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<br />SSI DEC 01 00 0123 2 of 5 <br />A MINIMUM AND DEPOSIT PREMIUM IS INDICATED FOR THE COVERAGE PROVIDED BY THIS POLICY. MINIMUM <br />AND DEPOSIT PREMIUM SHALL BE DEFINED AS THE PREMIUM AMOUNT DUE AT THE INCEPTION OF THE POLICY. <br />EVEN THOUGH THE POLICY IS “RATABLE” (SUBJECT TO ADJUSTMENT BASED ON RATE PER SALES), UNDER NO <br />CIRCUMSTANCES WILL THE ANNUAL EARNED PREMIUM BE LESS THAN THE MINIMUM PREMIUM, OR A RETURN <br />PREMIUM BE GENERATED. THIS POLICY IS SUBJECT TO AUDIT. <br /> <br />DESCRIPTION OF OPERATIONS / CLASSIFICATION - Per Application <br />DAMAGES RESULTING FROM WORK OR OPERATIONS WHICH ARE NOT SPECIFIC AND CUSTOMARY TO THE <br />DESCRIPTION OF OPERATIONS LISTED ON THE APPLICATION OR CLASSIFICATION SHOWN, OR OTHERWISE LISTED IN <br />THE APPLICATION USED TO BIND, ARE NOT COVERED ON THIS POLICY. <br /> <br />GENERAL LIABILITY COVERAGES LIMITS OF INSURANCE <br />GENERAL AGGREGATE LIMIT (Other than Products-Completed Operations) <br />PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT <br />PERSONAL/ADVERTISING INJURY LIMIT <br />EACH OCCURRENCE LIMIT <br />DAMAGE TO PREMISES RENTED TO YOU LIMIT <br />MEDICAL EXPENSE LIMIT <br />SELF-INSURED RETENTION (Per-Occurrence) <br />INDEPENDENT CONTRACTORS/SUBCONTRACTORS SUBLIMIT $50,000 <br /> <br />COVERAGE PART MINIMUM & DEPOSIT PREMIUM <br />Premium <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />POLICY FORMS <br /> <br />COMMERCIAL GENERAL LIABILITY POLICY DECLARATIONS - FORM SSI DEC 01 00 0123 <br />MANUSCRIPT COMMERCIAL GENERAL LIABILITY COVERAGE FORM - SSI GL 01 00 0123 <br /> <br />POLICY ENDORSEMENTS - SEE LIST OF STANDARD ENDORSEMENTS BELOW, AND THE SCHEDULE OF <br />ADDITIONAL ENDORSEMENTS MADE PART OF THIS POLICY. <br /> <br />NOTE THE FOREGOING POLICY FORMS ARE SUBJECT TO EXCLUSIONS, CONDITIONS, <br />ENDORSEMENTS, SUBLIMITS AND TERMS THAT MAY DELETE, MODIFY OR EXPAND THE COVERAGE <br />PROVISIONS STATED ELSEWHERE IN THE POLICY. PLEASE CONSULT AND REVIEW YOUR POLICY <br />CAREFULLY. <br /> <br /> <br />$5,000 <br />$1,000 <br />$4,480.18 <br />$1,000,000 <br />$1,000,000 <br />Surplus Lines Tax <br />Stamping Tax <br />$50,000 <br />$134.41 <br />$8.06 <br />$2,000,000 <br />$2,000,000 <br />Docusign Envelope ID: C32ED128-E8C0-4517-B42B-471D21968944