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<br />" <br /> <br />e e <br />)~ SCOTTSDALE INSURANCE COMPAN? <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SUPPLEMENTAL DECLARATIONS <br /> <br />Polley No. <br /> <br />CPS0279401 <br /> <br />Effective Date <br /> <br />Named Insured LA PORTE BAY AREA HERITAGE <br /> <br />, Agent No. <br /> <br />05/09/1999 <br />12:01 AM.. Standard Time <br />42002 <br /> <br />0; <br /> <br />Item 1. Limits of Insurance <br /> Coverage Limit of Liability <br />Aggregate Limits of Liability Products/Completed <br /> $ 500,000 Operations Aggregate <br /> General Aggregate (other than <br /> $ 500,000 Products/Completed Operations) <br />Coverage A - Bodily Injury and anyone occurrence subject <br /> Property Damage Liability to the Products/Completed <br /> Operations and General ., <br /> $ 500,000 Aggregate limits of Liability <br /> anyone premises subject to the <br /> Coverage A occurrence and : <br /> the General Aggregate Limits <br />Damage to Premises Rented to You Limit $ 100,000 of Liability <br />Coverage B - Personal and anyone person or organization <br /> Advertising Injury Liability subject to the General Aggregate . <br /> $ 500,000 Limits of Liability <br />Coverage C - Medical Payments anyone person or subject to the <br /> Coverage A occurrence and <br /> the General Aggregate limits <br /> $. 5,000 of Liability <br />Item 2. Form of Business and Location of Premises <br />Form of Business: <br />0 Individual o Partnership or Joint Venture o Limited Liability Company <br />m Organization (other than Partnership. Joint Venture or Limited liability Company) <br />Location of All Premises You Own. Rent or Occupy: <br />910 PARK, LA PORTE, TX 77572 <br />Item 3. Forms and Endorsements <br />Form(s) and Endorsement(s) made a part of this polley at time of Issue: <br />See Schedule of Forms and Endorsements <br />Item 4. Premiums <br />Coverage Part Premium: $ 250 <br />Other Premium: $ <br />Total Premium: $ 250 <br /> <br />\ <br /> <br />; <br /> <br />THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND <br />THE POLICY PERIOD. <br /> <br />CLSoSo-1L (9-98) <br /> <br />INSURED <br />