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E • ST.11107dAS OFFICE Policy Period From: 12/27/2011 To: 12/27/2012 at 12:01 a.m. Form of amed Insured's Business: O Corporation; O Partnership; O Individual; O Other: Type of Insured's Business ITEM TWO — SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge i

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e 3 Check appropriate box for federal tax classification of the person whose name a entered on kne 1. Check only one of the following seven boxes. O Individual/sole proprietor or O C Corporation K S Corporation O Partnership O Trust/estate single-member LLC El Limited kablity company. Enter the tax cla

e 3 Check appropriate box for federal tax classification of the person whose name a entered on kne 1. Check only one of the following seven boxes. O Individual/sole proprietor or O C Corporation K S Corporation O Partnership O Trust/estate single-member LLC El Limited kablity company. Enter the tax cla

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