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Policy No, PAC 6- 44 -28 -42 -07 <br />BUSINESSPRO CRIME COVERAGE PART <br />DECLARATIONS PAGE <br />NAMED INSURED: JOINT ORANGE CHATHAM COMMUNITY POLICY PERIOD: <br />ACTION, INC. 06/30/90 to 06/30/91 <br />The Crime Coverage Part consists of this Declarations Form, the Crime General <br />Provisions Form and the Coverage Forms indicated as applicable. <br />COVERAGE, LIMITS OF INSURANCE AND DEDUCTIBLE: <br />Coverage Form(s) Forming Part <br />of This Coverage Part <br />EMPLOYEE DISHONESTY FORM A <br />PREMIUM <br />Premium for This Coverage Part: $ <br />Limit of <br />Insurance <br />Deductible <br />Amount <br />500.00 <br />Premium <br />$ 551,00 <br />Total 1$551.00 <br />Premium shown is payable: $ at inception: <br />5 <br />FORMS AND ENDORSEMENTS Applying t& this Coverage Part and Made Part of this <br />Policy at Time of Issue: <br />SEE CR 88 01 <br />CANCELLATION OF PRIOR INSURANCE: <br />acceptance of this Coverage Part, you give us notice cancelling prior Policy <br />ur Bond Nos <br />the <br />cancellation to be effective at the time this Coverage Part becomes effective. <br />BUSINESSPRO (Reg. U.S. Pat. Off.) <br />CR 78 00 (Ed. 01/86) PRO (Page 1 of 1) 06/22/90 SLW <br />