# Comprehensive General Liability Insurance

**Policy Number:** 32 78 678-00

## Additional Declarations

**Location of all premises owned by, rented to or controlled by the named insured:**
- Owner
- General Lessee
- Tenant
- Other

**Part occupied by named insured:**

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

## Schedule

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

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

**Total Advance Premium:** $ [Amount]

## General Liability Hazards

| Description of Hazards | Code No. | Premium Bases | Rates | Advance Premiums |
|------------------------|----------|---------------|-------|-------------------|
| Premises - Operations   |          |               |       |                   |
| AS PER SCHEDULES IN COMPANY FILES |          |               |       |                   |
| Escalators (Number at Premises) |          |               |       |                   |
| Independent Contractors |          | Cost          | Per $100 of Cost | INCL.             | INCL.             |
| Completed Operations    |          |               |       |                   |
| Products                 |          |               |       |                   |

## Definitions

1. **"admission"** 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.
2. **"cost"** means the total cost to the named insured with respect to services performed for the named insured during the policy period by independent contractors of all work let or sublet in connection with each specific project, including the cost of all labor, materials and equipment furnished or delivered in connection with such 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 remuneration on a basis other than receipts from telecasting, broadcasting 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 charges for the use or rental of mobile equipment by aircraft pilots and co-pilots, subject to any overtime earnings or limitation of remuneration rule applicable in accordance with the terms of 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.

**Total Advance B.I. and P.D. Premiums:** $ [Amount]