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' ESSEX INSURANCE COMPANY <br /> r ! <br /> MARKEL <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> SUPPLEMENTAL DECLARATIONS <br /> p, These Supplemental Declarations forma 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 $ 11000 , 000 <br /> Personal and Advertising Injury Limit $ 11000 , 000 <br /> Each Occurrence Limit $ 11 0 0 0 , 0 0 0 <br /> Damage to Rented Premises $ 501000 Each Occurrence <br /> Medical Expense Limit $ 1 , 0 0 0 Any One Perso <br /> BUSINESS DESCRIPTION AND LOCATION OF PREMISES COVERED BY THIS POLICY <br /> Form of business : <br /> El Individual O Joint Venture El Partnership ® Organization (other than Partnership or Joint Venture) <br /> Location of all premises you own, rent or occupy: 2145 14th Avenue Vero Beach , F1 32960 <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 Incl Incl Incl Incl <br /> Completed Operations ( after - school program <br /> Exhibitions - - in buildings - other than 63217 0 ) 2 events Incl 172 . 5 Incl 345 . 00 <br /> not - for - profit including products & <br /> completed operations <br /> Additional insured per ME009 144 . 00 <br /> TOTAL <br /> ADVANCE <br /> * (a) Area , (c) Total Cost , (m) Admission , (p) Payroll , (s) Gross Sales , (u) Units, (o) Other PREMIUM $ 4 , 227 . 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 ) 1 011 - 1095 ( 07 - 01 ) 8 ME - 001 ( 04 - 00 ) , ME - 001A ( 07- 01 ) , ME - 009 ( 04 - 99 ) , ME - 013 ( <br />05 - 02 ) , 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) INSURED <br />