Fillable Form 2.: COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS

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Form 2.: COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS

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COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS
POLICY
NUMBER:
Stock
Company
1.
NAMED INSURED:
2.
LIMITS
OF
INSURANCE
-
INSURANCE APPLIES ONLY FOR COVERAGE FOR WHICH
A
LIMIT OF
INSURANCE
IS
SHOWN.
General Aggregate Limit (Other than Products/Completed Operations)
Products/Completed Operations Aggregate Limit
Each Occurrence Limit
Personal
&
Advertising Injury Limit
Damage
to
Premises Rented
to
You Limit
Medical Expense Limit
3.
LOCATIONS
of all
premises you Own, Rent,
or
Occupy
$
$
$
$
$
any one premises
$
any one person
No.
Address
City
State
Zip
PREMIUM BASIS
RATES
ADVANCE PREMIUM
4.
CLASS **
Code
/
Exposure
Prod/CO
All
Other
Prod/CO
All
Other
No.
No.
No.
No.
No.
** If
Classifications
are
Numbered,
the
coverage applies
to the
corresponding Location No.
** If
Classifications
are
Numbered,
the
coverage applies
to the
corresponding Location No.
TOTAL:
$
(s) gross sales
- per
$1000
(p) payroll
- per
$1000
(c)
total cost
- per
$1000
(a)
area
- per
1000
sq.
ft.
(m) admissions
- per
1000
(u)
units
(e)
each
(o)
other
5.
Policy may
be
AUDITABLE
(t) see classification notes
in
company
or
ISO Commercial Lines Manual
6.
SPECIFIC GENERAL LIABILITY FORMS/ENDORSEMENTS
This
page alone does
not
provide coverage and must
be
attached
to a
Commercial Lines Common Policy Declarations
Common Policy Conditions, Coverage Part Coverage Form(s) and
any
other applicable forms and endorsements.
S2000 (06/01)
Page
1 of
1
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Completed 15 March 2022

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