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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />Policy Number: PHPK829334 <br />® See Supplemental Schedule <br />Agent# 25656 <br />uMi i S UF- INSURANCE -- <br />$ 4, 000, 000 General Aggregate Limit (Other Than Products — Completed Operations) <br />$ 4 , 0 00 , 0 0 o Products /Completed Operations Aggregate Limit (Any One Person Or Organization) <br />$ 2, 000, 000 Personal and Advertising Injury Limit <br />$ z, o 0 0, o 0 o Each Occurrence Limit <br />$ loo , 0 0 o Rented To You Limif <br />$ _ o Medical Expense Limit (Any One Person) <br />FORM OF BUSINESS: CORPORATION <br />Business Description: For Profit Social Service Corporation <br />Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED <br />AUDIT PERIOD, ANNUAL, UNLESS OTHERWISE STATED: N/A <br />Claasificatlorts Coda No. <br />Premium <br />Basis <br />Rates <br />Prem./ Prod./ <br />O Com . O <br />Advance Premiums <br />Pram./ Prod) <br />O Com . O <br />SEE SCHEDULE ATTACHED <br />TOTAL PREMIUM FOR THIS COVERAGE PART: <br />§ i7,sai.00 <br />i <br />RETROACTIVE DATE (CG 00 02 ONLY) <br />This insurance does not apply to "Bodily Injury ", "Property Damage ", or "Personal and Advertising Injury" which <br />occurs before the retroactive date, if any, shown below. <br />Retroactive Date: <br />FORM (S) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule <br />Countersignature Date Authorized Representative <br />