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Includes copyrighted material of Insurance <br />GA 233 09 17 <br />Services Office, Inc., with its permission.Page 2 of 17 <br />b.Loss Of Earnings: $ 500 <br />5. Medical Payments <br />Medical Expense Limit: $ 10,000 <br />9. Property Damage To Borrowed Equipment <br />Each Occurrence Limit: $10,000 <br />Deductible Amount: $ 250 <br />16. Voluntary Property Damage Coverage <br />(Coverage a.)And Care, Custody Or Control Liability <br />Coverage (Coverage b.) <br />Limits Of Insurance <br />Coverage a. <br />$1,000 Each Occurrence <br />$5,000 Aggregate <br />Coverage b.$5,000 Each Occurrence unless otherwise stated $ <br />Deductible Amount <br />(Each Occurrence) <br />Coverage a.$250 <br />Coverage b.$250 unless otherwise stated $ <br />COVERAGE PREMIUM BASIS <br />(a)Area <br />(b)Payroll <br />(c)Gross Sales <br />(d)Units <br />(e)Other <br />RATE <br />(For Limits in Excess of <br />$5,000) <br />ADVANCE PREMIUM <br />(For Limits in Excess of <br />$5,000) <br />b.Care, Custody Or <br />Control $ <br />TOTAL ANNUAL PREMIUM $ <br />DocuSign Envelope ID: 40A229C5-D4FB-45FE-AB8A-DFDF4EE51ADF