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DocuSign Envelope ID:8C7A270E-432E-42E0-A5B7-5136E53010EC <br /> Philadelphia Indemnity Insurance Company <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br /> Policy Number:PHPK1542474-000 Agent#:6039 <br /> See Supplemental Schedule <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 Prod./ Prod./ <br /> Classifications Basis Prem./Ops. Comp.Ops. Prem./Ops. Comp.Ops. <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", "Property Damage", or"Personal and Advertising Injury"which occurs before the <br /> retroactive date, if any, shown below. <br /> Retroactive Date: <br /> FORM(S)AND ENDORSEMENT(S)APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule <br /> Countersignature Date Authorized Representative <br /> Page 1 of 1 <br />