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Northfield Insurance Company COMMERCIAL GENERAL LIABILITY <br />St. Paul, MN 55102 COVERAGE PART DECLARATIONS <br />I:ffective Date: 0 3/ 2 7/ 2 0 07 12:01 A.M. at your mailing address Policy No: WS 0 0119 5 <br />Idamed insured: <br />13eau Negrete DBA K& B Lawn Care <br />I_IMITS OF INSURANCE <br />Each Occurrence Limit <br />$ 300, 000 <br />Damage To Premises Rented To You Limit <br />$ 10 0, 0 0 0 Any One Premises <br />Medical Expense Limit <br />5~0 0 0 Any One Person <br />Personal and Advertising Injury Limit <br />$ 3 00 , 0 0 0 Any One Person or Organization <br />General Aggregate Limit <br />600~000 <br />Products/Completed Operations Aggregate Limit <br />$ 600, 000 <br />13USINES5 INFORMATION <br />Form of Business: FX~ Individual ❑ Joint Venture <br />❑ Partnership ❑ Limited Liability Company ❑ Trust <br />❑ Organization, including a Cor <br />poration (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 <br />Hugo OK 74743 <br />'REMIUM <br />Rate Advance Premium <br />Loc. <br /># Classification Code No. <br />Premium Base Pr/CO All Other Pr/CO All Other <br />1 Landscape Gardening. - 97047 <br />p+ 17,000 27.079 $ .oo $ 460.00 <br />Products-completed operacions are <br />subject co General Aggregate Limit. <br />Subline Premiums s .00 $ 460. o0 <br />Total Advance Premium $ 460.00 <br /> <br />=ORMS AND ENDORSEMENTS <br />The schedule of coverage declarations, forms and endorsements shown on S1 D-ILS make up your policy as of <br />he effective date shown above. <br />THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE <br />FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. <br />S2584D-CG (9/05) Includes copyrighted material of insurance Services Office, Inc., with its permission. Page 1 of 2 <br />