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This Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any other Forms and Endorsements <br /> issued to be a part of the Policy. This insurance is provided by RLI insurance Company. <br /> RLI Insurance Company <br /> Peoria, Illinois RL[ <br /> RLIPack BUSINESSOWNERS DECLARATIONS <br /> Policy Number:PSB0006683 [] New [X] Renewal of PSB0006683 <br /> Named Insured and Mailing Address: Agent/Broker: 68072 <br /> Fehr& Peers IOA Insurance Services (68072) <br /> 3875 Hopyard Rd,Ste 200 <br /> 100 Pringle Avenue, Suite 600 Pleasanton, CA 94588 <br /> Walnut Creek, CA 94596 <br /> Policy Period: From 12-06-2021 To 12-06-2022 <br /> 12:01 A.M. Standard Time at your mailing address shown above. <br /> Legal Entity: Corporation <br /> LOCATION SCHEDULE <br /> Described Premises Address: <br /> Refer to RLIPack Schedule of Locations, PPB 501 <br /> Refer to RLIPack Businessowners Supplemental Declarations- Building and Locations Coverages, PPB 111,for <br /> coverage details. <br /> Billing Plan: Direct Bill, Full Pay <br /> Audit Frequency: Waived <br /> Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree <br /> with you to provide insurance as stated in this policy. <br /> Estimated Premium, excluding Terrorism: $22,810 <br /> Terrorism Charge: $610 <br /> Applicable Taxes, Fees,and Surcharges: $5.64 <br /> TOTAL ESTIMATED PREMIUM, TAXES, FEES,AND SURCHARGES: $23,425.64 <br /> Countersigned By Authorized Representative Date: <br /> 12-07-2021 <br /> PPB 100 12 10 pg. 1 of 2 <br />