**COMPREHENSIVE GENERAL LIABILITY INSURANCE**

**For attachment to Policy No. 32 78 678-00**

**ADDITIONAL DECLARATIONS**

- **Premises Information:**
  - Interest of named insured in such premises:
    - Owner
    - General Lessee
    - Tenant
    - Other

- **Part occupied by named insured:**
  - Enter below.

**The following discloses 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 coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such coverage shall be as stated herein, subject to all the terms of this policy having reference thereto.

| Coverages | Limits of Liability | Advance Premiums |
|-----------|---------------------|------------------|
| A—Bodily Injury Liability | $ | $ |
| B—Property Damage Liability | $ | $ |

**Form numbers of endorsements attached at issue:** $ | Total Advance Premium $ |

**General Liability Hazards**

| Description of Hazards | Code No. | Premium Bases | Rates | Advance Premiums |
|-------------------------|----------|---------------|-------|-------------------|
| Premises - Operations | AS PER SCHEDULES IN COMPANY FILES | | | IMCL. IMCL. |
| Escalators (Number at Premises) | Number Insured | Per Landing | | |
| Independent Contractors | AS PER SCHEDULES IN COMPANY FILES | Cost | Per $100 of Cost | IMCL. IMCL. |
| Completed Operations | AS PER SCHEDULES IN COMPANY FILES | (a) Receipts | (a) Per $1,000 of Receipts | IMCL. IMCL. |
| Products | AS PER SCHEDULES IN COMPANY FILES | (b) Sales | (b) Per $1,000 of Sales | IMCL. IMCL. |

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

**When used as a premium basis:**
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 on admission tickets, contracts, or otherwise.
2. "Cost" means the total cost to the named insured with respect to operations performed for the named insured during the policy period by independent contractors, including labor, materials, equipment furnished, or delivered for use in the performance of work, whether furnished by the owner, contractor, or subcontractor, including all fees, allowances, bonuses or commissions made, paid or due.
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 well as any amounts collected from the sale of goods or services, whether from sales of tangible personal property, broadcast or motion pictures, and includes taxes, other than 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 engaged in the operation of motor vehicles and co-drivers, subject to any overtime earnings or limitation of remuneration rule applicable in accordance with the manuals in use by the company.
5. "Sales" means the gross amount of money charged by the named insured or by others trading under his name for all goods and products sold or distributed during the policy period and charged during the policy period for installation, servicing or repair, and includes taxes, other than taxes which the named insured and such others collect as a separate item and remit directly to a governmental division.