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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />PoFicy Number:PHPK803569 -001 <br />See Supplemental Schedule <br />Agent #:6039 <br />LIMITS OF INSURANCE <br />G <br />53,000,000 <br />General Aggregate Limit (Other Than Products - Completed Operation) <br />53,000,000 <br />Products /Completed Operations Aggregate Limit (Any One Person Or Organization) <br />51,000,000 <br />Personal and Advertising Injury Limit <br />51,000,000 <br />Each Occurrence Limit <br />5100,000 <br />Rented To You Limit <br />52,500 <br />Medical Expense Limit (Any One Person) <br />FORM OF BUSINESS:Individual <br />Business Description :FFEness Tratrter <br />Location oT All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED <br />AUDIT PERIOD ANNUAL, UNLESS <br />OTHERWISE <br />STATED: <br />ClasslftpUorss <br />Promlum <br />Basis <br />Rates <br />Prod) <br />PremJO s. Com s. <br />Adwnce Prornlums <br />Prod) <br />PremJO s. Com s. <br />SEE SCHEDULE ATTACHED <br />TOTAL PREMIUM FOR THIS COVERAGE <br />PART: X182.00 t.,.w..ie.a <br />Retroactive Date(CG 00 02 Only) <br />This Msurance does not apply to "Bodily Injury ", "Property Damage ", or "Personal and Advertising Injury" which occurs before the <br />retroactive date, if any, shown beFOw. <br />Retroactive Date: <br />FORMS) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: S�Ter To Forms Schedule <br />Countersignature Data Authorized Representative <br />Page � oT 1 <br />