# Comprehensive General Liability Insurance Coverage Schedule

**Policy No:** EA 86-63-700  
**Effective Date:** [Not specified]  
**Agency No.:** [Not specified]

## Location of All Premises Owned by, Rented to or Controlled Interest of Named Insured in Such Premises

- Enter "SAME" if same as Item 1 of Declarations.
- By the named insured: "OWNER", "GENERAL LESSEE" or "TENANT".
- Part occupied by named insured: [Not specified]

## As per Schedules in Company Files

### Description of Hazards
- **Premises—Operations**
  - **Code No.:** [Not specified]
  - **Premium Bases:**
    - (a) Area (sq. ft.)
    - (b) Frontage
    - (c) Rentable Area
  - **Rates:**
    - (a) Per 100 sq. ft. of Area
    - (b) Per $100 of Remuneration
  - **Advance Premiums:**
    - Body Injury
    - Property Damage

- **Escalators (Number at Premises):**
  - **Number Insured:** [Not specified]
  - **Per Landing:** [Not specified]

- **Independent Contractors**
  - **Cost:** Per $100 of Cost

- **Completed Operations**
  - **Receipts:**
    - (a) Per $1,000 of Receipts

- **Products**
  - **Sales:**
    - (b) Per $1,000 of Sales

## Total Advance Premium: $ [Not specified]

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

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**Z 007094**