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a <br /> f.. <br /> ESSEX INSURANCE COMPANY <br /> MAWL <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <` SUPPLEMENTAL DECLARATIONS <br /> These Supplemental Declarations form a part of policy number . 3 CK3 3 0 8 <br /> LIMITS OF INSURANCE <br /> General Aggregate Limit (other than Products/Completed Operations) $ 2 0 0 0 0 0 0 <br /> Products/Completed Operations Aggregate Limit $_ 100 0 0 0 00 <br /> Personal and Advertising Injury Limit $ 1 0 0 0 0 0 0 <br /> Each Occurrence Limit $ 1 0 0 0 0 0 0 <br /> Damage to Rented Premises Each Occurren e <br /> Medical Expense Limit $ 3 000 Any One Perso <br /> BUSINESS DESCRIPTION AND LOCATION OF PREMISES COVERED BY THIS POLICY <br /> Form of business: <br /> ❑ Individual ❑ Joint Venture ❑ Partnership ® Organization (other than Partnership or Joint Venture) <br /> Location of all premises you own, rent or occupy: 2145 14th Avenue Vero Beach , F1 3 2 9 6 0 <br /> PREMIUM <br /> Description of Hazards/ Rate Advance Premium <br /> Insured Classifications Code No. *Premium Basis PR Co All Other Pr Co All Other <br /> Camps - - not - for - profit Including Products & 41422 0 ) 200 Campers Incl Flat $ Incl $ 3 , 738 . 00 <br /> Completed Operations ( summer ) <br /> Camps - - not for profit Including Products & 41422 0 ) 60 Campers Inc ( Incl <br /> Completed Operations ( after - school program Incl Incl <br /> Exhibitions - - in buildings - other than 63217 0 ) 2 events Incl 172 . 5 Incl <br /> not - for - profit including products & 345 . 00 <br /> completed operations <br /> Additional insured per ME009 <br /> 144 . 00 <br /> TOTAL <br /> * (a) Area , (c) Total Cost, (m) Admission , (p) Payroll , (s) Gross Sales, (u) Units (o) Other ADVANCE <br /> PREMIUM $ 41227 . 00 <br /> FORMS AND ENDORSEMENTS other than applicable forms and endorsements shown elsewhere in thepolicy) <br /> Forms and endorsements applying to this Coverage Part and made part of this policy at time of issue : <br /> 011 - 1054 ( 04 - 00 ) , 011 - 1095 ( 07- 01 ) , ME - 001 ( 04 - 00 ) , ME - 001A ( 07- 01 ) , ME - 009 ( 04 - 99 ) , ME - 013 ( 05 <br />- 02 ) 8 ME - 024 ( 09 - 00 ) , <br /> ME - 026 ( 10 - 99 ) , ME - 030 ( 04 - 99 ) , ME - 048 ( 04 - 99 ) , ME - 064 ( 04 - 99 ) , ME - 143 ( 04 - 99 ) , ME - 170 ( 08 - 95 ) , <br /> ME - 235 ( 08 - 02 ) , <br /> CG 00 01 ( 07 - 98 ) , CG 21 69 ( 01 - 02 ) <br /> THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS , TOGETHER WITH THE COMMON POLICY <br /> CONDITIONS , COVERAGE FORM (S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. <br /> 011 - 1061 (8-02) <br /> INSURED <br />