BUSINESSOWNERS POLICY CHANGE ENDORSEMENT
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BUSINESSOWNERS POLICY CHANGE ENDORSEMENT
BU 12 01
(Ed. 01 83)
THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW
EFFECTIVE DATE I COMPANY I POLICY NUMBER
3-20-86 West American Ins . CO. B PW 1 7 4 1 71
Policy Period FROM TO o Standard Form
one year 3-20-86 3-20-87 ~ Special Form
Name Insured and Mailing Address REPRESENTATIVE: Agent or Broker and Office Address
DBA: Harbor Barber & Beauty Styles Burke-Lehman Insurance
25 Causeway Blvd. Clearwater, FL
Clearwater Beach, FL 33515 09 00 1379
Authorized Representative
POLICY CHANGES
It is hereby agreed that IIPollution Exclusion Endorsementll
form GU271 (6-85) is made part of this policy.
No change in premium.
2-13-86 mcs/bh/DW
POLICY AMOUNT AND PREMIUM ADJUSTMENT
Limits of Liability Premiums
Coverage Previous New Previous New 0 Add'!. Premium
Description Limit Limit Premium Premium 0 Return Premium
$ $ $ $ $
OPTIONAL COVERAGES
The following optional coverages are added under this policy when designated by an "X" in the box(es) shown
below, 0 Add'!. Premium
Limits of Liability C Return Premium
n Employee Dishonesty $5,000 each occurrence $
L_
~ Exterior Signs $
-
C Exterior Grade Floor Glass Included under Coverage A or Coverage B
C Burglary and Robbery Refer to Page 6 & 7
of the Standard Form
0 Boiler, Pressure Vessels and Air Conditioning Equipment I ncluded under Coverage A or Coverage B
0 Other (Describe)
Total Additional or Return Premium
Nil
BU 12 01 (Ed. 0183)
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BUSINESSOWNERS, POLICY
RENEWAL CERTIFICATE
ATTACH THIS CERTIFICATE TO YOUR POLICY
lr~
~p 0 THE OHIO CASUAlTY INSURANCE COMPANY
The Ohio Casualty Group 0 AMERICAN FIRE AND CASUALTY COMPANY
e WEST AMERICAN INSURANCE COMPANY
of Insurance Companies
136 North Third Street, Hamilton, Ohio 45025
References in the policy to "the Company" or "this Company"
mean the Company designated above by the letter X,
In consideration of the premium, the policy designated below is renewed for the policy period stated below, subject to all its terms except
as otherwise specified herein,
Policy Number BPW 17 41 71
Named Insured Allen Beach DBA:
Mailing Address 25 Causeway Bl vd.
To~~'o~tc1;:: C 1 ea rwater Beach. FL 33515
County. State,
Zip Code)
Policy Period: From:
Renewal Premium $
Harbor Barber & Beauty Styles
158.
3-20-86
To'
3-20-87
Beginning and ending at 12 noon Standard Time (12:01 A,M, In
California and Oregon) at the Address of the Insured stated above.
IN WITNESS WHEREOF, this Company has executed and attested these pre-
sents; but this certificate shall not be valid unless countersigned by a
duly authorized Agent of the Company,
Countersigned at Clearwater, FL
~s 20th day of t~arch
l.414/~ ~'A~
Burke-Lehman Insurance 09 00 1379 L
Date Issued 2-13-86 mcs/bh/DW Authorized Agent I
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President
19-86-
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Secretary
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~11i"itlli"illl('itll('itilfJl
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'rn BP 700-1 R.C, (Std.)
PLEASE ATTACH TO YOUR POLICY
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(The Altaclling Clause 'd be completed ~nlY when this endorsement is issued sUbseqult to preparation of the policy.)
\. Il 09 28 (Ed. 06 85) .
POLLUTION EXCLUSION
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GU 271
(Ed, 6.85)
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
BUSINESSOWNERS POLICY
COMPREHENSIVE GENERAL LIABILITY INSURANCE
CONTRACTUAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
This endorsement, effective
(12,01 A, M" standard time)
, forms a part of Policy No,
issued to
by
Authorized Representati~
It is agreed that the exclusion relating to the discharge, dispersal, release or escape of smoke, vapors, soot. fumes, acids, alkalis, toxic chemicals, liquids
or gases, waste materials or ather irritants, contaminants or pollutants is replaced by the following:
(1) to bodily injury or property damage arising out of the actual, alleged or threatened discharge, dispersal, release or escape of pollutants:
(a) at or from premises owned, rented or occupied by the named insured;
(b) at or from any site or location used by or for the named insured or others for the handling, storage, disposal, processing or treatment of waste;
(c) which are at any time transported, handled, stored, treated, disposed of, or processed as waste by or for the named insured or any person
or organization for whom the named insured may be legally responsible; or
(d) at or from any site or location on which the named insured or any contractors or subcontractors working directly or indirectly on behalf of
the named insured are performing operations:
(i) if the pollutants are brought on or to the site or location in connection with such operations; or
(ii) if the operations are to test for, monitor, clean up, remove, contain, treat. detoxify or neutralize the pollutants,
(2) to any loss, cost or expense arising out of any governmental direction or request that the named insured test for, monitor, clean up, remove, contain,
treat. detoxify or neutralize pollutants.
Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot. fumes, acids. alkalis, chemicals and waste,
Waste includes materials to be recycled. reconditioned or reclaimed.
Copyright. Insurance Services Office, Inc" 1985