JENNIFER BACKHAUS DBA BACKHAUS DANCE (2)

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* S9 * 04/11/2022 * GLP 3961460 01 GREAT AMERICAN ASSURANCE COMPANY *D/B* 072977484 262428 CG 20 01 Primary And Noncontributory —Other Insurance Condition..................................................................13 CG 20 03 Additional Insured — Concessionaires Trading Under Your Name.........................................................13 CG 20 05 Additional Insured — Controlling Interest..........................................................................................13 CG 20 07 Additional Insured — Engineers, Architects Or Surveyors....................................................................13 CG 2010 Additional Insured —Owners, Lessees Or Contractors —Scheduled Person Or Organization CG 2011 Additional Insured — Managers Or Lessors Of Premises....................................................................13 CG 20 12 Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits Or Authorizations.......................................................................................................................................13 CG 20 13 Additional Insured — State Or Governmental Agency Or Subdivision Or Political Subdivision — Permits Or Authorizations Relating To Premises..........................................................................................................14 CG 2016 Additional Insured —Vendors .......................................................................................................14 CG 2018 Additional Insured — Mortgagee, Assignee Or Receiver.....................................................................14 CG 20 23 Additional Insured — Executors, Administrators, Trustees Or Beneficiaries.............................................14 CG 20 24 Additional Insured — Owners Or Other Interests From Whom Land Has Been Leased..............................14 CG 20 26 Additional Insured — Designated Person Or Organization...................................................................14 CG 20 27 Additional Insured —Co-owner Of Insured Premises. ......................................................................... 14 CG 20 28 Additional Insured — Lessor Of Leased Equipment............................................................................14 CG 20 29 Additional Insured — Grantor Of Franchise.......................................................................................14 CG 20 30 Oil Or Gas Operations— Nonoperating, Working Interests................................................................. A 4 CG 20 31 Additional Insured — Engineers, Architects Or Surveyors....................................................................14 CG 20 32 Additional Insured— Engineers, Architects Or Surveyors Not Engaged By The Named Insured...................14 CG 20 33 Additional Insured — Owners, Lessees Or Contractors —Automatic Status When Required In Construction Agreement With You_ .......................................................................................................14 CG 20 34 Additional Insured — Lessor Of Leased Equipment —Automatic Status When Required In Lease AgreementWith You...............................................................................................................................14 CG 20 35 Additional Insured —Grantor Of Licenses —Automatic Status When Required By Licensor ..........................14 CG 20 36 Additional Insured — Grantor Of Licenses........................................................................................14 CG 20 37 Additional Insured— Owners, Lessees Or Contractors —Completed Operations.......................................14 CG 20 38 Additional Insured — Owners, Lessees Or Contractors —Automatic Status For Other Parties When Required In Written Construction Agreement................................................................................................14 w.�M�iam� ��LIDLAP%iOVm BY: © Includes copyrighted material of Insurance Services Office, Inc., wi SDM-1040 (Ed. 12119) (Page 3 of 15)