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di MARKEL INSURANCE COMPANY <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />• DECLARATIONS <br />104 <br />R <br />POIICv No: MTK70002501-00 <br />Effective Date: 05/27/2013 <br />__A ­A Time <br />LIMITS OF INSURANCE <br />General Aggregate Limit (Other Than Products—Completed Operations) $2,000,000 <br />Products --Completed Operations Aggregate Limit $2,000,000 <br />Personal and Advertising Injury Limit $1,000,000 <br />Each Occurrence Limit $1,000,000 <br />Damage To Premises Rented To You Limit SEE MGL 1215 Any One Premises <br />Medical Expense Limit SEE MGL 1215 Any One Person <br />RETROACTIVE DATE G 00 02only) N/A IN §TATE OF NEW YORK <br />Coverage A of this Insurance does not apply to 'bodily injury' or 'property damage' which occurs before the Retroactive Date, if <br />any, shown here: <br />(Ener Date a'None' M no Retoacthre Date appees) <br />BUSINESS DESCRIPTION AND LOCATION OF PREMISES <br />Form of Business: Corporation <br />Business Description: Ambulance Service <br />Location of All Premises You Own, Rent or Occupy: <br />SEE ATTACHED "EXTENSION OF DECLARATIONS" <br />PREMIUM <br />Advance <br />Classification Code No. Premium Basis Rate Premium <br />SEE ATTACHED "EXTENSION OF DECLARATIONS" <br />Total Advance Premium: $12,379 <br />FORMS AND ENDORSEMENTS (otherthan applicable Forms and Endorsements shown elsewhere in the policy) <br />Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue: <br />SEE "SCHEDULE OF FORMS AND ENDORSEMENTS" <br />THESE DECLARATIONS TOGETHER WITH THE COMMON PO LICY CONDITIO NS, CO VERAGE PART DECLARATIONS, COVERAGE PART COVERAGE FORM(S) <br />AND FO RMS AND ENpORSEMENfS, IF ANY, ISSUED TO FORA A PARI THE REOR COMPLETE THE ABOVE NUMBERED POL ICY., <br />MD011 (9/99) Includes copyrighted material al Insurance Services Office, Inc., with it s permission. Page 1 of 4 <br />88 <br />