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COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />Policy No.CP 2634658 <br />Effective Date:02/28/2020 <br />12:01 AM STANDARD TIME <br /> LIMITS OF INSURANCE <br />Each Occurrence Limit$1,000,000 <br />Personal & Advertising Injury Limit (Any One Person/Organization)$1,000,000 <br />Medical Expense (Any One Person)$5,000 <br />Damages To Premises Rented To You (Any One Premises)$100,000 <br />Products/Completed Operations Aggregate Limit$2,000,000 <br />General Aggregate Limit$2,000,000 <br /> LIABILITY DEDUCTIBLE$0 <br /> LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY <br />LocationAddressTerritory <br />1211 North Main St, South Bend, IN 46601004 <br /> PREMIUM COMPUTATION <br />RateAdvance Premium <br />LocClassificationCode No.Premium BasisPr/CoAll OtherPr/CoAll Other <br />1Additional Insured - Managers or Lessors of 499501 Per Additional 0.000100.000$0$100 <br />PremisesInsured <br />1Caterers110395,000 Per 1,000 Sales0.2044.951$1$25 <br />1Restaurant - with no sale of alcoholic beverages - 16900350,000 Per 1,000 0.8555.165$299$1,808 <br />with table serviceSales <br />MINIMUM PREMIUM FOR GENERAL LIABILITY COVERAGE PART:$625 <br />TOTAL PREMIUM FOR GENERAL LIABILITY COVERAGE PART:$2,233 <br />(This Premium may be subject to adjustment.) <br />MP - minimum premium <br />Coverage Form(s)/Part(s) and Endorsement(s) made a part of this policy at time of issue: <br />See Form EOD (01/95) <br />THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. <br />Includes copyrighted material of ISO Commercial Risk Services, Inc., with its permission. <br />Page1Of1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983, 1984, 1988 <br />CL150 (10/03) <br />