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Mutual Company <br />Nonassessabie <br />CHURCH MUTUAL INSURANCE COMPANY <br />3000 Schuster Lane, P.O. Box 357, Merrill WI 54452 <br />COMMON POLICY DECLARATIONS PAGE, <br />a <br />POLICY NO.: 0176846 -02- 822788 <br />ITEM 1. NAMED INSURED AND ADDRESS: <br />APOSTOLIC ASSEMBLY OF THE FAITH IN CHRIST JESUS <br />INC <br />308 N MAIN ST <br />SANTA ANA CA 92701 -4853 <br />ITEM 2. POLICY PERIOD: FROM 09/01/15 TO 09/01118 0176846 -02- 504901 <br />12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE (RENEWAL OF) <br />ITEM 3. THE NAMED INSURED IS: RELIGIOUS INSTITUTION <br />ITEM 4. AGENT: 75 -133 <br />CHURCH & CASUALTY INSURANCE AGENCY <br />3440 IRVINE AVE... SUITE 150 <br />NEWPORT BEACH CA 92660 <br />(800) 995 -7525 <br />ITEM 5. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS: <br />FORMS AND ENDORSEMENTS WHICH APPLY TO THIS ENTIRE POLICY: <br />A 050(01 -98) <br />MUTUAL AND COMMON POLICY CONDITIONS <br />A 051(06 -87) <br />CALCULATION OF PREMIUM <br />A 9009(01 -12) <br />CONDITIONAL EXCLUSION OF TERRORISM <br />A 936(10 -12) <br />CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL <br />UN 720(01 -08) <br />NOTICE - DISCLOSURE OF TERRORISM PREMIUM <br />PROPERTY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: <br />A 100(01 -01) <br />PROPERTY CONDITIONS <br />A 100.1(05 -03) <br />STATEMENT OF VALUES <br />A 1001(01 -08) <br />IDENTITY RECOVERY COVERAGE FORM <br />A 1009(11 -08) <br />WATER EXCLUSION ENDORSEMENT <br />A 101(04 -06) <br />BUILDING AND PERSONAL PROPERTY COVERAGE - RELIGIOUS <br />A 103.3(05 -03) <br />MARGIN CLAUSE ENDORSEMENT <br />A 109(06 -87) <br />CANCELLATION CHANGES <br />A 117.1(05 -89) <br />COVERAGE EXTENSIONS AND ADDITIONAL COVERAGES <br />A 127(04 -06) <br />CAUSES OF LOSS - SPECIAL FORM <br />A 138(01 -98) <br />LOSS PAYABLE PROVISIONS <br />A 150(06 -00) <br />TENTATIVE RATE <br />A 154(10 -99) <br />SYSTEMS /EQUIPMENT BREAKDOWN COVERAGE FORM <br />A 936.1(12 -05) <br />CALIFORNIA CHANGES - ACTUAL CASH VALUE <br />A 936.2(01 -04) <br />CALIFORNIA CHANGES <br />A 945.2(01 -08) <br />CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br />LMuUfru(ja'1. <br />A 001 CD(10 -99) -CA PAGE 1 ISSUED DATE: 08/20/15 <br />