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Philadelphia Indemnity Insurance Company <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />Policy Number: PHPK1086454 -002 <br />fly See Supplemental Schedule <br />Agent #:6039 <br />LIMITS OF INSURANCE G <br />$3,000,000 General Aggregate Limit (Other Than products — Completed Operation) <br />$3,000,000 Products /Completed Operations Aggregate Limit (Any One Person Or Organization) <br />$1,000,000 Personal and Advertising Injury Limit <br />$1,000,000 Each Occurrence Limit <br />$100,000 Rented To You Limit <br />$2,500 Medical Expense Limit (Any One Person) <br />FORM OF BUSINESS: Individual <br />Business Description: Fitness Trainer <br />Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED <br />AUDIT PERIOD, ANNUAL„ UNLESS OTHERWISE STATED: <br />Rates Advance Premiums <br />Premium Prodd Prod.1 <br />Classifications Basis Prem. /0 s. Comp.Ops. Prem. /Ops, Comp. ORS, <br />SEE SCHEDULE ATTACHED <br />TOTAL PREMIUM FOR THIS COVERAGE PART: $122.00 Included <br />Retroactive Date(CG 00 02 Only) <br />This insurance does not apply to "Bodily Injury ", <br />retroactive date, if any, shown below. <br />Retroactive Date: <br />"Property Damage ", or "Personal and Advertising Injury" which occurs before the <br />FORM(S) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule <br />Countersignature Date Authorized Representative <br />Reviewed by <br />Carmen Acosta <br />R f eCreation <br />Page 1 of 1 <br />