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CERTIFICATE OF INSURANCE (2) . The ENCLOSURE is for your records . Date: . 6-25-86 The enclosed contains a Mortgage Clause, or Loss Payable Clause in your favor. Additional Insured Ownen Clearwater Beach Seafood Company and Policy No. Ohio Casualty Co. #GLW(87)0135989 10 City of Clearwater P. O. Box 4748 Clearwater, FL 33518 kD~ r L INSURANCE AGENCY INC. 620 BYPASS DRIVE em P. O. BOX 5026 CLEARWATER. FLORIDA 33618-4985 Phone: (8131 797-4499 Tampa: 229-8208 ~G1:- \' ~ \. fl>. ~ '\. \.. '\.~ ~~\l.~\.. \.. G € ~....,$)...\ ,\\\.\to" \\\.t; ..~ ca\\\$at\'i' ." ca\\.e\\ \\\e ....,'i ",e\e'" (.0 .,,, Qat\'i t$,1(-, ....\s$\'.l" ~ ,,<- ,.... '>J 'C. ~v \- )\)~ i' q"l.'OOb ~~\O caSU~\.'/ ....t.\\.\~U t..'O'Ov,tSS "\. t-$, · 9 to ' G\'On. \ c:. \'_ '" 'I ' 9;;......~'. - co'('\\,\>?J.-r\,es 0' \(\Sut?J.(\Ce \..~ &5:' '\. \.. '\. '1 i Of ..' \..1.~1."'S' i t>-i'\\1 '\. ~.,)\'':l- _ ~ O\. \.. 'i . 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"2. -- S'{~"~(' o \-' '( \::Sl- .' r, "'(" , ., . .,,' (; ^k1031 ~..\ .'1"0 ('10 \.~ .- ______ :~ (.>J .J'} . rf..~ v .~ ,)(" \., o~\G\~p...\, 00 "e Ohio Casualty Ql>up of Insurance Companies "H:ST ,:VkRICJ\N hJStJPt\f\:CC COtWANY Policy No. GlW en1) 0 13 59 39 ClL:ARWATr:R lH.:Af.II SL:AF-OOO. PIC. PAGE 1 SU!:':"UlL ,'F HA7A:W(; pp,nnW1 *** I-'? f ,., I S~.: S / 'W r;:,JII., 1 [UN S **,;: D L S (l-' I P T ION n F I L".( " ~: r = ~1.^l, f.r~r', Si-.:Ili"'..JI: '-1T~ r'nllLI~Y - ~~ F. T "ll (l~S~ rnnF - ~4~Jl PHfr'lur, qt'.:)t: - 1,4')(; ~.cU^I'~r. r:~:lr !',ATtr;; - PER IOO 5'.1');\0[: i :":T f. .,. .. : \ . I ... CU''1,il\lhJ ::.Ir":'- I.I~lT::; . 1 1Il.~ ~ ~< 71'~ .(I'J [)t::SUU l' r I uN UF d 1\ U'.!UJ: RES T AU'1ANTS-WI TH S.\L f elf a\LC)I!'lLIC rl[:VF"l\C.(,:,. lH,'l /'~' U:S') IHAN f'"J'> r..F T!P' rr!l."l M-lNU,"'L nFcr:lPTS rHo T!r ~LSl f\~I?^'n-I../TTHiJUT iU,!;C'. 1-'-lJ'11~ ClA~ <", ,:Un: - ~l !!f~ h:'. PREiHUt'" jl!\:-:::: - 1.,';(".(; ~';.lUI\PT r.I:i-:T p. 1\ F: '; - P Eft 1 U (j ~ I.) 1I t'\'~ I: P: t: T (.'; rl'.~ L~ Ul :.; I j , I~ l F ll~" I f S 1'\ T:. <-; 11/l.11,1 ?,104.0U OlSU:IPTIUN Ill" llt./f:P(]: AU T_F1tV' I L~: P /\ kIt.: I r,![; II R L/lc:..- 11':(. uln ;w:; nr: 1 v' - pI .'\ H t f\" lJ <;;:-;) p:)f{. "'C!JW:n lJ'~ "T',~/,\Yff ~;rP.VICf:- 'WI.:N Ali~-! pr:"p.ATH1 HI cm~r,;'cn!J., "ITI! "'lnIC'~ E'ITU":PLl :it:S C L ^ S "; UJlli. - 757"'. '.) PRUlIU,',' i'l\S:;. - l.,O(;iJ St)ll\;~r- FU~'I Rl\r.:S - p:-r~ idC Sl'^i'J ;-:'c.T f:'I;'~:fi.JL,j ~)I:--l(;Lt lJi:fTS I; /\ T .:. .I..,';:? 3,~ . (l II V:"'!T l'iU~') Ill! FAG:: 002 TH'= rORFGOINi~ LJISrLflS!~:) ,~'-L ~I,'/.'Ii~ns l.,r~lq{r:ll "~"~FU~'f1r:~ Kr.':J'rt, Tn EXIST /I.T TH~ EFFECTIVE OAT!: qr- fHI:> PCLlfY, lJ~U::..,'S OTHr')','l')': STATHj lIEPEIN. Dc.. Uf,U:}dh Ill, 1'..o~' . ,. ~ .t 'ti w - - N f'! 00 jle Ohio Casualty CilJup of Insurance Companies HFSl Ar"tHICMl J-JSllni\tKF rn:W^NY G L \~ (n 1 J fl J. ~ 5 '1 fl 9 Policy No, CLEARWATER BEACH SEAFOUD, INC. PAGE 2 SC"U1UIJ OF HA7MtfJS PF EM IUt, DESCRIPTln~ UF IIf,ZJ\Hf1: "DC I T I eN At r'JS UI{ t~rJ-U"Nf P. S.. t"'ANAGU"tS U'{ I1PUtl',TOI~S "l- t,:{ r ,II S r s ~\S pI P t\TT/\Cl~.~() I ;"J'JIIQ--;::111 'n LttlOq CL/\~~ crJf~:: - no('n1 PR,EWIlP., ~',\S..: - 1 f l.rYl :.. OUN~ r r r:r 1 RATI..:_~ - p,~:t~ 1()f1 <:;'1'i\1:~ f;d':T '".,1 :- S CLi!~~J:'r::f) Sll".;t:' L 1 "I T:) ~.. " 1 _~~~ .,~ 72.(JU DESc.nIPTH1N 01= I"LVN~D: t. YlI TI '1;~ ,'"t L I II S l."~ c fl-( i{:~ 1 !~ S .. ril\, I'! t\', ;':I~~) 'I t, UP [r.. I\.TfW ') II F F'It L ;.; T .., I: S A5 PH~ ^Tr,"r:H:~P r.\lJr;~SLi'ENT ['JlU'! (L/',S~: rr..lf'l~ - 'In/')1 PP,UllU'" ':,I\S~'- 1..,''''1') S'IU/lIU rU'l gAr.s - f,T. 11)0 S)t~A;:i.: FF:lT C'l~','HkiJ :)!i'C',L! I111TS :~ ^ Tf <:; 1J .1) 7(, ?lO.OO DFSC1'11'TrUN Ilr i:,'t^!',"': ,ll,1)i) I T 1.' liJ.'\l 1 WJlW \. i'-U'.~w'n<:, r"",lJ/.f:'_I~,S L:') npH{ 1'). fm',~; Jlr. r ~1. f iTI S f ~ A:' pro o\TT"CHU) f::r,(lP~' n 'H L~' 1. ,)..... CLAS'~ liJfk: - (J0,d)f PRGHUi-l rp..St'7 - 1,'\(l11 ~; IU'\fU; P':Yf RATes - r)L~ luO ~~:I;UAi-:( f '::":1 rll:~;,lm:iJ :;li,C\...: 1..1;;rl:':' ~ 1\ l ~ .'~ (' ": 3.0U l.l1'nl''''~'1 II!,J FACI (;'J3 THE FOREGUINt. tHSCl'J.>;-S ^ll Pi" ~.';S l"):"~'~! '1 :{'I'r1Q'i, ~'~rJUWN II) 'XIST ,q THF EFFECTIVE DAIF- "F IHl~ f',LJCY" ""lr:~~; ';rHrr~.JTS" "1',\TI!! "'::c:Ii'~. IIO..! UhUJ,,1.! Cli.,l'>'., 00 e Ohio Casualty ~up of Insurance Companies NAME OF COMPANY weil A!1ERICAN PI~;URM"Cf: ((prMJY Policy No. ~tw (Pl) 0 13 59 89 Ramed In.ured ClI:AR4AH:R !lEACH S~:ftt=Ofl09 INC.. PAGE 3 S(~'H:\lLiLL UF H!\lAl1IJS PRnlHHI *** 1':'i,f)UCTS /'I,m l.U:WlPt'lt..J) 1':-'1 Hflll1,'i;) ....../4,....... "'lr ..~ -," OESCU r' T IIJn '.IF Ii 1\ lll, l?.lJ: :'o'1FAT, FISH, SUIFI'(Fl (I:< 1)1-'lllT~Y -f~FT.... I L C LAS ~ Cl, , 1 ~ - ') I, " 11 PRHlrur,! M~~E - J2\1,'J!Hl 'Wlt/\I'\ CF !HLLIPrs RATtS - I~':R 1ge')p;'l)'-L.I\.n.-~ nr 1.~p_ElrTo:., ~~. ,\ 1 t. -:~; nr"nJNFi) SLlr~L: LI;"IT:> .. i <:,~ 155.00 DESCRIPTIGN OF HAZ^~U: M~~AT, FISH, SEfIFUUlJ C~ ,J~Ul TltY -~, HS l~.:; ^ t.: (LAS';; COli.. - J(lf,?) pl~C"'lIn \".I\S( - (,...,nun '!(.LlAi'') I'F PC.IP1S RAT;:S - 1'...:1, l.,nun iJI)lL^R'; rr hU:Flvrs ; \ r:- s C ,..1; l; \ 1 j ,j ;~ n .) I ~J '~ l r t I . 41 T '). ..?l~ L't .0 () O::::SC;'H'TJ:..;i-! FI: :U71\f !': q.c_,_:.:~ '~!~ 1:~:~T 'j'r"r,:rl~)-I~)' .:/\..'?~. I ,Ii-: Ui~, ~";' :,jjL T ,!f~--\~J ;', ,- 'J.-\<~,\.I,I.-<; ; t'~ h..:IT )!\'."~>1 r..n f:!],'i.:dl.iI'TIlJ'J ~\l\ r;{1 "{t~:l:)::'~ ( l ^ S :: f '. ) 11 .: - ~. :.11 :i 1 PREtn:UIi ',~A:,.::: - ./',:.hHl PI'Ll{l~;' r1f ,,(cr-l')I~; P.ATi_S - ~LP. hnOO L'lJLL'\i{\ (IF ~"Ci'IPlC;:: ~'~lr~..S ~ 5', ~. CU:~JI.Jr:jj SI.I';Lr tI~:lTS 3~.no DESU'. I 1-'T lti:'J OF ~'i\.; t!W: iu ~lY': ,,\.H "~-'.f111; ~!'.ll (if ALCuHfLIC :\r:1Jrr'i\,l<~~'lllq f.'::,'. L :: '" ~~ r II P. ~J 7 ~,'1" I' f P ! r:. T 1.1 r ," I.. A\~NIJ,I\l RLCr::IPlS o. HE T{ I: S T ^;, ~ .t\ f"l- ~JI HilJ'.IT IJ ^ 'I C f: :-: U1 r,;( C LAS ~; ell f) r: - :"; I;: ~) ) PH.Fi'llU:1 n.\Si': - /'/'\"fUn\) ~)L,LL:~!':, Ijf- 1:,Tr.Ti.'IS RATLS - PLR 1,O{)I'; r~~:ll.~.!\:) ('iF !(':'.:~HlfS r, \T r: C:LiF~II.F-,) .:iT,.. 1_' I..p.'IT') 1.. /: .".) J 'S r~ .. 1')') cll.!rr.:tF:; ml P"GI: 00,,+ THE FOREGOINF I)T~;C1Jlsr~> ^l '- '1"II\I~;)S P:_;lJ;~fJ !Ir".-ll"'il' f' i,f"(l:I#N Tn rXI<iT JlTTHF. EFFECTIVE OAT~: or- THIS fH'tU:Y, 'Hlf':', nTH~:'-I.I I ~JT.\1,:r; HlRlHl. ,-J ..' t. U t./ iI:'\ h h ~ \..J 1 ,'. ~E OF COMPANY , WLST iVd:YICAN IN')tJP-l'.!..JCF UJMPI'tJy Policy No. :. ' ,I.mld Insured. CLl:AR~M TER BEACH 5cAFnOD, INC. PAGE 4 scm:.puu.=.. OF H^' i\iUJS PRPHUM I. **:~ TrITAL ';u:r[.\'~'-E PH-HUIJ:" .....~~J.. '1"",. 'V' r \~: ': !~ I ~ h) .) 14 F'-! '- 1'1 11 S $0::1,71'2.00 THE FORfGOINr, :;JS(U!:~::S /lLt I:,~:,'\~:"S P'\'~'~rL' 11.'I"-l'j'>'~ K:'::l\J!~ Tn r-XIST ;'\T ll-lE EFFECTIVE DlH' "F fl-lIS rULH:Y, 11;:1 L~~S I~T}!;-t~'iJ')'_ :.1'I\'TfJ' IlfREHJ.. ~ lic,,) U6ilj;,t, Udl)' (The Attaching Clause ne.mPleted only when this endorsement Is Issued subsequent .aratlon of the policy.) LIABILITY L.333 Rev. 10.80 MASTER PAK ENDORSEMENT :.. This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following designated insurance: COMPREHENSIVE GENERAL LIABILITY INSURANCE This endorsement, effective 5-31-86 (12:01 A. M., standard time) issued to Clearwater Beach Seafood, Inc. West American Insurance Company by , forms a part of policy No. GLW 13 59 89 End. #7 6-9-86/l1I'l/JN/DlVS AIM Insurance Agency, Inc. 09 00 1301 Authorized Representative SCHEDULE Personal Injury and Advertising Injury Liability Aggregate Limit. shall be the per occurrence bodily injury liability limit unless otherwise indicated herein. Limit of Liabillty $ 500 ,000 Aggregate Limit of Liability-Premises Medical Payments Coverage: $1,000 each Person unless otherwise indicated herein $ Limit of L1ability..:.-Fire Legal Liability Coverage: $50,000 per occurrence unless otherwise indicated herein: $ !'ach person. per occurrence. Advance Premium Three Year Premium 1 Yr. Minimum Premium 3 Yr. Minimum Premium $ 558. 500. I. CONTRACTUAL LIABILITY COVERAGE (A) The definition of incidental contract is extended to include any contract or agreement relating to the conduct of the, named insured's business. (8) The insurance afforded with respect to liability assumed under an incidental contract is subject to the following additional exclusions: III to bodily injury or .pr~perty damage fo.r which. t~e insured has assumell liability under any inCidental contract, If such Injury or damage occurred prior to the execution of the incidental contract; (2) if the insured is an architect, engineer or surveyor, to bodily injury or property damage arising out of the rendering or failure to render profes- sional services by such insured, including la) the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs or specifications, and Ib) supervisory, inspection or engineering services; (3) if the indemnitee of the insured is an architect, engineer or surveyor, to the liability of the indemnitee, his agents or employees, arising out of la) the preparation or approval or the failure to prepare or appro~e maps, drawings, opinions, reports, surveys, change orders, deSigns or specifications, or Ib) the giving of or failure to give directions or in~t~uctions .by the indemnitee, his agents or employees, prOVided such giVing or failure to give is the primary cause of the bodily injury or property damage; (4) to any obligation for which the insured may bp. held liable in an action on a contract by a third party beneficiary for bodily injury or property damage arising out of a project for a public authority: but this exclusion does not apply to an action by the public authority or any other person or organization engaged in the project: 151 to bodily injury or property damage arising out of operations, within 50 feet of any railroad property, affecting any railroad brid~e or trestle. tracks, road beds, tunnel, underpass or crossing: but this exclusion does not apply to sidetrack agreements. IC) The following exclusions applicable to Coverages A (Bodily Injury) and B IProperty Damage) do not apply to this Contractual liability Coverage: (bl, Ic) (2), Id) and Ie). (4) to personal injury or advertising injury arising out of libel or slander or the 'publication or utterance. of . defamatory or disparaging material con. cermng any person or orgamzatron or goods, products or services or in violation of an individual's right of privacy, made by or at the di'rection of the insured with knowledge of the falsity thereof: (5) to personal injury or advertising injury arising out of the conduct of any partnership or joint venture of which the insured is a partner or member ~nd which is not designated in the declarations of the policy as a named Insured: (6) to advertising injury arising out of (al failure of performance of contract, but this exclusion does not apply to the unauthorized appropriation of ideas based upon alleged breach of implied contract, or (b) infringement of trademark, service mark or trade name, other than trtles or slogans, by use thereof on or in connection with goods, products or semces sold, offered for sale or advertised, or (c) incorre~t description or mistake in advertised price of goods, products or servIces sold, offered for sale or advertised: (]) with respect to advertising injury (a) to any insured in the business of advertising. broadcasting, publishing or telecasting, or (bl to any injury arising out of any act committed by the insured with actual malice. IC) Limits of Liability Regardless of t~e ~u.mber of (1) insureds hereunder, (2) persons or organiza- tIOns who sustain Injury or damage, or (3) claims made or suits brought on account of personal injury or advertising injury the total limit of the company's liability under this coverage for all damages shall not exceed the limit of liability stated in this endorsement as "aggregate". (0) Additional Definitions "Advertising I~Jury" means !njury arising out of an offense committed during the ~olrcy .perlod occurrrng. In the course of the named insured's advertising actiVities, I' such- inJury arISes out of libel, slander, defamation, violation of r!ght of privacy, piracy, unfair competition, or infringement of copyright, htle or slogan. 11_ .." . . ., (The Attaching Clause. completed only when this ~ndorseme;t is Issued SUbSeqUepreparatlon of the polley.) LIABILITY L 9109 (Ed. 7.66) G 109 ADDITIONAL INSURED (Premises Leased to the Named Insured) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABIlITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABIlITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABIlITY INSURANCE STOREKEEPER'S INSURANCE This endorsement, effective 5-31-86 (12:01 A. M., standard time) , forms a part of policy No. GLW 13 59 89 End. #8 6-9-86 /mvs issued to Olearwater Beach Seafood, Inc. by West American Insurance Oompany AIM In SCHEDULE Premiums Bodily Property Injury Damage liability liability Designation of Premises (Part Leased to Named Insured) 37 Causeway Blvd. Clearwater,lll. 33515 Name of Person or Ollanization lAdditional Insured) City of Clearwater P. O. Box 4748 Clearwater, Fl. 33518 582. Incl. It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated above, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises designated above leased to the named Insured, and subject to the following additional exclusions: The insurance does not apply, 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises; 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated above. ..... \ \ / --...... cThl Attlchln. CIIUH nlld bee.ted on., wIltll tltll "'~~nt 'I I":'" .u....quent to .left of tilt polley.) LIABILITY 1111 PRODUCTS HAZARD REDEfiNED Ll194 (Ed. 7"'1 This endorsement modifies such insurance as is aflorded by the provisions of the policy r,'atinl to the folloWinl: COMPREHENSIVE 'ENEUL LIABILITY INSURANCE COMPLnED OPEUTlONS AN. PlODUCYS LIABILITY INSURANCE ,./ This endors.m.nt, eflective 5-31-86 (12,01 A. ..., .tandard tlllll) . forms a flirt of policy No. GLW 13 59 89 End. #9 6-9-86/MM/JN/mvs Clearwater Beach Seafood, Inc. West American Insurance Company AIl!... In~;y mmm .??l:l()~~l Aulhorl.. IIlpre Inl.11 Refreshment Stands - no hawking or peddling - no ..lCtlptl...fPr..lm ..d Oper.tlt.s: beverages or food. served for cons~tion on the premises - Code #58131 Restaurants - with sale of alcoholic beverages that areeless t~an ?~ of the total annual receipts of the resta~ragt - It is agreed thIXift~1A<ie1it~o _ijl, J~Rtf _II' arising oul of the n....d illsand's pr.ducts manuf.tluM@Qfl. .ia~~tributed III on, from or in connetlion with the use of .ny premis.s described in this endorsement, or (2) in conn.ction with the conduct of any operation described in Ihis endorsement. when conducled by or on behalf of the ...11I IM..II, the definition of "preducts hmrll" is .mended to read as follows: "predacts h.zard" includes lI.dll, I.jary and ,r.,.rtr ....... arising oul of (a) Ihe nallled insur.d's ,rlducts or (bl relianc. upon a representation or warranty made wilh respect Ih.r.to; bul only if lhe klllil, "'jlry or pr.pertr ...... occurs after physical possession of such products has been r.linquished to others;" Issued to by \ ~, ',- ....... . .----..., . LI~BIUTY r (The Attaching Clause need.mll,eted only when this en:orsement ~s Issued SUbSeqUen.eparetlon of the policy.) , " Additional Premium $ 27. GL 04 19 (Ed. 09 821 HIRED AUTOMOBILE AND NON-OWNED AUTOMOBILE LIABILITY INSURANCE ENDORSEMENT L J349 (Ed. 9-82) . This endorsement modifies such insurance as is afforded by the prOVisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', lANDLORDS' AND TENANTS' LIABILITY INSURANCE " This endorsement, effective c;-,n-86 (I{,'Ol "( M., standard time) , forms a part of policy No. GLW 13 59 89 Clearwater Beach Seafood, Inc. End. #10 6-9-86/MM1JN/DlTS Weet American Insurance com:;:I,t1. u 9'?~.~?~~u. . r~.QClu)'291 AUlh!~epresentatl e SCHEDULE Issued to by Jnsurance is prOVided only with respect to those coverages for which a specific premium charge is shown: Coveraa;e Advance Premium Non-Ownership liability $ 27. Hired Automobile liability $ Incl. NON-OWNERSHIP LIABILITY The insurance applies to bodily injury or property damale arising out of: The use of any non-owned automobile In the business of the nlmed In- sured by any person other than the named insured. HIRED AUTOMOBILE LIABILITY The insurance applies to bodily injury or property damage arising out 01: The maintenance or use of hired automobiles in the business of the named Insured by the named insured or an employee of the named Insured. With respect to the insurance provided by this endorsement: 1. The exclusions, other than exclusions (0, (gl, m, and the Nuclear Energy liability Exclusion (Broad Forml are replaced by the following: (a) to liability assumed by the insured under any contract or agree- ment; (b) to bodily injury to any employee of the insured arising out of and in the course of his employment by the insured or to any obligation of the insured to indemnify another because of dam- ages arising out of such injury, but this exclusion does not apply to any such injury arising out of and in the course of domestic employment by the insured unless benefits therefore are in whole or in part either payable or required to be provided under any workmen's compensation law; (c) to bodily injury or property damage arising out of the ownership, maintenance, operation or use of any non-owned automobile used in the conduct of any partnership or joint venture of which the insured is a partner or member and which is not designated in the policy as a named insured; (d) to bodily injury or property damale resulting from the handling of property (1) before it is moved from the place where it is accepted by the person usi ng a non-owned automobile or a hired auto. mobile for movement into or onto the automobile, or (2) after it is moved from a non-owned automobile or a hired automobile to the place where it is finally delivered by Ihe person using the automobile; leI to bodily injury or property damale resulting from the movement of property by a mechanical device (other than a hand truckl not attached to the hired automobile or non-owned automobile; lh) to property damale to (1) property owned or being transported by the insured or (21 property rented to or in the care, custody or control of the insured, or as to which the insured is for any purpose exercising physical control. 2. The "Persons Insured" provision is replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: la) the named insured; (bl any other person using a hired automobile with the permission of the named insured, but with respect to bodily injury or property damage arising out 01 the loading or unloading thereof such other person shall be an Insured only if he is: (II a lessee or borrower of the such automobile, or (2) an employee of the named Insured or of such lessee or borrower; (c) with respect to a non-owned automobile, any partner or execu- live officer of the named Insured, but only while such automobile is being used in the business of the named insured; (d) any olher person or organization, but only with respect to his or its Ilabi Iity because of acts or omissions of an insured under a, b or c above. None of the following is an Insured: (al any person engaged in the business of his employer with respect to bodily injury to any fellow employee of such person injured in the course of his employment; (bl any partner or executive officer with respect to an automobile owned by such partner or officer or a member of his household; (c) any person while employed in or otherwise engaged in duties in connection with an automobile business, olher than an automo- bile business operated by the named insured; (dl the owner or lessee (of whom the named insured is a sublessee) of a hired automobile or the owner of a non-owned automobile or any agent or employee of any such owner or lessee. 3. The "Definitions" provision is amended to include the following definitions: "automobile business" means the business or occupation of selling, repairing, servicing, storing or parking automobiles; "hired automobile" means an automobile nol owned by the named insured which is used under contract in behalf of, or loaned to, the named insured provided such automobile is not owned by or registered in the name of (al a partner or executive officer of the named Insured or (b) an employee or agent of the named insurfd who is granted allowance 01 any sort for the use of such automobile; "non.owned automobile" means an automobile not owned by, reg- istered in the name of, hired by (or used under contract in behalf of) or loaned to the named insured; provided that, if the named insured is a partnership, such automobile is not owned by or registered in the name of a partner thereof. 4. The "Other Insurance" condition is replaced by the following: The insurance afforded by this endorsement shall be excess insur- ance over any other valid and collectible insurance available to the insured. / ~, '.',,- '--...- -(TM Attaching Clause neeemPleted only when this endorsement is issued sUbsequent.arallon of the polley.) LIABILITY G 109 ADDITIONAL INSURED (Premises Leased to Ihe Named Insured) L 9109 (Ed. 7.66) This endorsement modifies such insurance as is aHorded bj Ihe provisions (If the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' L1ABIUTY INSURANCE OWNERS', LANDLORDS' AND TEHANTS' LIABILITY tNSURAHCE STOREKEEPER'S II.SURANCE This endorsement, effective 5-~1..a6 (12:01 A. M., standard lime) . forms a part of policy No. <WI 13 59 89 Bnd. 18 6-9-86/IIVn/IlVI issued to Oieannat.r Beach Seafood., Ine. by West American Ineurance Oompany Ant Inwrance Agenc7. Ino. 09 00 1301 AlIihorlii;.j' Rejiii;seiiii.iiv,;.... SCHEDULE Bodily Injury Liability Premiums Property Dama~e liability Designation of Premises (Part Leased to Named Insur~d) Name of Person or Ollanization (Additional Insured) ~ Incl. ,;l7 ~ ') l' { c'r'''I (t . 37 Caue...,1Q' Blvd. Clearwater ,11. 33515 City ot Olearwater P. O. Box 4748 Olearwater. 11. '3518 It is agreed that the "Persons Insured" provision is amended 10 include as an insured Ihe person or organization designated above, but only with respect to liability arising oul of the ownership, maintenance or use of that part of the premises designaled above leased to the named Insured, and subject to the following additional exclusions: The insurance does not apply: 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises; 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated above. .. ~ cTh~ Alllthln' 'C'IUII n..eMlllltld onlJ w~," thll Indorll",lnt II IliUM IUbllqUent.parlllon of till polltJ.) LIABILITY U11 PRODUCTS HAlARD REDEfINED lllM (Ed. 7"6/ This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following; COMPREHENSIVE llENERAL L1AIllITY INSURANCE COMPLETED OPERATIONS AND 'RODUCTS L1AIILlTY INSURANCE This endorsement, effective '-~l-86 (12:01 A. M., IUndard IIml) , forms a part of policy No. QLV 13 59 89 bl. 19 6-9..../IttV.TIf/aY. issued to Clearwater Beach Seatood. he. V.at Aaer1can InlNrance CoaPIlD7 by AD! Inwranc. AS.no7. Iu. 09 00 l~l .............. "Aulho;i"dii,p;,'i,iii,'iiy,' ........ ..... ........................... Betroshmtnt BtllDd.. - no h.vk1Da or ~ pt44liDI - no Description of Prolltim Ind Operations: blverngG8 or food served tor Con.llUllftlon on the premi... - Cod. #581'1 Re.taurants - _ith ..le ot alcoholic beverag.. that arel... than ?" of the total annual roceiptR ot the re.~.~t_- It is agreed tha~~rRsiel~i!fo fAMI, I~RS1~ dl;'le arising out of Ihe n.med insurtd's preducts manufactuJt~., ~i5atributed (lion, from or in connection with the use of any premises described in this endorsement. or (2) ;n connection with the conduct 01 any operation described in Ihis endorsement. when conducted by or on behalf of the ..llIed hll.,.d, the definition of "products haard" is amended to read as follows. "preducts hazard" includes bodily Injury and property damal' arising oul of lal Ihe named insured's preducts or (bl reliance upon a representation or warranty made with respect thereto; but only il Ihe bldily in/.ry or preperty 1I.male occurs after phys;c./ possession of such products has been relinquished to others;" .. " LIABILITY (;he A~tachlng CI~use need ePleted only when this endorsement Is Issued ~ubsequent .aratlon of tha policy.) L 8349 (Ed. 9-82) Additional Premium $ ~. GL 04 19 (Ed. 09 82) HIRED AUTOMOBILE AND NON-OWNED AUTOMOBILE LIABILITY INSURANCE ENDORSEMENT This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL L1ABJLITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABIlITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE This endorsement, effective (l~~~~ard time) , forms a part of policy No. (11M l' 59 89 :Ind. 110 6-9-86,IJIVJI'/_. Clearwater Beach Seatood. IDe. Ve.t Amerioan Inauranoe O~ A~._~.~~~~_~__~6!~_l_t.._!~~_!__.~__~.__~'-91 Authorized Representative Issued to by SCHEOULE Insurance is provided only with respect to those coverages for which a specific premium charge is shown: Coverage Advance Premium Non-Ownership liability $ 27. Hired Automobile liabilily $ Incl. NON-OWNERSHIP LIABIlITY The insurance applies to bodily injury or property damage arising out of: The use of any non-owned automobile in the business of the named in- sured by any person other than the named insured. HIRED AUTOMOBILE LIABILITY The insurance applies to bOdily injury or property damage arising out of: The maintenance or use of hired automobiles in the business of the named insured by the named Insured or an employee of the named Insured. With respect to the insurance provided by this endorsement: 1. The exclusions, other than exclusions (I), (g), m, and the Nuclear Energy liability Exclusion (Broad Form) are replaced by the following: (a) to liability assumed by the insured under any contract or agree. ment; (b) to bodily injury to any employee of the Insured arisinR out of and in the course of his employment by the insured or to any obligation of the insured to indemnify another because of dam. ages arising out of such injury, but this exclusion does not apply to any such injury arising out of and in the course of domestic employment by the insured unless benefits therefore are in whole or in part either payable or required to be provided under any workmen's compensation law; (c) to bodily injury or property damage arising out of the ownership. maintenance, operation or use of any non-owned automobile used in the conduct of any partnership or joint venture of which the insured is a partner or member and which is not designated in the policy as a named insured; Id) 10 bodily injury or properly damage resulting Irom the handling of property III before it is moved from the place where it is accepted by the person using a non-owned automobile or a hired auto- mobile for movement into or onto the automobile, or (2) after it is moved from a non-owned automobile or a hired automobile to the place where it is finally delivered by the person using the automobile; leI to bodily injury or property damage resulting from the movement of property by a mechanical device (other than a hand truckl not attached to the hired automobile or non.owned automobile; (h) to property damage to III property owned or being transported by the insured or (2) property rented to or in the care, custody or control of the insured, or as to which the insured is for any purpose exercising physical control. 2. The "Persons Insured" provision is replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: (al the named insured; (bl any other person using a hired automobile with the permission of the named insured. but with respect to bodily injury or property damare arising out of the loading or unloading thereof such other person shall be an Insured only if he is: III a lessee or borrower of the such automobile, or (2) an employee of the named Insured or of such lessee or borrower; (e) with respect to a non-owned automobile, any partner or execu- tive oHicer 01 the named insured, but only while such automobile is being used in the business of the named insured; Cdl any other person or organization, but only with respect to his or its liability because of acts or omissions of an insured under a. b or c above. None of the following is an Insured: (~) any person engaged in the business of his employer with respect 10 bodily injury to any fellow employee of such person injured in the course of his employment; (bl any partner or executive oHicer with respect to an automobile owned by such partner or officer or a member of his household; (e) any person while employed in or otherwise engaged in duties in connection with an automobile business, other than an automo- bile business operated by the named insured; (dl the owner or lessee (of whom the named insured is a sublessee) of a hired automobile or the owner of a non-owned automobile or any agent or employee of any such owner or lessee. 3. The "Definitions" provision is amended to include the following definitions: "automobile business" means the business or occupation of selling, repairing. servicing, storing or parking automobiles; "hired automobile" means an automobile not owned by the named insured which is used under contract in behalf of, or loaned to, the named insured provided such automobile is not owned by or registered in the name of (al a partner or executive oHicer of the named insured or (bl an employee or agent of the named insured who is granted allowance of any sort for the use of such automobile; "non. owned automobile" means an automobile not owned by, reg. istered in the name of, hired by (or used under contract in behalf oil or loaned to the named insured; provided that. if the named insured is a partnership, such automobile is not owned by or registered in the name of a partner thereof. 4. The "Other Insurance" condition is replaced by the following: The insurance aHorded by this endorsement shall be excess insur. ance over any other valid and collectible insurance available to the insured. !ssued by T~e Stock Company Herein Called The I' mpany WEST AMERICAN INSURANCE COM NY 2420 EAST LINCOLN A.VE ~NAHEIM CALIF 92806 INCORPORATED UNDER THE LAWS OF CALI FORtH A AGEWNUMBER POLICY NUM,aER I ~ . I 09-00- .. OlWCW (87) 400-04-92 (9 J~~ra2Ql~p.s~sua'ty Group INFORMATION PAGE WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY Item 1. NAMED INSURED & MAILING ADDRESS PRODUCER'S NAME & MAILING ADDRESS CLEARWATER BEACH SEAFOOD INe AIM INSURANCE AGENCY tNe 37 CAUSEWAY BLVD P 0 80X 5025 CLEARWATER FL 33515 CLEARWATER Fl 33518 I INSURED IS CORPORATION PREVIOUS POLICY NUMBER wew (86) 400-04-92 Locations - All usual workplaces of the insured at or from which operations covered by this policy are conducted are located at the above address unless otherwise stated herein. SEE ATTACHED SCHEDULES OF OPERATIONS. Item 2. POLICY PERIOD 12m.A.M. standard time at the address FROM 05/31/86 TO 05/31/87 I of the Insured as stated Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: FLA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100.000 each accident , Bodily Injury by Disease $ 500.000policy limit Bodily Injury by Disease $ loo.oooeach employee .. C. Other States Insurance: Part Three of the policy. SEE ATTACHED ENDORSEMENT NONE Item 4. 2n~~~~!~~9s~T~~,Nex~~t ~n~C~T~~I~~rovided elsewhere in this policy, do nof modify any of the I I . Estimated Total I Rate per Estimated Code No. Remuneration $100 of Re- Premium other provisions of this policy. Ii Annual 0 3 Year muneratlon Xi Annual 0 3-Year STORE: MEAT, FISH OR POUlTRY - RETAIL 02 8031 !O,OOO 5.87 1,761 RESTAURANT NOC 05 9079 116,000 3.80 4,408 PREMIUM DEVIATION ( 15.0~ ) 925 PREMIUM AFTER DEVIATION 5,244 TOTAL ESTIMATED ANNUAL STA.NDARD PREMIUM 5,244 PREMIUM DISCOUNT, IF APPLICABLE .1 t ( Sl = EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) 85.00 MINIMUM PREMIUM $ 349 FLORIDA I TOTAL ESTIMATED PREMIUM 5.324.00 If indicated below, interim adjustments of premium shall be made. n Semi-Annually n Quarterly o Monthly Deposit Premium $ 5324.00 ENDORSEMENTS (FORM NUMBER) WCOO0308 CW3001 I Issue Date04/18/86 05 Sf PETERSBURG BRANCH OFFICE Authorized Representative Copyright 1983 National Council on Compensation Insurance. e. 3010 (We 00 00 01) INSURED'S COpy 111111_1- ..lIIIiii WORKERS CO~PENSATION A.EM PLOYERS LIABILITY INSURANCE plCY WC 00 03 08 (Ed. 4-84) PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT The policy does not cover bodily injury to any person described in the Schedule. The premium basis for the policy does not include the remuneration of such persons. You will reimburse us for any payment we must make because of bodily injury to such persons. Schedule Partners Officers Others WIlJ.W1 F. (DDfIH ~ v. amaH PAESJIBT SB;/TI9S This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Q)/31/B6 Policy No. tOl (87) 4(X)..(M-~ Endorsement No. Insured Q.EAIWUER B90I SfARXI) DC Premium $ Countersigned By OCJ..OO- 1:1>1 we 00 03 08 (Ed. 4-84) Copyrlghl1983 Nallonal Council on Compensallon Insurance. iv~KERS C~ENSATION AtMPLOYERS LIABILITY INSURANCE pot CW 3001 lEd. 4-84) PREMIUM DISCOUNT ENDORSEMENT - FLORIDA The premium for this policy and the policies, if any, listed in item 2 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in item 1 of the Schedule. The final calculation of premium dis- count will be determined by our manuals and your premium basis as determined by audit. Premium subject to ret- rospective rating is not subject to premium discount. Schedule Estimated Eligible Premium Discount Percentage First $5,000 NIL Next $95,000 2.0% Next $400,000 4.0% Balance 6.0% 1. 2. Other policies: 3. If there are no entries in items 1 and 2 of the Schedule see the Premium Discount Endorsement attached to your policy number: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policV.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Countersigned By Includes material of the National Council on Compensation Insurance, copyright 1983 used with its permission. to " ... I ~ !. t1h.lt.ENtLOSURE . , . ;r:iiis~".;fOil~Ybui',records~' Date: ':~>/f;~11F;tf:f;,;';~. .... . 'i;dl>J;;?~' endosed contains 8 Mortgage Clause, or Loss Payable dause <J.i;, .:it~~lnyour, favor. ' , '-:>":'~i;'/~-;~.~>~_;":il'" ,:,:<:~ . . 71J1(~6:; Addlttohel "nlut.d "" ,~'.4, __ ,_..4o I :..lr ~d~'..." INsqMNe~~~ENq~lNc~" " . .... I :.20 tYPAl' ~~iL;i~lli:i": . , .,. P.'o!:8()WlO..\"'\":': "tJ~ml , CLWtWAfeA.~LO'.tIOA ;a:JGi.~"sJ''':;:i'! . ." ~I (.131181.......,: ";:':!"f;'f::!~i::i':>:.' .~r*"PI,...j. ?0r.;'..ftt..'~.'. ...,.,r.... t.~,..:. ."': . ._..-..-..<........_._..___.__4..--.......____ ._..._......__._...J...~2.': ~..~... I' .. ;;;;; ;;::;;;;;; ;;;..= :::~.::: =. .M.....~.Jo .C'8eO(at,r Beach Seafood ~J r<;; ..;>.; '- - ~,. Travelers Insuranc."650-607G812~I-TRI-86 .. ... ~. :~ .. -,. .. , \, I '. .. "