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Philadelphia indemnity Insurance Company <br />One Bala Pilaza, Suite, I Do, Bala Cynwyd, Pennsylvania 19004 <br />COMMON POLICY DECLARATIONS <br />Policy Number: PHPK1342298-000 <br />Named Insured and Mailing Address: Producer: 6039 <br />Marc Payan, dba WCCD, LLC. Maguire Insurance Agency, Inc. <br />59 Long Mdw 27101 Puerta Real Suite 200 <br />Irvine, CA 92520- Mission Viejo, CA 926'91- <br />Policy Period From: 05f28/2015 To: 05/28/2015 at 12:01 AM. Standard Time at your rnaiting <br />address shown above <br />Business Description: Fitness Trainer <br />Style/Art: Coach <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECTTO ALL THE TERMS OF THIS POLICY, WE <br />AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS <br />PREMIUM' MAY BE SUBJECT TO ADJUSTMENT. <br />PREMIUM <br />Commercial' Property Coverage Part <br />Commercial General Liability Coverage Part <br />$182.00 <br />Commercial Crime- Coverage Part <br />Cornmercial Inland Marine Coverage Part <br />Commercial Auto Coverage Part <br />Commercial Stop Gap Part <br />Businessowners <br />Workers Compensation <br />Taxes/Fees/Surcharges <br />$50.00 <br />Total $232.00 <br />FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE <br />Refer To Farms Schedule <br />*Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations <br />Countersignature Date Authorized Representative <br />