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<br />. : 7145475408 Dec. 13 2001 05: 12PM P2 <br />FROM OCCTAC FAX NO. <br /> . COMMERCIAL LINES POLICY <br /> COMMON POLICY DEClARATIONS <br /> I<J New GREAT DIVIDE INSURANCE COMPANY }J _ 2601-677 <br />'-' 0 Renewal Scottsdale, Arizona <br />[I Rewrite <br /> 0 Crass Ref. Policy No GC039470 <br /> <br />Named Insured and Maning Address <br />(No SIr!!.!'!, lewn or City, Covtlly, Sllll9. ZiCl CCCl~1 <br />SONIA MISCULIN <br />DBA EL RINCON FLAMENCO <br />210 N BROADWAY <br />SANTA ANA CA 92701- <br /> <br />Agent and Mailing Address Agency No. <br />:1'110, Stlul, Town 0' City. County, St3l'e, Zip Code) <br />'Transcal Associat.es <br />3800 Watt Avenue, Ste 110 <br />Sacramento, CA 95B21 <br /> <br />406- 00 <br /> <br />Policy Period; <br /> <br />From 06/0r/2001 to <br />at your mailing address shown above. <br /> <br />06/01/2002 <br /> <br />at 12:01 A.M, Standard Time <br /> <br />Business Description: DlINeS INSTRUCTION <br /> <br />Tax Slale ~ <br /> <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, <br />WE AGREE WITH you TO PROVIDE THE INSURANCE STATED IN THIS POLICY. <br /> <br />THIS POLICY CONSISTS OF THE FOllOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. <br />THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br /> <br />'-' <br /> <br />Commercial General UabUiIy Coverage Part <br /> <br />$ <br />$ <br /> <br />PREMIUM <br />743.00 <br /> <br />',"". <br /> <br />ADOITIONAl OEPOSITS <br />REOUIREO ON eHOOFf81MiNTS <br />TO THE POLICY '''Ii}R 10 <br />COVERAGI: 6EtNEl illt9YlB!D <br /> <br />$ <br /> <br />',......'-".. .-.'...... ~ n';...'........ ....: <br /> <br />$ <br /> <br />Tax & Fee SChedule <br />policy Fee <br /> <br /> $ <br /> TOTAL ADVANCE PREMIUM $ 743_00 <br />$ 1.50.00 (Minimum & Depoo~l <br /> TOTAL TAXES & FEES $ 150.00 <br /> TOTAL $ 893 _ CO <br /> <br />Form(s) and Endorsement(s) made a part of this poiicy at lime of Issue': <br />RQtar to S902 (12/98) Schedule of Forms and E~dorsements <br /> <br />"'Omit' applicable Forms and Endors~ments if shown in specific Coverage Part/Coverage Form Declarations, <br /> <br />#fad A~ <br /> <br />\",.- <br /> <br />Countersigned: sacramen:co, C.1\ By <br />07/25/2001 PM/kG Cou/'l...t~snafur.Ot Aul:l'!orirecl Re?r~llIatl~, wNc:hevsr is ~I)plicable <br /> <br />THESE [)ECL.AAATlONSTOGE1HE~ Wfnt THE COMMON POLICY CONOtTlON9 COVIi~1; p&:;y OECl-^PAT,ONe, CCV'lii:rvo.Q.C ~.........,. c.C':>VI'f:"'^"~ <br />ffiRM{g) AND ~RU.S AND'=NOORsE~NTS, IF Il:NV.I~UcO TO ~RM A.~~I. lHF.AeCF: ~~~~~ ~~~~nE:E1~~'9&, <br />............ ~_I of Insurance SeNl~ OffICii. Inc. .....," 'l~ parmlil8lOn. CoPY'19 -. <br />Includes. Cl)~gl~""" mai:t....r.g <br />