Laserfiche WebLink
CPD -PIIC (01/07) <br />Philadelphia Indemnity Insurance Company <br />One Bala Plaza, Sutte 100, Bala Cynwyd, Pennsylvania 19004 <br />COMMON POLICY DECLARATFONS <br />Policy Number: PHPK803569 -001 <br />Named Insured and Malling Address: <br />Chihiro Sano <br />106 Yorktown Ln <br />Costa Mesa, CA 92626- <br />Policy Period From: 1 2/0 812 0 1 2 To: 12!08/2013 <br />Business DescNptlon: FFtness Trainer <br />Producer: 6039 <br />Maguire Insurance Agency, Inc. <br />27101 Puerta Real Suite 200 <br />MissFon Viejo, CA 92691- <br />at 12:01 AM. Standard Tfine al your malting <br />addrosa atwwn above <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE <br />AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />TFi1S POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A Pf2EM1UM IS FNDICATED. THIS <br />PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br />PREMIUM <br />Commerdal Property Coverage Part <br />Commercial General Liability Coverage Part <br />Comrnerdal Crime Coverage Part <br />Commerdal Inland Marine Coverage Part <br />Commerdal Auto Coverage Part <br />Commerdal Stop Gap Part <br />Buslnessowners <br />Workers Compensation <br />S 182.00 <br />Taxes/Fees/Swcharges X50.00 <br />Total x232 00 <br />FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE <br />Refer To Forms Schedule <br />'Omits applicable Forms and Endorsements If shown in spedfic Coverage Part/Coverage Form Dadarations <br />Countersignature Date <br />Authorized Representative <br />