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COMMERCIAL GENERAL LIABILITY <br />COVERAGE PART DECLARATIONS EXTENSION <br />POLICY NUMBER: NN1285075 <br />Effective Date: 06/19/2021 12:01 A.M. Standard Time <br />LOCATION OF PREMISES <br />Location of All Premises You Own, Rent or Occupy: <br />PREMIUM <br />CODE # - CLASSIFICATION <br />'` <br />PREMIUM <br />BASIS <br />RATE <br />ADVANCE <br />PREMIUM <br />Prem/Ops <br />ProdO/P omp <br />s <br />90656 - L818 Artisan Contractor Extension — <br />Al — Waiver of Transfer of Rights of <br />Recovery Against Others To Us — Automatic <br />Status When Required In a Written Contract <br />Or Agreement Premium is fully earned <br />91581 - Contractors - subcontracted work - in <br />connection with construction, <br />reconstruction, erection or repair - not <br />buildings NOC <br />t <br />c <br />1 <br />14,600 <br />FLAT <br />. 780 <br />3.228 <br />250 <br />11 <br />47 <br />❑ Additional page needed. PREMIUM FOR THIS COVERAGE PART $ 1, 524 <br />THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. <br />S170 (07/09) <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />Page 1 of 1 <br />