BUSINESS OWNERS POLICY # BO 770 47 53
iiBUSINESSOWNERS STANDARD POLICY
~t;;] BUSINESSOWNERS SPEC 1"_. . POLICY .' /,_- .'
-.' EXCELSIOW'INSURANCE COMPANY,
DAILY REPORT
COUNTERSIGNATURE DATE
7115/81
USE, N. Y.
RENEWAL OR REPLACEMENT NO.
10 71047'53
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Item DECLARATIONS POLICY NUMBER BO 770 92 61
1. ~anleJ ~nsureJ All. a. ....
d/b/. ..her vt.,Barber Stym
Mailing Address .... 16 Claanat:er Kadaa 71-75 C._f.,. ~...rd b
(Number, Street, City or Town, County,State & Zip No.l C1euwater. nod.da 31515 . RECE'VE
2. Policy Period: ~:~;~~~~: :~~ ~~~~~~Jaalt :h2e nAodo:;e5~1~~d~;: I~;s~~e~l~t~:et~o:;, From: To: K'
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. Agent or Broker .lack ._, l~ 81
REPRESENTATIVE: JUL 21
Office Address . 09-168
Town and State . Cl....u:.r . Rer1cla 33515
CITY CLE ~
.dl,. r i HAI'~SOM I\C:;ENCY
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:.. 4';;),1::16:'; P. 0, IAlX 3344
71-76 CAU~""^".v RI vn 1", r.l, "i" ___.ft
3. The Named Insured is: ~ Individual o Partnership o Corporation
o Other (Specify)
4. ~agl!e's Name and Address -
Locat1_ .f ...t S-.
5. Occupancy 1'. yaap
6. In Consideration of the premium Insurance is provided the named insured with respect to those premises described in the Schedule belll,w and with
respect to those coverages and kinds of property for which a specific limit of liability' is shown, subject to all of the terms of this policy including
forms and endorsements made a part hereof:
SCHEDULE-SECTION I-BUILDING. BUSINESS PERSONAL PROPERTY, LOSS OF INCOME, tt MONEY & SECURITIES
Described Premises Limits of Liability
Cov. A Builaing(s) nn BuS.8tl:"_ CGaChh $
.tnccval fr... wttll .....,. f1.een ... nef .laN $
$
Cov. B-Business $
Personal Property $ 6.600.00
Personal Property $
Automatic Increase in Insurance. Coverage A-Building(s) shall be automatically increased by 2%.
Cov. C-Loss of Income Actual Loss Sustained, Not exceeding 12 Consecutive Months.
Cov. D-Money and Securities "NOT APPLICABLE FOR On Premises- $10,000
STANDARD POLICY" Off Premises- $ 2,000
SCHEDULE-SECTlllH II COMPREHENSIVE BUSINESS LIABILITY COVERAGE
Limits of Liability
Cov. E-Business Liabilih $ I.UUO.UUU.W each
The limit of liability with respect to the completed operations and products hazards combined is an aggre- occurrence
gate limit for all occurrences during the policy period.
Fire Legal Liabilit~ $50,000 each occurrence
Cov. F-Medical Payments $1,000 each person
$10,000 each accident
7. Optional Coverages: The following optional coverages are afforded under this policy only when designated by an "X" in the box(es) shown below.
Limits of Liability
Employee Dishonesty $5,000 each occurrence
Exterior Signs $
1 Exterior Grade Floor Glass Included under Coverage A or Coverage B
Other (Describe) $
8. Policy forms and endorsements ,.,. .... f;)J.
attached at inception, if any: 1U0201 (11/7') .1U0404(8/79). D.0002(1/17) .CL2l1S( 1/68)
9. Annual Premium for the H Standard Policy and o~ Coverages $ &U.l.W-
Special Policy $
tt NOT APPLICABLE FOR STANDARD POLICY. ---_._...._._~
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Countersigned Bf===:::~
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, Authomed Agent
Form No. B0700.1 DR Rev. 12/16/75
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(XI BUSINESSOWNERS STANDAltD POLICY
~. "_~BUSINESSOWNERS SPECI~~POLlCY ~
This Declarations Page with "Policy Provisions" completes
Item
1.
DECLARATIONS
..NameJ Jn~ureJ
Mailing Address
(Number: Street~I!y,!lr Tow_~C2~D.!.Y.!~~~_~~E!e....~J,)
Policy Period: ~:I.';~~~'I': ::::: ~/:~~"'I~,,'~d\ III~~ fi::;'~~~~:ll~:~1 J;i.~~.~I;I~I'~I~~J'U"~' from:
Agent or Broker
Office Address
Town and State
POLICY NUMBER 80 77 [!
Allen R, Beach
d/b/a Harbor View Barber Styles
Room 06 Clearwater Marina 71-75
Clearwater, Flotida 33515
8/29/80 To: 8 2
Jack Ransom Agency
~elSior
INSURANCE COMPANY OF NEW YORK
SYRACUSE NEW YORK 13201
The Named Insured is: G3 Individual D Partnership
D Other (Specify)
Mortgagee's Name and Address
Employee Dishonesty
_Ex!er_i.oLSJ.~.s
X Exterior Grade Floor Glass
Other (Describe)
8.
Policy forms and endorsements
attached at inception, if any:
BD 00 01(8/76) BD 01 22(11/75)
IL 00 02(1/77) BD 04 04(8/79)GL 21 15
Annual Premium for the X Standard Policy
Special Policy
9.
tt NOT APPLICABLE FOR STANDARD POLICY.
Countersigned By
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