# Comprehensive General Liability Insurance

**Coverage Part**

**Policy No.:** 69 06 923

**Location of all premises owned, rented to or controlled by the named insured:**

- Owner
- General Lessee
- Tenant
- Other

**Part occupied by named insured:**

The following disclosures all hazards insured hereunder known to exist at the effective date of this policy, unless otherwise stated herein.

**Schedule**

The insurance afforded is only with respect to such of the following described hazards as are included by endorsement or otherwise. The form of the company's liability assumed with respect to each hazard shall be as stated herein except to all hazards of this policy having reference thereto.

| Coverages | Limits of Liability |
|-----------|---------------------|
| A - Bodily Injury Liability | Each occurrence $ Aggregate $ Advance Premiums $ |
| B - Property Damage Liability | Each occurrence $ Aggregate $ Advance Premiums $ |

**Form numbers of endorsements attached at issue:**

**Total Advance Premium:**

**General Liability Policies**

| Description of Hazards | Code No. | Premium Basis | Rates | Advance Premiums |
|-------------------------|----------|---------------|-------|------------------|
| Premises - Operations    |          |               |       |                  |
| Independent Contractors |          |               |       |                  |
| Completed Operations     |          |               |       |                  |
| Products                 |          |               |       |                  |

**AS PER SCHEDULES IN COMPANY FILES**

**Escalators (Number of Premises):**

**Independent Contractors:**

**Completed Operations:**

**Products:**

**AS PER SCHEDULES IN COMPANY FILES**

**Total Advance B.I. and P.D. Premiums:**

**Words used in a given context:**

1. "Admissions" means the total number of persons, other than employees of the named insured, admitted to the event insured or to events conducted on the premises whether or not admission has been charged.
2. "Cost" means the cost incurred for each completed operation performed for the named insured during the policy period by independent contractors, including all work let or sublet in connection with such specific project, including the cost of all labor, materials and equipment furnished, used or delivered for use in the execution of such work, whether furnished by the owner, contractor, or subcontractor, or otherwise, and any overhead or general expenses allocable to such operations.
3. "Receipts" means the gross amount of money charged by the named insured for such operations by the named insured or by others during the policy period as specified in the schedules attached hereto, and includes taxes, other than the taxes which the named insured collects as a separate item and remits directly to a governmental division.
4. "Remuneration" means the entire remuneration earned during the policy period by proprietors and by all employees of the named insured, other than chauffeurs, drivers, and other employees who are paid by the hour, subject to any overtime earnings or limitation of remuneration rule applicable in accordance with the standards in use by the company.
5. "Taxes" means the gross amount of money charged by the named insured or by others, including under his name for all goods and products sold or distributed during the policy period, whether or not such goods or products are sold or distributed in the course of rendering services, but includes sales, other than the taxes when the named insured and such others collect as a separate item and remit directly to a governmental division.

**MM 009576**