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DocuSign Envelope ID:85CA5012-FA70-46C8-8F09-F65071 A07951 <br /> CPD-PIIC (01/07) <br /> MP II r Philadelphia Indemnity Insurance Company <br /> One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 <br /> AN Wilk <br /> COMMON POLICY DECLARATIONS <br /> Policy Number: PHPK561270-006 <br /> Named Insured and Mailing Address: Producer: 6039 <br /> Connie Winstead Maguire Insurance Agency, Inc. <br /> 3000 Montgomery St 27101 Puerta Real Suite 200 <br /> Durham, NC 27705- Mission Viejo, CA 92691- <br /> Policy Period From: 04/30/2016 To: 04/30/2017 at 12:01 AM.Standard Time at your mailing <br /> address shown above <br /> Business Description: Yoga Trainer <br /> Style/Art: Pilates <br /> IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE <br /> AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br /> THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS <br /> PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br /> PREMIUM <br /> Commercial Property Coverage Part <br /> Commercial General Liability Coverage Part $66.00 <br /> Commercial Crime Coverage Part <br /> Commercial Inland Marine Coverage Part <br /> Commercial Auto Coverage Part <br /> Commercial Stop Gap Part <br /> Businessowners <br /> Workers Compensation <br /> Taxes/Fees/Surcharges $50.00 <br /> Total $116.00 <br /> FORM (S)AND ENDORSEMENT(S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE <br /> Refer To Forms Schedule <br /> *Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations <br /> Countersignature Date Authorized Representative <br /> GGG <br />