JENNIFER BACKHAUS DBA BACKHAUS DANCE (3)

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S9 « 04/11/2022 ` GLP 3961460 01 GREAT AMERICAN ASSURANCE COMPANY 'D/B` 072977484 262428 CG 20 13 Additional Insured - State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises CG 20 15 Additional Insured - Vendors CG 20 18 Additional Insured - Mortgagee, Assignee Or Receiver CG 20 23 Additional Insured - Executors, Administrators, Trustees Or Beneficiaries CG 20 24 Additional Insured - Owners Or Other Interests From Whom Land Has Been Leased CG 20 26 Additional Insured - Designated Person Or Organization CG 20 27 Additional Insured - Co-owner Of Insured Premises CG 20 28 Additional Insured - Lessor Of Leased Equipment CG 20 29 Additional Insured - Grantor Of Franchise CG 20 30 Oil Or Gas Operations - Nonoperating, Working Interests CG 20 31 Additional Insured - Engineers, Architects Or Surveyors CG 20 32 Additional Insured - Engineers, Architects Or Surveyors Not Engaged By The Named Insured CG 20 33 Additional Insured - Owners, Lessees Or Contractors -Automatic Status When Required In Construction Agreement With You CG 20 34 Additional Insured - Lessor Of Leased Equipment -Automatic Status When Required In Lease Agreement With You CG 20 35 Additional Insured - Grantor Of Licenses - Automatic Status When Required By Licensor CG 20 36 Additional Insured - Grantor Of Licenses CG 20 37 Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 38 Additional Insured - Owners, Lessees Or Contractors - Automatic Status For Other Parties When Required In Written Construction Agreement These endorsements are revised to remove the phrase "shown in the Declarations" in order to account for limits of insurance that may be available under an endorsement attached to the Policy. Some endorsements include other minor editorial revisions. These changes result in no impact on coverage. CG 21 01 Exclusion - Athletic Or Sports Participants CG 22 71 Colleges Or Schools (Limited Form) CG 22 72 Colleges Or Schools These endorsements are revised: So that negligent supervision -related language will apply to the participation or practicing of any sports or athletic contests, and To replace "while" with "arising out of in relation to the phrase "practicing for or participatinc can be revealed at a time later than the related practice or participation. w.k rM� _ riEV1EV.Ep6 MCRW®ar. © Includes copyrighted material of Insurance Services Office, Inc., wi SDM-1040 (Ed. 12119) (Page 14 of 15) """" 9e tO 1Ntle