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 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 2015 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 ....... ....... ... . _....... ......... ... ...... ..14 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 ConstructionAgreement 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 A © Includes copyrighted material of Insurance Services Office, Inc., wi SDM-1040 (Ed. 12/19) (Page 3 of 15)