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<br />. . ~ ... ... . .. .. <br /> <br />COVERAGE PART OWNa LANDLORDS' AND TENANTS' LIABILITY INSURIA <br />COVERAGE FOR DESIGNATED lIMlSES AND RELATED OPERATIQNS IN PROGRESS'HER THAN STRUCTURAL <br />ALTERATIONS, NEW CONSTRUCTION AND DEMOLITION <br /> <br />L 6416 <br />(Ed 173) <br /> <br />For attachment to Pol icy No. GLA <br /> <br />13019G <br /> <br />, to complete said policy <br />ADDITIONAL DECLARATIONS <br /> <br />Location of GUedB=S (ENTER. SAME. <br /> <br />Interest of named insured in insured premises (CHECK "ELOWl <br />DOWNER D GENERAL LESSEE [i) TENANT D Other <br /> <br />IF SAME LOCATION AS ADDRESS SHOWN IN ITEM I OF OECL,ARATIONS) <br /> <br />Part occupied by named insured (ENTER "ELOW) <br /> <br /> <br />~Il~cai SCHEDULE <br /> <br />insurance afforded is only with respect to such of the following Coverages as are indicated by specific premium charge or charges. The limit of the company's <br />ility against each such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto <br /> <br />SD <br /> <br /> <br />Advance <br />Premiums <br /> <br />Coverages <br /> <br />A Bodily Injury Liability <br />B-Property Damage Liability <br />Form numbers of endorsements attached at issue <br /> <br />$ 1 .00 <br />$100.00 <br />$ <br />Total Advance Premium $ 2 0.00 <br /> <br />Description of Hazards <br /> <br />General Liability Hazards <br />Code Premium Bases <br />No. <br /> <br />Rates <br />B.1. P.O. <br /> <br />Advance Premiums <br />Bodily Injury Property Damage <br /> <br />Premises. Operations <br /> <br />LOWJWl FIELD <br />SAI MARCOS, TEIA8 <br />AIBPOBTS - OOJItl!:RCIAL <br /> <br />458328 <br /> <br />I'Ll! <br /> <br />CJIABGE 150.00 <br /> <br />100.00 <br /> <br /> <br />Escalators (Number at Premises) <br /> <br />(a> Area (Sq. Ft.) <br />(b) Frontage <br />(c) Admissions <br />(d) Receipts <br />(e> Units <br /> <br />Number Insured <br /> <br />(a) Per 100 Sq. Fl. of Area <br />(b) Per Linear Foot <br />(c) Per 100 Admissions <br />(d) Per $100 of Receipts <br />(e) Per Unit <br /> <br />Per tandi~ <br /> <br />JIOT COYEUD HEIlEOID1!:R <br /> <br /> <br />Total Advance B.1. and P.O. Premiums $ <br /> <br /> <br />.,' 'e~" - ..-.'>.. .f, <br /> <br />ed as a premium basis: <br />h t t I ber at persons other than em"\o~ees ot the named insuTed, a~mi\ted to tne event \nSUlea Of to events comluc\en on tn. <br />" means t e 0 anum , . ~ . <br />whether on paid admission tickets, compllmentary.tlckets or passes.. named insured or by others during the policy period <br />gross amount of money Chatrgefd bytth1e namt.ed mbsrouareddcafsOt~nSgU~~ :~~~~Iop~~t~~e~h~nd includes taxes, other than taxes which the named <br />S ipts baSIS other than recelp S rom e ecas mg, . _ . ' <br />~' 'tl' <ec, ~ separate item and remits directly to a governmental diVISion. <br /> <br />ll.{f lIe.~~. ~'> . (over) <br />