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Northfield Insurance Company COMMERCIAL GENERAL LIABILITY St. Paul, iVIN 55102 COVERAGE PART DECLARATIONS <br />, <br />I:ffective Date: 0 3/ 2 7/ 2 0 07 12:01 A.M. at your mailing address Policy No: W S 0 0119 5 <br />IJamed Insured: <br />13eau Negrete DBA K& B Lawn Care <br />i_IMITS OF INSURANCE <br />Each Occurrence Limit $ 300, 000 <br />Damage To Premises Rented To You Limit $ 10 0, 0 0 Any One Premises <br />Medical Expense Limit _5,_0 0 0 Any One Person <br />Personal and Advertising Injury Limit $ 3 0 0, 0 0 0 Any One Person or Organization <br />General Aggregate Limit 600 , 000_ <br />Prod ucts/Com pleted Operations Aggregate Limit $ 600 . 000 <br />13USINESS INFORMATION <br />Form of Business: []X Individual ❑ Joint Venture ❑ Partnership ❑ Limited Liability Company ❑ Trust <br />❑ Organization, including a Corporation (but not including a partnership, joint venture, trust or <br />limited liability company.) <br />Loc. # Address of All Premises (Including Zip Code) That You Own, Rent or Occupy <br />1 309 1/2 E Main Hugo OK 74743 <br />DREMIUM Rate Advance Premium <br />Loc. <br /># Classifcation Code No. Premium Base Pr/C0 All Other Pr/CO A~I t er <br />97047 p+ 17,000 27.079 $ .00 $ 460.00 <br />1 Landscape Gardening. - <br />Products-completed operacione are <br />eubject co General Ag9regate Limic. <br />Subline Premiums $ .00 $ 460. o0 <br />Total Advance Premium $ 460.00 <br />=ORMS AND ENDORSEMENTS <br />'the schedule of coverage declarations, forms and endorsements shown on S1D-ILS make uP Your PolicY as of <br />he effective date shown above. <br />THESE DECLA <br />ORM(S,AND FORMS AND OENDO SEMENTS,EF NYA SISUED TO FORM A ART HEREOF, COMPLETE T~ EOABOVE NUMBERED POLICYVERAGE <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 <br />S2584D-CG (9/05) <br />_r__ <br />