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-)� SCOTTSDALE INSURANCE COMPANY' COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS Policy No. __cPs2sGL23o Effective Date 12:01 A.M., Standard Time Named Insured x>sA SaUaLAx pJ_&cTiME LE&R r*c _Agent No. Item 1. Limits of Insurance Coverage Limit of Liability Aggregate Limits of Liability Products/ Completed $_ 2,000,000_ Operations Aggregate General Aggregate (other than $___ 2 000 000 _ Products/Completed Operations) Coverage A - Bodily Injury and any one occurrence subject Property Damage Liability to the Products/Completed Operations and General $_�0001000__ Aggregate Limits of Liability anyone premises subject to the Coverage A occurrence and the General Aggregate Limits Damage to Premises Rented to You Limit $ 1001000of Liability Coverage B - Personal and any one person or organization Advertising Injury Liability subject to the General Aggregate $__�i 0001000 Limits of Liability Coverage C - Medical Payments any one person subject to the Coverage A occurrence and $ 5,000 the General Aggregate Limits Item 2. Description of Business Form of Business: ® Individual Cl Partnership ❑ Joint Venture ❑ Trust ❑ Limited Liability Company ❑ Organization including a corporation (other than Partnership, Joint Venture or LimilVd'lily Company) Location of All Premises You Own, Rent or Occupy: See Schedule of Locations Item 3. Forms and Endorsements Form(s) and Endorsement(s) made apart of this policy at time of issue: See Schedule of Forms and Endorsements Item 4. Premiums Coverage Part Premium: $ 1,920 Other Premium: $ Total Premium: $ 1, 920 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. CLS-SD-1 L (8-01) INSURED c l s ed11 g. f ap