br />$'1,000,000 <br />Personal and Advertising Injury Limit <br />$'1,000,000 <br />Each Occurrence Limit <br />$'100,000 <br />Rented To You Limit <br />$2,500 <br />Medical Expense Limit (Any One Person) <br />FORM OF BUSINESS:Individual <br />Business Description: Fitness Trainer <br />Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED <br />AUDIT PERIOD, ANNUAL, UNLESS <br />OTHERISE <br />STATED: <br />Rates <br />Advance Premiums <br />Premium <br />Prod./ <br />Prod./ <br />Classifications <br />Basis <br />Prem. /O s. Com _ O s. <br />Prem. /O s. Com _ O s. <br />SEE SCHEDULE ATTACHED <br />TOTAL PREMIUM FOR THIS COVERAGE PART- $� 22-00 Included <br />Retroactive Date(CG 00 02 Only) <br />This insurance does not apply to "Bodily Injury ", "Property Damage ", or "Personal and Advertising Injury" which occurs before the <br />retroactive date, if any, shown below. <br />Retroactive Date: <br />FORMS) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule <br />Countersignature Date Authorized Representative <br />Page � of 1 <br />C <br />