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MEMO REGARDING RENEWAL OF LEASE & INSURANCE POLICY I ~ )1 I :,..-.,' ,'/.-' I?, r!, c ~ I ,-' C I T Y OF CLEARWATER POST OFFICE BOX 4748 C LEA R W ATE R, F LOR IDA 3 35 1 8 OFFICE OF HARBORMASTER September 26, 1984 Mr. & Mrs. Al S. Allison 225 Country Club Drive Apt. 221 Largo, FL 33541 ~ r, t>~".E: ~~"../l.: ~ ~ cu ~'~ 1984 Dear Mr. & Mrs. Allison: ~::1TY CLERK On July 13, 1984, you requested a five-year renewal of your curr~nt lease on the Colony Marina Restaurant. Your request is being deferred pending city action on the mar1na architectrual study currently in process. Following city decisions on recommendations of the study, your request will be reconsidered. On September 20, 1984, the city commission authorized extension of your current lease on a month-to-month basis pending resolution of the architectural study. Please continue with your enterprise and I will advise you of any additional actions you may need to take. Sincerely, /' ~r- /j7J?-~~ -'---,~- - B. R. Burchhel') Harbormaster . BRB:mm Enclosure: Commission Agenda Item cc: Thomas A. Bustin, City Attorney Elizabeth S. Haeseker, Assistant City Manager Lucille Williams, City Clerk ..~ Sfteed = JfI(}/Jl,(} ~~Bc/.' , .1 Colony Marina Restaurant, Inc. I tf-6- ~ b 13 C!.- ~/& 4/9/84 Enclosed you will find a copy of the insured1s policy, if this is not sufficient please contact me at 442-2137. r City of Clearwater TO 25 Causeway Blvd. Clearwater, Fla. 33515 L ATTN: Bill Held Co11ene Barnhouse ~~'-Z- CITy OF . ~RWATER APR ( HA.RBoR !) 1984 ~A.STE.R. 'S OFFICE. ~ t RHODES INSURANCE AGENCY, INC. POST OffiCE lOX 51606 CLEARWATER. FLORIDA 33518 Phon.. 813.442-2137 ,~ QCCt:.\"t:.O \ "G J.~v ~, \. ,,} \?;'OOc \ '\ ",~'\" O_t-.?'A i\ \0-'\"1 s- . I . rr ~ j' t < 1--- I. INStJ"ANC[ '-....' .!-.~ t:u;n \~ ~ ~ POLICY HUMBER AMO-8533 AMERICAN LIBERTY INSURANCE COMPANY DeCLARATIONS - PREMISES / OPERATIONS LIABILITY ITEM ONE NAMED INSUREDColO1lYMad,~. ....tarat. I... ADORESS 71-75 C~~lllft. - Cl..rwter. rr. 33515 FORM OF NAMED INSUREO'S BUSINESS' I%l CORPORATION; 0 PARTNERSHIP; 0 INDIVIDUAL orO OTHER NAMEDINSURED'S BUSINESS: llan....rall!: POLICY PERIOD: FROM 12/2~/8~_TO AUDIT PERIOD: 12/21/1. ANNUAL. UNL.ESS OTHERWISE STA TEDl 12:01 A,M. StOlldorel Time of the Nomed I".ur.d'. Add,... .toted oboye. ITEM TWO SCHEDULE OF COVERAGES: Tbe insurllnce a(forded h on 1\' w.th re"pf'cl 10 'tlJch or tbe rollowing Coverages IS are indicated by!iland attached to and rorming a part or this policy. The IIm.t "I th,' C"mI'AnY'9 liability against each such Coversge shall be as sfated herein, subject to all the terms or 'this polley havinl1: ,..r.".,",-,- th...elo. ----- Po lie No. X COVFIUGF PARTS LIMITS OF LIABILITY -----.---- -_._-- Bodily Injury Li.bility: sl00 ,000 Each Occurrence sl00 ,000 Aggregate A-2 X Comp,ch""!Ii\'I' (;pnf'.nl I .iahi Illy Insurance Property Damage LiabUlty: S 50 ,000 Each Occurrence S 50 ,000 Aggregate A-3 X AmendAto,y Endn,s..,.,..nt.. (CClL) A-4 Premise!l Med,cAI Paymenls In!lur.n('e See Coverage Part Spf'cial Multi, P<'ri I Po Iiey See Division 'c' A-6 Personal Inju,v Liahihly Insu,ance See Coverage Part A-7 Storekt"epe'r'!l InSllrallCt" See Coverall" Part A-8 Druggist!l' Liability I"!lu..nce See Coverale Part A-tO Contractual I.llIolI.,y In!lmancf' See Coverage Part Garage Insurance' See Division 'B' A-t2 Nu'sin~ Home f'rofe's!llC'nal Linoility In!lurance See Coverage Part A-t3 Funeral Dirf'cfo.'" p".f......io".1 Liabilily Insurance See Coverage Part ------_._- A-t4 Vrlerlnllrla"'r, I'rnfr,,~,i"'"al I.iahllity In!!urance See Coverage Part --- 01her See Coverage Part --, --.- -- -. ----- FORM NUP,1BEHS OF FNrl(IR~ I '11:""" S, ()TlIlll THAN THOSE ENTERED or; ( "\')'lV,!': pART(S). ATTACHED AT ISSUE: ctOO19(7-78) JJ9194(7-66) \ Absence or an fiJ In lh.. ("ov..r:'1~"" ...., "OVf"rllgf" part'l shown above indicates such coverage part is not p1'Ovided in thla policy. Thoae , !!hown by an [1C) will be affix.'" 8'1 A r,ul'pll'menl to Ihis Declarations Page. Tbe!!e declaration!! are compl"lf"d oy . dltorlo!lure or all hazards known to exist at the inception or thia policy. Such Description or H.zards schf'dul"!1 ar.. A" P'" NAme.. In!lu,..,I'.. application, or aigned renewal inatructiona, on rile witb the Company. Cover.ge I. restricted to tho!lt" bararrl!l An.1 expo!lure..; except th.t newly acqulr dered next anni- versary rating date rollowing ~H1ch acquisition, o COUNTERSIGNED AT Cl..nraur. n. DATE Juuary 6 19~ BY Dou. I... ~. SG-54S 6-1s A . " '1 " ". f ~,'(~ .' <, I t.."" I t .,! .. . .' ... ~ I \ .. ' " '" .. " " .. " . . , ~-"'-- - - - -- ---,-- -- - -_. - --------- . we AMENDMENT ENDORSEMENT AMERICAN LIBERTY INSURANCE COMPANY DIV. D Thi$ endorsement is issued for attacnment to ond fOI m, n port 01 tne h<>low numbered policy, effective on tne dote indicated. All terms and conditions of the policy (including any endorsement thereon) to which this endorsement is allnched ren""n unchanged except os amended by tnis endorsement. - ' Effective Dote Paltey Ne> Ay""I Countersigned (City, State) End No. 1'2/28/83 AHO-8S33 Rhodes Insurance. Clearwater, FL Named lr':\Jred Signature of Agent Colony Marina Restaurant. Inc. ~In consideration of an additional premium of $64, it is understood and agreed that the policy is amended as follows: Payroll is amended as follows: Code Classification Prem.Basis Rates Annual PreaiU1ll 9079 Resta.rant 34,067 Less 10% Deviation 3.44 1172 X.90 lOSS +35 1090 JMQ~ ,~ Expense Constant CITY Pi CLEARWATER Less Previous Deposit Additional PreBium APR 2t 1984 H4RBO~MASTERS OFFICE 11III..... . FORM A242 Ell. THE STATESMAN GROUP IN WITNESS WHEREOF, the designated company has caused this policy 10 be signe1 by its president and secretary, but the same shall not be binding upon the company unless countersigned on the declarations page( s) hy a duly authomed agent of the designated company, AMERICAN LIBERTY INSURANCE COMPANY (~ 'n..-. ~ Secretary . INSU"'A.NCl: G When both' this insurance and other ins~rJce apply to the loss on the same. basis, whether primary, excess or contingent, the company shall not be liable under this policy for a greater proportion of the loss than that stated in the applicable contribution provision below: (I) Contribution by Equal Shares. If all of such other valid and collectible insurance provides lor contribution by equal shares, the company shall not be liable for a greater proportion of such loss than would be pay- able if each insurer contribute!! an equaLshare until the share of each insurer llQualsthe lowest applicable limit of liability under anyone policy or the full amount of the loss is paid, and with respect to MY amount of ,loss not so paid the remaining insurers then continue to contribute equal shares of the remaining amount of the loss unti I each such insurer has paid its limit in full or the full amount of the loss is paid (b) Contribution by limits. If any of such other insurance does not provide for contribution by equal shares, Ihe company shall not be liable lor a greater proportion of such loss than Ihe applicable limit of liability under this policy for such loss bears to the lotal applicable limit of liability of all valid and collectible insurance against such loss. 7, SubfOlltton: In the evenl of MY payment under this policy, the Compr ny shall be subrogated to all the insured's riRhts of recovery therefor against any person or organization iIld the insured shall execute iIld deliver instruments and papers anddo 'htlatever else is necessary to secure SUch rights. The Visored shall do nothing after loss to prejudice such ri~ts. 8. Chances: NOtice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in MY part of this policy or estop the company from asserting any right under the terms of this policy; nor shall the terms of this policy be waived or changed, except by endorsement issued to form a part of thiS policy, 9. Asslanment: Assignment of interesl under this policy shall not bind the company until its consent is endorsed hereon; if, however, the named o \. '--,,' t> \.I ~G-34S (6/82) insured shall die, slh insurance as is afforded by this policy shall apply (1) to the named insured's legal representative, as the named Insured, but only while acting within the scope of his dutie~ as such, Md (2) wi th respect to the property of the named Insured, to the person having proper temporary custody thereof, as insured, but only until the appointment (W1( Qualification of the legal representative. 10. Three Year Policy If this policy is issued for.8 period of thrll8 years any limit of the company's liability stated in this policy as "aggregate" shall apply separately to each coosecutive annual period thereof. 11. Cancellation: This policy maY be cancelled by the' named Ins.1It by surrender thereof to the company or any of its authorized agents or by by mailing to the company written notice stating when thereafter the can- cellation shall be effective. This policy may be cancelled by the company by mailing to the named insured at the address shown in this policy, written notice stating when not less than 10 days thereafter such can, cellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice, Th! time of surrender or the effective date iIld hour of cancellation stated in the notice shall become the end of the policy period. Delivery of such written notice either by the n-.eel Insured or by the company shall be equivalent to mailing. If the named insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the com- pany cancels, earned premium shall be computed pro rata. Premium ad justment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. 12. Declarations: By acceptance of this policy, the naNd insured agrees that the statements in the declarations are his agreements and represent a- tions, that this policy is issued in reliMce upon the truth of such rp{\" sentations and that this policy embodies as agreements existing betwee, himself and the company or any of its agents relating to this insurance 1/~ President ~ ~':.",'. V ~ v TJiE A.B,C. COVERALL POLICY NO. ..,..,.533 PLAN .... PROVIDED BY ~MERICAN LIBERTY INSURANCE COMPANY DIVISION A Premises and Operations Liability Insuring Agreements " In considerati!lf' of the payment of the premium. in reliance upon the statements in the declarations made a part hereof and subject to aU of the terms of this policy. agr.. with the named insured as follows: , . DEFINITIONS . ...... used if' ltIis I'Qlicy I including endorsements forming a part hereof): "e,"aler" means any hoisting or lowering device to connect floors or ............,. means a land motor vetucle, trailer Of semt-tra,ler designed landings, whether Of not In. service, and all apclliances thereo! including 'or traWl 00 public roads (Including any machinery or apparatua attached any car, platform, shaft, holstWay, stauwey, fUllway, power equtpllent and ltIereto), Dilt does not include mobile equipment; machinery; but does not include an automGbU, servicing hoist, or a hOist ~odily=' \ ., means bodily injury. sickness or disease sustained by any without a platform, outside a building il Without .mechanical power or " pll10n OCCUI1 duringtht policy period including death It any time not attached t~ buIlding walls, or a h~ or maten~1 h~lSt used 10 altera- Iti thtrtfrom' ' lion, construction or demollllon operallons, or an inclined conveyor used, "'" AI . eKclusively lor carrying property or a dumbwaiter used exclusively for i "COllapse hlZlrd" includes "structural property damage': as delined ~arrying property a~d ~aving a compartment height .n~t exceeding fomleet, herein and ~operty damaae to any other property at any time resulting explosion Iward' Includes prOperty d.age auslng out of blasting or therefrom. ' Structural property damage" means the collapse of or struc- ex,plosion, The elplosi~ hand does not include.p~operty d_aee (1) tural injury to any building or structure due to (1) grading of INld, exca- ar~slOg out of the explOSion of au or steam. ~ssels, ~Ipmg under pressure, vating, burrowinj..lilling, back-IIlling, tunnelling, pile driving, cofferdam prtme movers,. machinery or power transmitting equlpme~t, or (0) all sing work or caisson work or (2) moving, shoring, underpinning, raising or out of operatlon~ performed '?r the named insured b~ mdependent con. demolition 01 any building or structure or removal or rebui Iding 01 any tractors, or (3) Included Within the completed OperatUlrlS .hazard or the structural support thereof. The collapse hazard does not include property underl'~d property d~~ hazard, or (4) for which liability IS assumed d.... (1) arising out of operations performed for the named Insured by by t~e Insured under an Incu'ental ~tract; , . independent contractors, or (2) included within the completed operatiClls "InCidental contract" me~ns any wr~tten m lease of premises, (2) ease. ~ard or the underground property damage hazard, or (3) for which liabil- ment a.greement, ex~ept In conn~tlon WI'" construction or. demobtlon ity is assumed by the insured unller an incidental contract; operatIons on or. adJacent to. a rallro~, (3) undertakl.ng to indemnify a " munlclpalltyrequued by muOlclpal ordinance, except tn connection With "co",,~.ted operations hazard" Includes bodily injury and. property dam- ~ork lor the municipality, (4) sidetrack agreement, or (5) elevator malnte' al' arlslOg out 01 opelatlons or reliance upon a representation or warranty nance agreement; . . made at any time with respect thereto, but only if the bodily injllY or "insured" means any person or organization qualifying as an insured In , PfOPerty dllllal' occurs alter such operations have been completed or the "Persons Insured" provision of the applicable insurance coverage. abandoned and occurs away from premises owned by or rented to the The insurance allorded applies separately to each insured against whom nam.ed Insured. "Operations" Include materials, parts or equipment fur- claim is made or suit is brought, except with respect to the limits of the nished In connection thereWith. Operations shall be deemed completed at company's liability; thl! earliest of the 10110wlO!; times: "mobile equiplIlIlIt" means a land vehicle (including any machinery or (1) when all operations to be performed by or on behalf of the named apparatus attached thereto), whether or not sel~propelled, (1) not subject 'nsured under the contract have been completed, to motor vehicle registration, or (2) maintained lor use exclusively on (2) when all operations to he performed by or 00 hehall 01 the named premises owned by or rented to the named insured, including the ways Insured at the site of the opclJlloIIS have bc~ completed, or Immediately adJOining, or (3) designed lor use principally off publiC (3) when the portion 01 the work out of which the injUry or damage arises roads, or (4) designed or maintained lor the sole purpose of affording has been put to its intended use by any person or organization other mobility to equipment of the following types lormlng an Integral part 01 or than another contractor or subcontractor engaged In perlorming opera- permanently attached to such vehicle: power cranes, shovels, loaders, tionsfor a principal as a part 01 the same project. diggers and drills; concrete mixers (other than the mix-in-transit type); Ope!ations which may require lurther service or maintenanc~ work, or graders, scrapers, rollers and other road construction or repair equipment; correctl~, repau or replacement because of any defect or deltclency, but air-compressors, pumps and generators, including spraying, welding anG which are otherwise complete, shall be deemed completed. building cleaning equipment; and geophysical exploration and well ser. The ~pleted operations hazard does not include bodily ",IIJ or vicing equipment: ' propefty:damaee arising out of , "named ins..ed" means the person or orianization natlled in Item \. 01 (a) operitionsin connection wi th the transportatIOn 01 property, unless the declarations 01 this policy; the bodily injury or property damage alises out of a condition in or on "named Inslled'~ products" means goods or products manufactured, sold, a vehicle created by the loading or unloading ttlereof, handled or distributed by ttlenamed insured or by others trading under his (b) the existence of tools, unlnslalled equipment or abandoned Of unu~ed name, including any container thereof (other than a vehicle), but ''n_ed materials, or, ,,' insured's products" shall not include a vending machine or Illy property Ic) operations for which ttle c1asslhcalloll ::tated In ttle policy or in the other ttlan such container, rented to or locate(! for use 01 others but not company's manual specllles "including completed operations"; sold; . SG-34S (1-1- 73) IN '''''ANC'' "occurrence" means an accident, including conlnllous, or repeated The named Insured shall mailt~in recorM of suchl'11:/C!;!tion 'as is nee- exposure to conditions, which results, during the POliCY period, in bodily essary lor premium computation, and shall send cople~, . -.uch records to i~ry or pr~rty ~ neith~r exp,ected nor intended from the stand- lhecompany al the end of the policy period and at such times during the pOInt of the Insured; policy terntory means, polic.v perIOd as the companv may direct. (1) the United States of America, its territories or posseSSIOns, or Canada, 2., Inspection and Audit: The company shaJl be permitted but not ooti. or gated to inspect the named insured's property and operations at any time (2) international waters or air space, provllledlhe bodily injury or proper- Neither the company's right to ~ke inspections n.or the making thellOt ly damaae does not occur in the course 01 Lravel or lIansportallon to nor any report thereon sh~1l constitute an undertaking.. on behalf of or for or from any otlft!r country, state or nation, or . , the benefit of the n8me~ Insured or others, to determine o! ~rrant. that (3) any~ere in the world with respect to damages because of bodily su~h property or operatlo~ are safe or healthful, or 1ft In complllftCl injury or property damage arising out 01 a product whICh was sold for WIth any law, rule or r1IgUlmon. " . ' use or consumption within the territory described in paragraph (1) The company ,may ex~m,"e and ,audit t~e -- m~s books and aboyeproyided the original suit for such damages is brought within re,co~s at any time dUllng t~e p011cr penod and, exte~slons 1hereoln such territory;' WIthin three years after the final. t~rmlnatlon of thiS policy" as far as they "products hazard" includes bodily injury and property damage arising relate to the sublect matter of thiS Insurance. out of the named Insured's products or reltanceupon a representation or 3. RESERVED FOR FUTURE USE ..,anty made at any time with respect thereto, but only if the bodily IIlury or properly damage occurs away trom premIses owned by or rented "' to the named insured and after phYSical possession of such products has been relinquished to others; -1lfOIIIrtv ........" mellM (1) physicalinjwy 10 or rleSlHlction Ill" tangible property which occurs during the policy pmiod, IIIl:hlfling Ihl! loss III use thereof at any time resulting therefrom, 1II (7) 10$.0; 01 use of tangible property which has not been physically injured nr, deslrnyed p'lIvided such loss of use is c=n occumnce durin!! the policy period; .........d ' dim... hlzmI" includes underground property ... as defiiled herein and property damage to any other property at F6IV tIme resulting therefrom. "Underground property damage" means .....-rtY ....... to wires, conduits, pipes, maios, sewers, tanks, tunnels, Il1V similar property, and any apparatus in connection therewith, beneath the slirface of the qround or water, caused by and occurring during the use of mechanical equipment for the purpose 01 grading land, paving, exca- vating. drilling. burrowing. filling, back-lilling or pile driving, The under- ...."d property dime.. huerd does not include property dam..e (11 Ifising out of operations per10rmed lor the named insured hy independent contractors, or (21 included within the completed operations hazard'or (31 for which liability is assumed by thl! insured uodm 0111 incidental contract. SUPPLEMENTARY PAYMENTS The company will pay, in addition to the applicable limit olliabiltty: (al all expenses incurred by the company, all costs taxed against the Insured in any suit defend~~ hy the company and all interest on the entire amount of any judgr;:.. therein which accrues after entry of the judgment and before the co",pany has paid or tendered or deposiled in court that part of the judgment which does not exceed lhe limi t of the company's liability thereon; Cb) premiums on appeal bonds requlled in any such suil, premiums on bonds to release attachments in any such su11 lor an amounl nol in eKcess of the applicable limit olli<lbillty 01 this policy, c) eKpenses Incurred by the insured lor 111<6\ aid to others at the lime 01 an accidenl, for bodily injury to whi ch thiS policy <lpplies; \U/ IIl8Sonablll elCpenses incurred hy lhn insured al Ihn r.lllllpanv's fllqUOS\ in assisting the company ill ttll! inVl!sllqalllJlI IIr dldl!II\P III allY dalln or suit, including actual loss 01 earnlll!IS nlll '" I'W!f)d $i'!. PI!1 day, CONDITIONS 1. Premium: All premiums for this policy sh<lll be computcd III <lccordance with the company's rules, rates, r<lting plans, premiums and minimum premiums applicable to the insurance <lllorded heretO, Premium designated to lhis poliCY <IS "<ll1v<lllce premlulII" IS a deposit premium only which shall be credIted to till' ;\Il111UIlI 01 tht: f',1I111~11 prcmlum clue althe end 01 the policy perIOd. ^' the close 01 e<lc:h IJeltod (or IJart thereof terminating with the end 01 the policy peltolll Itl";II~Il<ltcd III the declarations as the audit pellod the (!arll(,llllIt~lIll1l11 sh<lll hI' computed lor such period and, upon nohce thereol to lhl' named insured, :;h.11I become due and payable, If the folal earned prenllllm tor the policy pellod is less lban the premium previously paid, the company shall return 10 the named ilsurecl the unearned portion paid by tbe named insured. 2 lJ u 4. Insured's Duties in the Eyent of Occurrence, CIIl. ar SuIt: (a) In the event 01 an occurrence, written notice containing particulars suffiCient to idellllfy the insured and also reasonably obtainable infor- mation with respect to the time, place and cifcumstances thereof, and the names and addresses of.the injured and of availmle witnesses shall be given bv ,'r for the insured to the company or any of its author: ized agenls a'.)il as practicable. The n-.ed insund shall promptly take at his p.',!1se all reasonable steps to prevent othe~ bodily Injury or property damage from arising out of the same Of similar conditions, !Jul such expense shall not be recoyerableunder this policy. (b) If claim is made or suit is brought against the Insured, the I... shall immediately lorward 10 the company every demand, notice, sum: mons or olher process received by him or his representative. (c) The insured shall cooperate with the company and, upon the cOlllPlllY's requesl, assist in making settlements, in the con,duct of suits and in I ,) enforCing any fight of contribution or indemnity against any person or V organization who may be liable to the insured because of bodily IIjwJ or property damage wilh respect 10 which insurance is afforded under this policy; and the insured shall attend hearings and trials and assist in securing and giving evidence and obtaining lhe altend8l\ce of wit- nesses. The insured shall not, eKcept at his own cost, voluntarily make any payment, assume any obligation Of incur any eKpense other than for first aid to others at the time of accident. 5. Action Against Company: No action sha.lllie against the company 00- less, as a condition precedenllhereto, there shall have been .tull compli- ance with all of lhe lerms ollhis policy, nor until the amount of the III- sured's obligation to pay shall have been finally determined either lay Judgment against 'I'l' insured after actual trial or by written agreemenl 01 the insured, the cl:1!.Qnt and the company. ... Any person nr (111)'illzation or the legal representative thereof who has seCllrcd such Jlldl:lIIt'llt or wlttlen agreement shall thefeafter be entitled to recover under thiS policy to the extent 01 the insurance afforded by t~is policy. No person or organization shall have any right under this policy to join the company as a party to any action against the Insured to determine the insured's liability, nor shall the company be impleaded by the Insured or his legal representalive, Bankruptcy or insolvency of the ins.eeI or of the insured's estate shall not relieve the company of any of its obligltl tlons hereunder, 6. Other Insurance: The insurance afforded by this policy is primary in-, surance, except when stated to apply in eKcess of or contingenl upon the ahsence 01 other Insurance. When this insurance is Pfimary lI'Id the in- sured has olher Instil ,lice which IS slated to be applicable to the loss on an excess or .contingent basis, the amount of the company's liability under thiS polley shall not be reduced by the existence of such other Insurance. v 5 G-345 (1-1-731 G G \ \......../ v 'I INSUR ANC E .... I NUCLEAR EMERY UAIIUTY DClUSION ENDORSEMEIIT \ItUI FOIMI This endorsement modifies the provisions of this policy relating to ALL GENERAL LIABILITY AND MEDICAL PAYMENTS INSURANCE. It is qrnd tnlt: I. This policy does not 'PIlly: A. Under IllY lilbility Cover'lI, to Itt.ily illjllfY or ,,,,erty "11'11 11I with respect tll wIlich an Illsure' under Ihls policy is also an insured undIr . nuelear energy liability policy Issued by Nuclear Energy liability lMurlllCl Association. Mutual Atomic Energy liability Underwriters or Nude. Insur.nce Assocl.tion of Canada, or would be an insured under IllY such policy but lor its ter...ination upon exhaustion 01 its limIt 01 Iilbility; or 12) flsulting from the llIZartlln ,fI..rtltS of nucl..r materill and Wllh flspect to which- lal any person or organization IS required 10 main laIR llnallCi.1 protection pursuant 10 Ihe Atomic (nergy Acl of 19~4. or any law .mendatory thereof, or lbl Ihe ill"'" is. or had Ihls policy not been issued wo\lld be. entitled to indemnity from the United Slates of Americ., or .ny .gency thereof, under any agreemenl entered inlo by the United St.tes of America, or any agency Ihereof. wllh any person or orlanization, .. Under .ny Medic.1 P.yments Coverace. or under any Supplementary P.y, IIlIl1ts provision rel.tinl to first aid, to elpens!s Incurred w,Ih respect ,to M. ..,., resullinl from the hUIf"u, ,re..rt.., of IItICIeIf ..terial .nd .risinl out of the operation of a nuelnr facility by any person or orl.nil.tion. C. Under any liability Cover'le. to "'1" illjury or pr.,erty ..... resulting Irom the lI.motllus ",..rtlt. 01 IlKI.. .at.rial. If III the ..clelflllat.rill (a) is at any nKI.. ,facility owned by, or operated by or on behalf of, an illllfl' or lb) has been discharged or dispersed therelrom; (2) the lIucle.r lIat.rial is contained in spent fuel or wast. at .ny time possessed. handled, used. processed, stored, transported or disposed 01 by or on behalf 01 an ills.r.'; or (3) the b..ily illjllfJ or 'fI,erty dam ale arises out of Ihe furnishlRg by an illslfe' 01 services, materials. parIs or equipment in connecllon with the planning, constrw:lion. m~ln'pnance. operation or use of any nucl.ar facility, but if such faclllly I~ localed wilh," !hp Unlled Sfaf~s 01 Amenca, lis leHltooes or possessions or Canada. thiS ..cluSlon (3) IIIPlies only to 'flP'rty 'alllall to such nuclear facility and .ny property thereat. II. As used in this endorsement: '"llIzIrtle.s ......rtlt." include radiolCbve, lOlic or elplosive properties; "1IC1ear llltertal" means 111m 1IIlIriII, ....11I ...... IlIItrIII Of .,. prdllCt 'IlIteri.l; "lIwe. IIItlflal", ".,.11I ..... "'lflll", IIId ~ IlIIeriII" ItIw the meanlRg~ given them ill the Atomic Enero Act of 19S4 or in .., law amendatory thereof; "slllllt luel" means any fuel element or filii compontnt, solid or liquid, wttich has been used or elposed 10 radiation in . lICit. fleetlf; "WIlt." me.ns any waste m.terill Ul cont.mine ~ IIIlIriII IlId (2) resulting Irom the operation by IllY person or or,"il.tion of any..... lacility included within the definition of ..... ICllity under par'If'ph (.) or lbl thereof; "1IC1t.r facility" .mean. 1.1 any IIKI.. fI.... Ibl any equipment or device desiped or lIIId tor Ul ..parlll"l tile isototIts 01 uranium or plutonium, (2) process in, or utililinl .,.1It flit, or 131 handlinl, processinl or packllinl wllte, leI any equipment or device used for the ~ssinL f.bricatinl or alloyinl 01 special ..... ....,11I if .t any tnne the tot.llIIIOunt of sucII m. teriat in the custody of the 1-.11I at the premises wIlere such equipment or device is located consists 01 or cOnt.ins more than 25 IrlllS 01 plutonium or uranium 233 or .ny combin.tion thereof; or more than 250 grams of uranium 235, (dl any structure, basin, elcavation, premises or place prepared or used lor the storage or disposal 01 ..st.. and includes the site on which any of the forelOinl is loc.ted, .11 operations conducted on such site and .11 premises used for such operations; "lIlClelf react,," means any .ppar.tus designed or used to sust.in nucle., fission in a self,supportlRg chaIR reaction or to contain a critical mass of fISSIonable material; "prI,.rty 011I11'" includes all forms 01 radioactive contamination of property. sera. t&-71) THE STATI!BMAN GRDUP . 1 INaU"ANCE POLICY HUMBER AII>-I'SJ G AMERICAN LIBERTY INSURANCE COMPANY DECLARATIONS - PREMISES I OPERATIONS LIABILITY , ITEM ONE NAMED INSURED 'ColoaY lIarf... ".tarat. ~...o AODRESS 71-7' c...-y 11ft. - C1M1'Rtu,l I'L 33515 FORM OF NAMED INSURED'S BUSINESS: ~ CORPORATION; 0 PARTNERSHIP; 0 INDIVIDUAL orO OTHER NAMED INSURED'S BUSINESS: ".~...r..~ POLICY PERIOD: G FROM 12/2.1/13 TO AUDIT PERIOD: 12/./14 ANNUAL UNLESS OTHERWISE STATED: 12:01 A.M. Stonclard Timo at tho Nomad Insurod'. Ad.... .totod obon. ITEM TWO SCHEDULEO'COVERAGE~ The inaurance afforded Is only with respect to such of the following Coverages .. are indicated by Iila.d attached to and foming I part of thia policy. The limit of the Company's liability againat each luch Coverage shall be as srated herein, subject to all the te~a of this policy having reference thereto. : \.. V POliO No. .x COVERAGE PARTS LIMITS OF LIABILITY Bodily Injury Liability: slOl ,000 Each Occurrence slOO ,000 Ageregate A-2 ~ Comprehensive General Liability Insurance Property Damage LiabUlty: S 50 ,000 Each Occurrence - S 50 ,000 Aggregate A-3 X Amendatory Endorsements (CGL) A-4 Premises Medical Payments Insurance See Coverage Part Special Multi-Peril Policy See Division 'C' A-6 Personal Injury Liability Insurance See Coverage Part A-7 Storekeeper's Insurance See Coverage Part A-8 Drua:Ciats' Liability Insurance See Coverace Part A-I0 Contractual Li"hility Insurance See Coverace Part Garage Insurance See Division 'B' A-12 Nursing Home Professional Liability Insurance See Coverage P.rt A-13 Funeral Director's Professional Liability Insurance See Coverage Part A-14 Veterinarian's Professional Liability Insurance See Coverage Part Other See Coverage Part FORM NU~BERS OF F.NOORSEMENTS, OTHER THAN THOSE ENTERI-:D ON COVERAGE PART(S), ATTACHED AT ISSUE: ./ ./ GLOO19(7-78) L9194(7-66) Absence or an. !Xl , in the coverages or coverage parts shown above indicates such coverage part is not provided in this policy. Those shown by an rn will be affixed as a supplement to this Declarations Page. These declarations are completed by a disclosure of sl1 hazards known to exist at the inception or this policy. Such Description of Hazards schedules are as per Named In,,ured's application. or signed renewal instructions, on (ile .with the Company. Coverage is restricted to those hazards and expo"ur<'''; except that nawly acquired exposures may be considered aa covered until the next anni- versary rating date following such acquisition. \.I COUNTERSIGNED AT Cl..~t.r. ft. DATE J-.a'J 6 19~ BY 1lloCe. laa. 111- SGoS4S 1-71 A CIftUI( PIIT . I .. 'N.U~"NCE LUI5 COMPREIUSM ... LIAIIlIlY 11ISUwa: L" L COVERAIE a-IODlL Y INJURY LIABILITY but pertlI211lld (31 of tItis ..cIuIIon do not -V with mplCtto IIIbIllty lIlldIr. COVERAQ I-PROHRTY DAMAGE L1ABII:tlY, wrItt1l1 lidltnck 19rII...t IlId ... (31 0' this ucIuIIon d.. not eppIv with rapect till conpfty will lIlY on bIh8If of the i..,... III ,IIIIM which the ...... .. to tnfIrlY ..... lather _ to .....tont '1riIlnt out of tilt _ of III ....".t bIcomt ....-y oIlIigIlId to illY _ ....... becaUSl 01 ....... owned by. IIIltld to or CGIltI'OIItd by tilt .... ......: , , A. IIodiIy illiury Of (II to......-tv...... to pnmisa IIiIlIItId by 1M ..... ....... ..... out of Mh . B. property da..... ........ or .., pert th...f; tD whicIt "'i'-lnIurInct .... cauIId by III occumm:e. .nd the comlllftY ... .... tilt IIlIt to I.. of _ of ....... propIIty which ha '"" .....""YliCIIIY InJund or cleItroyed _ ..........., ,to dIfInd lilY suit lpinst the insured ...killll ....... on __ of ...... from ... ~~;I.., or ,..,.ny ...... '"" if .ny of the ..1...lions of thelllit .. 111 I dNy ill or IICIi of ..........nc. by ., OIl ....... of the __ ...... of lilY ........{~.. or fnudultnt. Illd may mike such inYlltigation end ~t of tRY contrICt or........... 01' , cIII.. 01' 1Uit,_ it dIIms .xpRient. but the comPIIIY shill not be alii...... .. IllY tRY (2) the::; II' tilt ..........,............ 01' work pIffonned by or 011 beheI. of F :; cfII.. Of' judjmut 01' to dlflnd lilY su~ .her the eppliceble limit ~ tilt COlIlfIIRY'a till ........ to IMIt till.... of ......., qutllty. nu. or dunbHlty '-" 1lIbIIlty. betn ..hIustId by PlYment 01 judgmtnb or 1IttI._1S. WI"llItt4hr ,.....tId by the ..... '-M;, btlaIMI;. . but this ..d\isIon .... not epply to I.. of _ of .... ....... pnptrty ....t1ng TNI iftsUllllCt d.. not 8pply: fro", .. .... IlId ICddIntII pltyeIaI lalury tD drcllstNctfoll of tilt ..... lit- (II to 1fIlIIK... ....- by tht 1_.... undtJ lilY contrat or ......... __ . .... ...... "..... ., work ptrfenlltd by or 1ft IlIhtIf of the ..... ....., Ifttr such .... ...-: but this .xclusion d.. not .,ply to I ..,.ty of fit_ or.-lty ..... or ..... ... ...... put to _ by lIlY .......or ......IItIDll othtr thlll ~ 0' thl ...... ....... prMucts or . _nty th.t work perfOf1lll4 by or on IlIhtIf ......: of till .....1..... wilt be dant in. worklllllllikt 1IlIAM'; ell) to '""'" ..... tD the ..... ......... ...... ....... out of IlICIt praductI If' Cbl to ~1IlIIy hIjlIry 01' pIafJIIty ......lriIing out of the lIWI*1hlP. 1IlIill..... ...... .., .... of sucII prodlICII; tloll. -, ...... 01' UfttoIdInt of ' .. ' " Cot to ......-tv ...... to work pIffonned by ., .. lIIIlIIfof tilt ..... ....... erIIIftg m . "" ~.. or tln:raft -- or apIfItId by or IIIltld or I"'" . MY ~ out of tilt work ., IllY ,"""on thtmf. or .. of ...... ... or ..,11"lIInt ' ; ijnurM.. furnitIlId ill cOlHIKtioll thInwIth: (2I'..v oth. 1IItII.... or lircraft .....tld by .ny person in the count of his (pi to ....... dlilllld .... till wlthllnMI. 1/lIPIC1IOll.1IpIlr. rtpIlCIlllItlt, or I.. of .... . Itllployment by illY _red; .. , _ _ of till ...... ......... ....... or work cOlll1lltJld by or for tilt .... ...... or of' but thillIClUlion d... nOf",ply to the ptrking of .n IUtomobilt Oft p,,""- 0MIId IllY property of wIllclI _ pnIductI or work """ I pert, If such produc1I, work or by. rantlll to or controlled by the ..- IMUred or the WlYS imm.di.tlly tdjeinin.. property n with..... from tlII IIlIfkIt or _ till bIctu. 0' lIlY known or If such ....... i. not owned by or rantld or lo.ned to illY insured; IUlpectld dtfIct or dtfIcIttlcy tIIeraIll; (el toll"~ In;ury or prOl*tY d_... erising out 01 111 the owntnhiP. IlIIillllMllCl. (q) to prepetty ......Included within: OI*'Iticill. .....loedlng or unlOlding of .ny mollill equipment while beinllllld illltly 111 the.......... .......Ill conMCtlOtl with ......_Idtntlfled In thl, pollcyby. ".~ or orgeniz.d recing. .p.d or demolition contllst or in lilY IbInting c1l11iflcttioll cadt numlMt wtllch Incluclll tilt sylllllol...... Ktlvlty.., In prectlce or prlplntion for eny such contlSt or ICtivIty or (21 tilt 121 till ....... .... .. COllIlICtkItl with opIIItlone IdIlltlfItd In thll policy by . ., OfJIfItioP~ UII of illY snowmobile or trailer designed lor uti thereWith; dllllflcttlon code nu"r wtllch IncIuclll tilt sylllllol "c", ( . Cdl to IIadIY ...,." or prOflllty d.mep wising out of .nd in the coune of the ~ (3) tilt ......... ~ II-. .... 1ft COMICtIon with ClpIrIlIatle 1dtntJ. '- tion 0' ...... .....Plftlllt by .n IIltomobile owned Of operated by or fIlltld or 10ItlId fItd 1ft this polley by l'-fIcttlon codlllUllllllr willch Inciu.. thlSYlllllol "u". .J to IllY 11lIlIpfI; , . II. PERlONIINSURED ell to~odlIy IliItIry or property ....... wiling out of the ownmhip. mllntltllllCl, ...... Etch of till foil....".. ...... undlr thlI__to tilt ... lit t"'" lItIow:. tloll. .... 10ldingllrunlOldinl of It) It till ...... ....... II .......... In the ........... . 1ft Intllvldutl, tilt IlIftOn .0 (1) IllY ,WItIrCnft CMAtd or opll'lttd by or rented or 101Ald to .ny 1IIIUfIIII, or ........... but only wltII rIIfIlCt to tilt conduct of . bull... of wtllcIl, lit " the 101. (21 lIlY 'othtt Wltin:raft oper.ttd by .ny penon in the coune of hi. employlllltlt by proprIItor; 1llY~; (III If tilt ...... ...... II ....... In thl dtcltrItIOtlI. IllIrtntnIllp Of JoIllt ""'tura. but this ..clusion d_ not .pply to wetercr.1t while IShore on prami.. owned by. tilt flIl'1ntnl11p OI'loInt WIIltuN eo dtIItnttId Illd lIlY _nlf or """'..... tIt",of IIut ranted to or cO!'trolltd by the nlmtel insured; only with f'IIIlIC1 to his IItIIIIlty . Mh; , If I to HIIAy IlltIry or property d.m. Irising out 01 the discherge, ditperstl. rll.. or Icl If tilt IIIIlII4 ...... is ........... In the dtcItrItIOM . otI!li' tlltn In Indlvldutl, IICIlII of lIIIokl. Vlpan. loot, fumes. lCids, IIhlis, toxic chemic.ls, liquids or gila. pert",",,1p or loInt VIlltlI". tilt ollllllutlon eo dtIItllItId '"' an., ..ICUtlw officer. wat. mettrilil or other irritlllll. contlminlnts or polluttnll into or upon Illld. tilt director or Itpc;kholdtr thtrtof wtlllllCtln. within thlleO'" of hi. dutl. _lIIch; Itmosphn or .1lY WItii' count or body of weter; but this exclusion dOlI not epply if 141.ny penon 10thII' thlll III .mploy. of tilt IlIlMd Itnuttdl or orgenlutlon wtllI. such d1schll'gl. dhp.... "'... or IICIpe ilsudden Ind.ccldentll; ectl", _ fill IItItt nIIntgIf for th.llIIllIlI.......: IlId III to....1ly IniPfI or IHOperty dim... due to wer, whether or not dlCl.rad. civil MI, 1.1 with fl4p1Ct to "', o",ratlon. 'or tilt pu".e of locomotion upon . public hllh....,. lneumctlon,' Flbllllon or revolution or to .ny .ct or condition incid.ntto .ny 01 thl of mlllll'l4ulPllllllt rigletll'td uncltr IllY IlI0t0r Vlhlell ra;ltrItIon 1_. f...oln.. willi rtIpICt to Iil .n .mploy.. of thl .._ I..... while \llllfltlng .ny luch llIulplMftt In tht 111 Iltbllity IllUmld by thl IMUM undlr In incidlntel contrlCt, or coum of hl1 .mploymlllt. .nd 121 IX pen.. for Ilrlt lid under thl Suppllmlntftry Plymlnts provilion; UII .ny othr Pll101l whll. opntlng with Ill. 1lIfllIicII0ll of the IIIllIIII ..... illY (hi to ~"'1Iy IlIju", or ,ropeny d.m.. lOt which the inlured or his indlmnit.. NY be IUch equlpmlllt regimrld In the nlllll of the ..lMd ..... IlId .ny ptI'IOll or held lilble ~ orpnlutlon 1""ly FllPollllbft for Mh ofllrttlon. but only If thIN Is no ather 111 _. penal' or orveniz.tion ,"geged in the business of mlnullcturing, distrlbutl"t. vllld .nd collectlbl. IAlUfIftCI IVIllibt.. 11thII' on . prtmery or .xc. 1IIIIt, to 11I11111 or ..mng IIcoholic bevereges, or such penon or ....nlzttlon; (21 If not 10 1IItIlIId. II .n ownlr or lenor of premises used for IUch purp.... provided thlt no penon or 0",",1ItI0ll shill lit III 1_1'Id untltr thl. IlIfII'IPh I.) by ,...n of tht .lIIng. ..!Ving or giving of Iny Ilcoholic bevtr.ge with rllpeet to: III In violltion of lAy ...tutl. ordinlllCl or regulllion, 111 bodily I.rv to IllY "'low ItlIplClyll of IUCIl /lIftOn InJurad In the COlI'" of his lill to. minor. .mployment, Of lillI to . penon under the influencI of Ilcohol. or (21 ,..,.ny ....... to property owned by. IInttd to, In cIItrgo of 01' ..,... by (lvl which c.- or contributll to thl intoxicllion 01 Iny ptI1On; the ... I_red or the .mpIoyer of illY fIIfIOtldllertbed In 11I11 """",,,h (III but ptrtI Oil. liiilllld (ivl of this Ixclusion do not .pply with rnpICt to liIbIIity of Thl1ln,uflllCl d. not IfIply to MdfIy 1_ JF '""'" n-.. trI..... out of thl thl ...... Of his in_nit. _ .n IIWIltf' or lenor described in (21 .bOvt; conduct of .ny pertntrlhlp or JoIllt VItlturl of wlIlclI tilt I..... 10 . pert"" or 11II"'''' iii to lAy obfigttion for which the iAlUrwd or eny cerrier II hi. intu"r NY be htId IItlIIt IIId wtllch I. not dlllgnltld In thll pelleY. . lIIIIlH ........ under IllY work"",,'1 complllSltion. unemployment comptnsetion 01' diubIIlty bent- III. L1M111 OF LIABILITY fltlltw. or undtr illY limller lew; Rlglfdl... 0' the nullllltr of 111 '-"* ulldtr tllIt polley, (2) /lIftOM or ....... ell to""'" to lilY ItlIplClyll of the insured .rising out of Illd in the COlI'" of his tlons wtlo sustain IIodIly .... Of '""'" ....... or ell cllllIW illicit or .... iNouIht t, ."""oylMftt by tilt iBslmd; but this Ixclusion dolS not .pply to litbility IS1IIIlIId by Oft ICCOUnt of III1d11y IllJory or ~ ......... Ill. COftlPltlY'I IIIIlItlty 10 HIftIttd . '"" the __ undtr .n illci4utll contnct; follows: Ikl to IIflIfII'ly ....... .to C...... A-The totlllltlllltty of till COlllllMY for III .........1nchMIl.. ........ .... t 11 property owned or occupied by or rented to the insured. ctrIlftd loa of ""'Icte. btctUII of HdIIy 1tsIIty........ by 0tlI or ""'" 1lIftOllI. the (21 property IIIId by thl iAlU,". or IIIUIt of IllY 0lIt _rIIllII shill not ..cttd till liftllt of ~"1Iy 1_ IItllHlty ItIltd In 131 property in the cere, custody or control 01 the insured or II to which the '--II the dtclll'ltlone -IPPllcaba, to ".h IICI",__ H il for lilY purpose exerciling physic.1 control; (Over) -; 0.345 (1-1- 73) "'2 ~ ":7 ~ '--,';" INSU...A,.",Ck.. I . '. , Subject to the abOVl pfovision nsper;ting ".... _nHCI". the totlllilbitity of tilt COlllpany for ell II........ beew. of 11111I ~odify injury included within tilt ce...... .......' Iward IlId 121 ell ~odify Injury included within the PfOducts .... 11III1 not ..ceedthelimit of hdlfy iniufy lilbifity stated in thlschedulta ..........". Ctmap 8-The total liability of the company for all....... because of ... .,.perty d_1II sustained by one or more persons or organizations as tlIe resuft of any one .ccumace shall nofexceed the I""it of propertJ .......liabilitJ stlted ill the schedule as applicable to "each lCettmllCt' . - Subject to the above pro,ision respecting "each occamtlCI", the tot,,' IlabiIity of tlle company for all _"II because of all property ... to wIlidt tills coverage applies and described in any of the numbered subpara.,_ below shall not exceed the, lilllit of PrttttrtJ dalUle liability stated in tllesclledule as '.'lIrepte"~, . .H;;- ',' ;:l', "-r~'::i":'\\~-":;',,-:, :-.~' ", ::;,.'--' (J) all Pr.rtr ....islniOutHof """,Ises or operations rated OIl. ,. muneration basis or -contractor's equilll1ltlnt rated on . receipts basil. Including prtperty d_,,1 for which liability is assullled under any i1c1dtatll _ Ctlltract relating to such premises or operations. but excluding prtpIftJ ..... included in subparagraph <21 below; , (2) all praperty IIIIl11P arising out of .nd occurring in the course of Clfllfltlons perforllled for the n..ell Insmll by independent contractors and pnem supervision thereof by the ....11 In.urell. including any sucll "'1IIflY ..... for which liability is assumed under any Incidtlltal CHtrICt relatinc to such operations, but this subparagraph (2) does not include ~ ...... arising out of maintenanet or repairs at premises owned by or rented to the ....11 I...... or structural alterations at sudt premises which do not Inwlve changing the size of or lIlO'Iinc bulldinp or other structures; - (3) .11' prtptrtJ dill'" Included within the prtducts .... Md all ......, ....... included within the Ct.pI"'d,,.ratlt.. Ilaurd. Such aggregate limit shall apply separately to the pl'IJIfty ... described III Subparagraphs Cll. (21 Ind (31 above, and under subparlgraphs UI and (2), separately with respect to each project away from premises owned by or fItlted to the Rallled Insured. CeverqlS A Ind B-For the purpose of determining the limit of the COlllI*lY's liability. all bodily Injury and property ....... arising out of continuous or ,. peated exposure to substantially the sallle general conditions shall be considered IS aris.ing out of one occurrence. IV. POLICY TERRITORY This insurance applies only to bodily injury or property ........ which occun within the policy tltmtory. ~ ~ u .~,;: ~ U' u SG.34S ..- , to' .. ~~- ~ I .~,.C;~" ~i ~; ..... .. t',~. i .... . .. ., \," " .; ., .: : .' : , . (The Attaching Clause nerd h,' romplrled only when this endorsement IS Issued subsequent to preparation ot the policy.) LIABILITY G 611 PRODUCTS HAZARD REDEFINED This endorsement rnc,Qlfies such~n~'~~e-~ ~Horder. ~ 'ih~ -P~;~ISIOI1S ~f the policy relatrng i~- the fOIiOwJ.ng: COMPREHENSIVE GENERAL lIABllIH INSURANCE COMPLETED OPERATIONS AND PRODUCTS LIABIlITY INSURANCE ---.-.--- . -- - ----- This endorsement. effective forms a ~,'rt of pJlicy No. 1:01 A M, stJndJrd t,nle\ issued to '7--, by tl Authorized Representative Descri"'ion 0' Premises and Operations: ".caurant 19194 . [,1 7,56' It is alreed th3t with respect to bedily injury or property damage arising out of the named insured's products manufactured. sold. handled or distributed III On. 'rom or in connection with the use of any premises deSCrIbed in this endorsement, or (2) in connection with the conduct of any operation described in thiS endorsement, when conducted by or on behalf nl t~e n'lIed insured. the definition 0' "pr.ducts hazard" is amended to read as follows: """ducts haZlt'd" includes bodily injury and property damale arising out 0' (a) the named insured's p,.ducts or (b) reliance upon a representation or warranty made with respect thereto; bllt only if the bodily injury or prolllrty dalllage occurs after physical possession of such products has been relinquished to others;" ...; ,. :\ f ~, \1 .' . At I , . -.. , .. .. . " .' I , . , -'-.--- AMENDMENT ENDORSEMENT AMERICAN LIBERTY INSURANCE COMPANY Tllll ,..dors.m.nt is Issued lor en.ehment to .nd forms. part of the below numbered polley, ellethve on th. d.'e indielttd, All ttfftll tftd CoMlbOftl of tilt polley (.11. (Iudlnl Iny ,"dor"m.n' 'hlreon, to whICh this endorsement IS .lllehed remlln unthlnced eaeept IS Imended by this endorttm,"t, ~_," No. r.-~~,~v!. .>~~~e ,. "r ..PoliCY No. Agent Countersilntd ICll" St8W (, li 'I;f' "Im.d Insur" : SicnltUft of At.llt GENEKAL LIABILITY AMENDATORY ENDORSEMENT - ADDITIONAL DEFINITION tl It is agreed that the following definition is added: "loading or unloading", with respect to an automobile, means the handling of property after it is moved from the place where it is accepted for movement into or onto an automobile or while it is in or on an automobile or while it is being moved from an automobile to the place where it is finally delivered, but "loading or unloading" does not include the movement of property by means of a mechanical device (other than a hand truck) not attached to the automobile. o . GLOOl9(Ed. 7/78) \.../ . \.-.., \.". \-I .~ I INIU....NCE I AFFIX HERETO ENDORSEMENTS A,l-m RIDERS APPLICABLE TO PAGE A.2, COMPREHENSIVE GENERAL LIABILITY. DO NOT ATTACH "COVERAGE PARTS" ~ , v j:':.::,\ o ~ ~ I THE A.B.C. COVERALL PLAN I POLICY NO. A.,....'" ~J ~ PA-OVIDED BY DIVISION C Af"ERICAN LIBERTY INSURANCE COMPANY f , . WIM.11l 93. TH. .TATEaMAN GROUP 4 . !. ; !The above designated herein referred to as the Company, in consideration of the payment of the agreed premi- um(.) and subject to the terms of this Policy and its Insuring Agreements, Agrees to pay for any direct and acciden. tal10ss in accordanct.' wilh such insuring aKreements with respect to the occurrence of any of the therein mentioned casu~lties or events durinK the policy period. GENERAL CONDITIONS t APPLICABLE TO CRIME COVERAGES, INLAND MARINE AND PLATE C;;LASS I .1. POLICY PERIOD - The Policy Period with respect to any Insuring Agreement shall begin ~t 12:01 A.M., Standard Time, on the date stated in such Insuring Agreement and end at 12:01 A.M., Standard Time, of the expiration date. If, subsequent to the inception date hereof, any Insuring Agreement is made a part of this policy by mutual agreement, then the Policy Period with respect to such Insuring Agreement shall begin on the date stated therein, and if, prior to the cancellation of this policy as an entirety, any Insuring Agreement is terminated, as hereinafter provi~litd, then 12:01 A.M., Standard Time, of the effective date of such termination shall be the end of the Policy P..riod .with respect to such Insuring Agreement. 2. INSURED'S DUTIES WHEII lOSS OCCURS - When loss occurs, the Jn$~red shall: . (a) protect the property, whether or not loss is covered by this Policy and its Insuring Agreements, and any fur- ther loss due to the Insured's failure to protect shall not be recoverable under this policy or it~ Insuring Agreements; reasonable expense incurred in affording such protection shall be deemed incurred at the Company's request; . (b) give notice thereof as soon as practicable to the Company, or any of its authorized agents and also, in the event of theft, larceny, robbery or pilferage, to the police, but shall not, except at his oWn cost, offer or pay any reward for recovery of the property; (c:) file proof of loss with the Compltny within sixty days after the occurrence of loss, (unless such time Is ex- tended in writing by the Company). in t~e form of a sworn statement of the Insured setting forth the interest of the Insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and cause of such loss, the amount of rental or other expense for which reimbursement is provided under this Policy or its Insuring Agreements, together with original receipts therefor, and the description and amounts of all other insurance covering such property. (d) Upon the Company's request, the Insured shall exhibit the damaged property to the Company and submit', and so far as is within his or their power shall cause all other persons interested in the property and members of the h04sehold and employees to submit. to examinations under oath by any persons designated by the Company, relative to any and all matters in connection with a claim and subscribe the same; and shall produce- for examination all boQks~f account, bills, invoices, and other vouchers and certified copies thereof if originals be lost, all at such r~llsonable times and places as the Company shall designate, and shall permit extracts and cop i_ thereof to be made. 3. A",STANCE AND COOPERATION OF THE INSURED - The Insured shall cooperate with the Company and, upon the Company's request, shall attend hearings and trials and shall assist in effecting settlements, securing and giving evidence, obtaining the attendance of witnesses and in the conduct of suits. The Insured shall not, except at his own. cost, voluntarily make any payment, assume any obligation or incur any expense. 4. SUBROGATION - In the event of any payment under this Policy, the Company shall be subrogated to all the In- sured's rights of recovery therefor against any person or organization and the Insured shall execute and deliver in- struments and papers and do whatever else is necessary to secure such rights. The Insured shall do nothing after loss to prej'ldice such rights. 5. LIMIT OF LIABiliTY - Settlement options - No abandonment. (a) Unless otherwise provided, this Company shall not be liable beyond the actual cash value of the property at the time any loss or damaKe Occurs and the loss or damage shall be ascertained or estimated according to such act. ual cash value with proper deduction for depreciation, however caused, and shall in no event exceed what it would then cost to repair or replace the same with matetial of like kind and quality, nor the applicable limit of liability stated in the declarat ions. . . TH. .TAT..MAN QACU.. SG.34 REV. 6/78 C-l :;~~?)'_: (_~~'.V':-''!;: ~ INSUR....CE I ' I h):-.io Illss ~h,.tl b., p,lId h"T"t1'Hi"'f Ih(' Insurpd has collec'....d thl" sam.' frclIn Ihl'rs, > If') It is lInd~'rst"ud .,"d d~r"t'd Ih.I, In thl.' E'\.l'nl of loss of or d<lm,q.:.' 10 ,tOy .rtide or urtic1l's which are a part, of ;; Set, the meaSlIfl' 01 II)ssol ,Ir cLmd~" tll such article or drtlClt-s shdll be a retlsontlble and fair proportion of th.' :,.t,i1 \.alu.' oi Ih., st"!. f'i\.ln.~ ,.,-n..,,,I.'r,I'I"" to 'he import;ann' of '-',lld drli.-\l' or articles; bUI in no t'vent shall Sll-.!~ 1,)ss tlr (Ltmd~" "t' nln~1rll'.'d '" mt'..n tnL.! loss of set. U ,dl In case of h),;s or lnillr\ hI dll\ P,trt 01 thl' Insured property cunsistln\!" when complett' for sale or usp, of Sl'\('wl poHtS. thiS COII~pany ,;h,dl O:1l\ t>., habit- for the insured \'alue ot the part lost or damaged. Ie) Th~Compan\' ma\ !';lV. ior !-nt' l1'ssln molll.~Y or may repair or rl'place the property or such p~rt thereof, as ..ipresaid, or may return any stolen propl'rty WIth pavment for any resultant damage thereto at any hme before the loss is paid or the property. is so repl..n'd, or may take all or such part of the property at the agreed or appraised ",due but there shall be no rlb.tndonment to the Company. . (0 In case of loss or damage. it shdll be lawful and necessary forthelnsured. his or their factors, servantsucl assigns, to sue. labor. and tra\'el for. in and "bout the defense, safeguard and reco\'ery of the property insured here- under. or any part thereof w,thout prejudice .to this insurance; nor shall the acts of the Insured or this Company, in reco\'ering, saving and preser\'in~the p~opE-rt\ ,"~ur('d in l'aseof loss or damll~e, be considered.. waiver or an ~ ceptancc of abandonment; to the chargt: whcreof this Company will contribute according to the rate and quality of the U sum herein. insured. . . S. APPRAISAL AND ARBITRATION - Ii thc Insured and the Company fail to agree as to the amount of loss,each lOhilll, on the written demand of either, made within sixt~' days after receipt of proof of loss by the Company, select a competent and disintt'resll'.j ilppraisN. and the appraisal shall be madeCtta reasonable time and place. The IApprai- Sl'rs shall first setel'til compl.tl'nrand [lJsinterested umpire, and failin~ for fifteen days to agree upon such umpire, tht'n. on the request of tht.' InslIn'd orthl' Company ,such umpire shall be selected by a judge of H court of record' in th(' ~tate in which such appraisal is pcndin~. The appraisers shall then appraise the loss, stilt in& separately the itctual cash \'i'ue at the timeoi loss Clnd the amount of loss~ and failing to agree shall submit their differences to the umpire. An award inwritingl,f any two shall determine the amount of toss. The Insured and the Company shall each pay his or its chosen appraiser and shall bear equally the other expenses of the appraisClI and umpire. , The Company shal.l not be held .to ha\'e w..ived any of its rights by any act relating to appraisCiI. 1. PAYMENT FOR LOSS - Action A~ainst .Company. ta) No suit.actionorpwcet'din~ ior the reCII\'ery of any claim under this Policy "hall be sustainable in any court of law or equity unIt's!> the same he cllmmpnCl'd Within twelve (12) months next after discovery b~' the Insured of the OCl'urrenl't.' which "i\'e~ ris(' III lht' <'1air.~. Prm.,dl'd. trow ever , that if by tlH' 1,Iws of thl' State within which this Policy is issul'c1 such limitation is in\',dld, tl1f.'11 ;Irl\ such claims shall be VOId unl('ss such action, slIit or proceeding be l'ommcnct:d within tlu' shorlt:st 1111111 olllfl'c' p("[l1Illted by the laws of such State to be fixed herein. (h) /\1\ adiustt.'d claims shall he p,lld or made good to the Insured WIthin ~ixty (60) days aft-er presentation and U'.. ltCn'ptance of ~atisfacton; proof ul Intert'sl ..ncl loss at the oHice of this Compan\'. 8. NO BENEFIT TO BAILEE - The inSIJr;tnn' afforded by this Policy and its Insuring Agreements shall not inure dirl'ctl~. or indirt'cth to thl' hl'nl'flt of otn\' c;Hli.'r or bailee liable for loss to the property. 9. FRAUD AND MISREPRESENTATION - Thl'; Policy and its Insurin~ A~reements shall be void if the Insured has concealed or misreprl'sentedanv rr.dtt'rt,t1 I.....' or t:ircumstance concernin~ thiS Insurance or the subject thereof or in case of any fraud, aHemp.lcd fraud or falsc s.....'aring by the Insured pertaining to this Insurance or the subject there- of. whether before or i.fter iI loss. 10. WAR CLAUSE - This polin dell'S nl,t IIhllre agdinst loss or damage caused by or resulting from: (1) 1I0stile or warlike ;tction In tIme' of peace or war, including action in hindering, combating or defending agninst an actual, impending or I'xpected attack, (a) by any government or sovereign power (de jure or de facto), or bv i1ny authority mainlainin~~ or USlnl'. millt..rv, naval or air forces; or (b) hy military, naval or air forces; or (c) by an a~ent of any !tIllch go\'ernment, I" .WI'(, dllt II, If 11., 'If forc..s; (2) Any weapon of war c.mpIO\.II1~ ;lltlmlc Ilssion or radioactive force whether in lime of peace or war; (3) Insurrection. rebell ion, re\.olutlOn. ci vii war, usurped power, or action taken by governmental authority in hindering, combatin~ or def('nding against such an occurrence, seizure or destruction under quarantine or Customs regulations, confiscation by order of anv government or public authority. or risks oftcontraband or illegal transporta- tion or trade. 11. CHANGES - Notice to any "gent or knowlPdge possessed by any agent or by any other person shall not effect a waiver or a change In any pi.rt of this Polin. or its Insuring Agreements or estop the Company from asserting any right undcr the terms of this Policy or its Insuring Agreements; nor ~hall the terms of this Policy or its In~uring A~rcements be waived or changed, exc.'!>1 hv "nnorsement issued to form it part of this Policy or its Insuring Agree- mcnts signed by an Officer or ,Ill t\~~l'nt ..t thl' ('(lfllp..nv. 12. ASSIGNMENT - ASSII',n,""nl ..I Inkrt'st unlln IIl1s Policy or its Insuring Agreemrnts shall not bind the Compsny until its t'nnsf'nl is t'IHlm",'d IW"''''I, ai, h"W"VI'I, II". Insurt'd shull <lit'. IIl1s Policy shull cover the Insured'. spouse, if II re"ident of tht' ~;amt' IIl1u..."lll"<I i.1 ,10,' 111111' "I "'lI"h df'lIth, Hnd 1~.',1I1 reprcst!ntntivt's us Insurl'ds; provided that nntiee tlf canccllntiCln ndd[I'~;st'd III Ih,. Insuwol nilrnl'd in thr d('c\aralwns ,tnd mailt.'d to thcsddress shown in this Policv shaIl bt' l;uffll'i('nt l1otir,' ,.. I'(fl'tl ..;m...,lIatilln of this Policy. 13. CANCELLATION - TIlls !'"IIC.\" itS i1n c'nl trl'ty (including all Insuring Agreements) or any Insuring A&reement may' be Cill1cellcd (i1) by a~f('em('nl between the Insured and the Company; or (b) by the Insured serving upon the W Company written notice stating when tht.'reaftcr such cancellation shall be effective; or (c) by the Company serving upon thc Named Insurcd at the address shown in this Policy written notice, stating therein the date when such can- cellation shall be eflecti\'e, but such date, if the nottce be served, shall be not less than 30 days after such service.The mailing of notice as aforesaid shall be suffIcient proof of its delivery to the In~ured. The unearned premium, if any, ccmputed pro rilta, if cancelled by the Company, or short rate if cancelled by the Insured shall be refunded as THE STAT.SMAN GRDUP C-2 SG.J4 G \.......i l.... v. v 'NIUA ....C E soon 'as practicable aher cance alia" becomes effective. but payment or leter of unurned premium is not a condi. tion of cancellat ion, The Company's check or the check of its representative mailed or delivered as aforesaid shall be a sufficient te"der of any refund of premIUm due to the Insured. 14. SPECIAL STATUTES - Tenns of this Policy and its In:;urinR ARreements which are in conflict with the Sta- tu~es of the State wherein this Policy is Issued are hereby amended to conform to 5uch Statutes. 1L TERRITORY - ThiS Pulley applies only to loss or damages which occur within any of the States of the United States of America, the District of Columbia, Virgin Islands, Puerto Rico, Canal Zone or Canada. IMWllMESS WHEREOF, the co~':y has caused this policy to be siptd by its p,esident and .talt.y, but the .... shill not be blndln. upon the cOlftI)any unless counterslllned on the declarations peae(') by . duly ..tho,iztd apnt of the company. AMERICAN LIBERTY INSURANCE COMPANY ~~.~ ~~~ 1 t?f. President : SG.34 C-3 l IN.U....NC E POL1CylUMBER .....", L, \.....- \., '---/ v . , > . .:t ~'t'; d', .' ~ ! "J,r '" .... DECLARA TIOHS - PLATE GLASS 1, NAMED INSURED AND .~ ADDRESS FOO' ColoaJ Karina ....tar..t. lac. n-7S ea...".,-.l". C1eanater. II. 33515 2. POLICY PERIOD F,onl2J2I/a t. . 12/28/14 NOON Stendard Tilll. at ill. .wr... of the n.lll" i "au," .a a'.'.d her.ln. (SIt_ Nu",~ ond St,.., 00' RFD. City. County, Stat. .nd Zip Cod.) IN S U RING A G R E EM E N T S 1. DAMAGE TO GLASS. To pay for damage during the polley period to the glass described in the schedule and to the lettering IUld om_entation separately described therein, by breakage 01 the Cla88 or by chemicals accidentally or maliciously applied. (bl installing temporary plates in or boarding up openings con taining such glas. when necessary becaus(" of unavoidabl" delay in repairinl or ,eplacing auch damaged glass; To pay for: (a) r("pairing or replacing hames Immediately encasing 8tId con. tiguous to such glass when neel'ssary because of IlUch d~ag~ . (c) removing or replacing any obstNctions. other. than wlndo,," dispfays, when necessary in replacing such damaged gins. letteung or omamentation. 2. LIMITS OF liABILITY AND SETTLEMENT OPTIONS. The limit of the company'. liability for damage Ihall not exceed Ihe .'. cash valuE' of the property at time of loss, nor what it would then cost to repair or replace the damaged property with other or nearelt obtainable kind and qualll~', nor the applicable limit of liability staled In the declarations; provided, however, the limit c company's liabililY under each of diVISions (a), (b) or (c) of the Insuring Agreement is S7S with respec't to loss due 10 anyone oee rence at anyone location separa,.,lv occurBed or deSigned for separate occupancy, The company may pay ror lh., loss In mon.,\, or may repair or replace the property, Any property so paid ror or repli",ed shall beco,," the property of the company. 3. EXCLUSIONS. This policy does not apply: (a) to loss by lire; (b) to loss dul' to waf. whelher or nol declared, civil war, iDsurrection, rebellion or revolution, or to any act or condition incidenl 10 allY of the foregoing. (d to loss due to nuclE'ar reaclion, nuclear radiatioD or radio active conlaminalion, or 10 any act or condition incidpnl to any of th" foregoing. 4. OTHER INSURANCE. If th.. Insured hAS olher insurllnce against a loss covered by this policy the company shall not be liable undt" thil policy ror a Kreater propo,llOn of such loss than the applicable Iimll of liability under Ihis policy bears 10 the lotal applicahl, limit or all valid and cOII..cllhl.. Insu,an".. aKainst "uch 108s, 5. DEFINITIONS. GlaBS, a8 used herein, shull be defined as "plain plate of not more than 1/4 inch II! thicknesa" (CIa.. A in company'8 manuals) unless Bpecifically descnbcd otherwl8e In the rallng schedule8. Any loss or claim ror loss shall be adjusted Bccomlngly. INAPPLICABLE POLICY CONDITIONS PARAGRAPH 5 OF DIVISION 11 GENERAL CONDITIONS DOES NOT APPLY WITH RESPECT TO THIS INSURING AGREEMENT. COUNTERSIGNED BY 1ho4Ie. Iu. 1.&7. DATED J....ry 6 19 84 These DECLARATIONS am the designated Coverage Parts .,d Endorsements, with the general pl'ovisions, complete this. SG.J4 Cl REV.3/75 TH. .TAT.-MAN GROUP H J I GLASS INSURANCE Schedule of glass covered by this policy and premium computation L.cotl... .f P,eml... No. H.llIht W.... Kind and Duc,lptl.n .f GI... S....t ..... N.., C'2 ond Stat. . CI... R... P,emlum Plo'.. In Inch.. In 'nche. .nd L.cotl.n In Building . .n" Zona ode . ... ft_7~ - .,... I. 711 ,- .. w._. .. ....-- A-' ~-, ,.., ... WI. tf. 7A U. - .. .a A.... Y_l 9_' II " "l 1.. 'U. " " .a-' ~-, ...., \-. " "l 7n 21& .. .. A.'I ~_t "f_t . " "l AA Aft .. .. .a-' "f_' "f_' .. .. 1 ..^ ... .. .. .&.-. "f_' 9__' : \. ~ tl .,n'-A REV. 2.74 u o ( \...,- v ON PAGE It..m POLICY NUMBER u_ ____ In Consideration of the premium ln~uroncp. is provided the named insured with respect to the designated premises shown in hem .s below and with r..spect to those coverogrs ond kinds of properly for whic!. a specific limit of liability is shown, subj.ct '0 all Df the terms of this _ 'policy includina -forms and ~n..'~OI..("mcnt:-. mode--n port hereof: In.u,anc. i. provid..d with r.sppct to the designolPd premis.. and with resp..ct to thas.. cov.rog.s and kind. of p,op.,ty for which a .p.cific limit of liability is shown, subject to 011 of the terms Df this policy including forms ond .ndolSem.nts mode a DO,t h",.of. Coinsu,anc. LIMIT OF' ...... ....V Percentage l.OC. HiO. . LOC.... NO. LOC. NO. BLDG. NO. .!.oolicabl. 'I 11IOO90 (Ed. 7 .77 ) (i"s"rt Nos. Dnd Ed. Dot..s): o. Section I -Forms ond_~dor~e~nI5 Only: / / 11I0466(10-13) CPOUS(ll-77) 1Ir0420(7-13) It012S(t-83) NPO012(1-13) KP01l6(7-77) ..1,,3(7-77) 11I0127(12-71) b. Section II Forms and EnJor~.("IT'ents Only' c. Section 111 Forms and Endorsements Only: 7. Mortgagee: (Nom. and Address) 8. Th. Total Advanc. P,em,um is $ 70 at incept i on and $ at each anniversary. and is payable $ 70 ..... lu. .Aa7. 5G-34 (REV, 6-82) BLDG. NO. Dggregat. each occicJent Addl. Cov. (Specify) SECTION III-CRIME _C~~.!'~A~~1-1_^"H~ul...1 III tt.fl flndu''''llIfll1l, mudfl part 01 this Policy, if indicat.d by I XI. 6. Forma and E"dor'"'"f''''' lIIud,. 111111 uf .111, pullt y..1 '"11" uf u'u.. In tIJJ"'UI1 to ~p('c:ial Multj.P",d PolICY Conditiona and D~fi'lltlon' Form DECLARATION~ 1. Colooy Karina ...t.....t. 71-7S Cau.v&7 11.,.. Clearwat.r. n. 3351S ...... Iu. IC'I. Cl......CU. II. ,. ,... ,.... XINfRESENTATIVE: Agent a' Broker Offic. Addr.ss No",," Ins",.d and Mailing Addr..ss (Numb.,. Str_t, Town, County. State & Zi.. No.1 '2:01 A.M. STANDARD TIME AT LO- CATION OF DESlcaNATED PREMISES T own and State .... From: To: 2. Policy P",jod: AMERICAN LIBERTY INSURANCE COMPANY 3. The Named Insu,ed is: I \Individual I IOther 1(1 Ca'pa,ation [l Par'nership LJ Joint V.ntu,. .. D..lgnat.d P'....i... (Ent., ..Sa...... if sa.... lacatlon a. abav.) Occupancy af P,....I... 1. 2. 3. ... "___.t . . . .-------- -.-- s. SECTION I-PROPERTY COVERAGE I.ce. NO. EluildinoCsl Personal Prooe,tv of the Insured Personal ProperlY of Others Addl. COy, (Specify) s anI' Is $ , , $ , , I . II """ ...lft....t eo.t. lire tela! Lia.1 te.. of lanfal. ,.., nl ., II each occurrence, S aggregote each occurrence. D.ductible: $ If no deductible stated aI-ave_ ,t." d"ductible shall be $100 each occurrence $1 OOOannrenate. SECTION II-LIABILITY COVERAGE LIMIT OF LIABILITY Bodily Injury and Prop"'ty Damage Liability Fo,m MP-200 Combined 5ingle Limit Pr.mises M.dical Payments ... cc each occurrence S eoch oerson I Agent 22 I . I OPTIONAL PERILS ENDORSEMENT MP 04 66 (Ed. 1083) v PROPERTY COVERED 0 Buildings iJ Personal Property of the Insured o Personal Property of Othen Sub~ to all the provisionS applicabll!"to Section I of this policy of whK:h t~!s endorsement is made a~rt.' except as otherwise provided for herein. the following perils are added to and made part of the "Penis Insured Against sectIOn of SMP ~al Bu"dinc For.m and SMP General Personal Property Form of which this endorsement IS made a part With respect to the coverage specified by an X In the appropnate box(es) above. I. PERILS INSURED AGAINST l. Water DalMII: Loss by water damage shall mean damage caused by the accidental discharge or leakage of water or steam from within a plumbing. heating or air conditioning system or domestic appliance only when such discharge or leakage is the direct result of the breaking or cracking of any pipes, fittings. parts, or fixtures forming a part of such system or appliance. including the cost of tearing out and replacing any part of the buildings covered required to effect repairs to the system or appliance from which the water or steam escapes. but excluding: 1. discharge or leakage of water or steam from within an automatic sprinkler system. The term "Automatic Sprinkler System" means any automatic fire protective system including sprinklers. discharge nozzles and ducts, pipes. valves. fittings, tanks (including compo- nent parts and supports thereof). pumps and private fire protection mains, all connected with and constituting a part of an automatic fire protective system; and non-automatic fire protective systems. hy- drants, standpipes or outlets supplied from an automatic fire pro. tectlve system. 2. the cost of repairing or replacing the system or appliance from which the water or steam escapes; 3. loss resultmg from freezing while the building at the described location is vacant or unoccupied, unless the msured shall have exer. cised due diligence With respect to maintaining heat in the buildings. or unless the plumbing and heating systems and domestic appli- ances had been drained and the water supply shut off during such vacancy or unoccupancy; 4. less if the damaged buildings or buildings containing the dam- aged property had been vacant beyond a period of 30 consecutive days Immediately precedmg the loss. 5. contmuous or repeated seepage or leakage of water or steam from within a plumbing. heating or air conditioning system or from Within a domestic appliance which occurs over a period of weeks. months or years. v I. Breakage of Glass: Glass breakage shall mean only the breakage of glassconstituting a part of the bUlldmgs covered hereunder, but exclud- ing neon tubing attached to the bUlldmgs. The Company shall not be liable for: 1. any glass breakage if the bUildings have been vacant beyond a period of 30 consecutive days Immediately preceding the loss; 2. more than 550 per plate. pane. multiple plate insulating unit. radiant heating panel. JalOUSie. louver or shutter; ], more than 5250 in anyone occurrence. J. FalHng Objects: Loss by falling objects shall not Include: 1. Ios~to personal property m the open; . 2. loss to the interior of the bUlldmgs or the property contained therein unless the bUildings covered or contamm~ the property cov- ered shall first sustam an actual damage to the exterior of the roof or walls by a falling obJect. \"--.;./ K. Wel&ht of Snow. Ice or Sleet: Loss by welRhl 01 ~now. ice or sleet shall mean only direct loss to Ihe property covered when caused by weight of snow. ice or sleet whICh results In phYSical damage to the build. ings covered or containing the property covered. The Company shall not be liable as respects this peril for loss to: 1, metal smokestacks. outdoor radio or television antennas includ- ing their lead'ln wiring. masts or towers: gutters and downspouts; yard fixtures: and. when outSide of buildings. awnings and personal property: nor to 2. fences: outdoor SWlmmll1~ pools. piers. wharves and docks; beach or diVing platforms. or appurtenances. retaining walls not constituting part of the building. walks. roadways and other paved surfaces; all when such loss IS caused by freeZing. thawing, or by the pressure or weight of Ice or water whether driven by wind or not. II. ADDITIONAL COVERAGE COLLAPSE-ThiS policy Insures against risk of direct phYSical loss Involving collapse of a building or Jny p.lI t of a bUIlding caused only by one or more of the follOWing a. fire: lip,htnlng: Wlnrl~torrll 11.1,1. (>xpln~I()Il. ~11I()ke. aircraft; vehi. cles; riot. Civil cammotlc"l. v.l~;1.11:'.lli "1 III00lir,(.,,'. nll~rhlet: break. age of glass. falling objects. ""1:.11101 .IIOW. ICl' (>, ,[eet. water dam- age; all only as iIlsured agalli..I III till'. pol,cy. b. hidden decay: c, hidden insect or vermin darnage: d. weight of people or personal property: e. weight of rain which coller!', on .J roof. f. use of defective matenal or rnptlll1{h In con~trtlc"on. remodeling or renovation If the COIl.lpSP weu! s dunng the course ot the con. structlon. remodeling or rennv..I lOll ~ ThiS Company shall not be liable for loss to the following types of prop- erty. if otherwise covered in thiS policy. under items b.. c.. d.. e. and f. unless the loss is a direct result of the collapse of a building: outdoor radiO or teleVISion antennas. Including their lead'ln wiring. masts or towers: aWlllngs: gutters and downspouts: yard fixtures; outdoor sWimming pools: fences; piers. wharves and docks; beach or diVing platforms or appurtenances; retainifjg walls: walk? roadways and other paved surfaces. t> Collapse does not include settling. cracking. shnnkage. bulging or ex. panslon. ThiS Additional Coverage does not Increase the amount(s) of insurance prOVided in thiS policy This Endorsement must be attached to Change Endorsement when issued after the Policy is written: MP 04 66 (Ed. 10 83) <;:opYrlghl. Insurance Services Office. Inc., 1983 . T I FIRE LIABILITY INSURANCE FORM (Fire and Allied Perils Only) I $' I CF OX 25 ~. 11 77) . .. POliCY NO. AlENCY c....y .... 't' /. :.. . :'," \,' '.Ciolli SECTION I-DESCRIPTION OF COVERAGE ....-...j . ~ ;01 .\ \~ .'; I I .1 '1 $ '.000 consistinl of being tne limit of the Company's liability for all damales as tne result of anyone accident,as respects property owned by otners 1N11....~1 in the care, custody or control of tile Insured, all wnile situated 7lr 75 C._I_, 11ft_ O.uwatM'. Jl. 3351' Ind occupied IS ".t_~_C the Company alrees witn tne named Insured to pay on behalf of tne Insured all sums whicn tne Insured snail become lei ally oblilated to pay as damales because of injury to or destruction of such property. including the loss of use thereof, caused by accident and arisinl out of peril!s) insured alainst, . subject to tne followinl provisions t t SECTION II-SPECIAL PROVISIONS APPLICABLE TO THIS COVERAGE . j ~ I I ,. POLICY PERIOD: Tnis insurance applies only to accidentswhich occur during tne policy period. 2, LIMIT OF LIABILITY: The inclusion herein 01 more than one Insured snail not operate to increase the limit of the Company's liability 3. POLICY PROVISIONS: None of the terms 01 the standard lire insurance policy, to which this form is attached, shall apply to the insurance afforded hereunder except tne provisions as to concealment, fraud and cancellation of policy. 4, DEFENSE, SETTlEMENT, SUPPLEMENTARY PAYMENTS: As respects tne insurance afforded by tne other terms hereof the Company shall: A. defelid any suit alainstthe Insured alleging such injury or de- struction and seeking damages on account thereof. even if such suit is groundless, false or fraudulent; but the Company may make such investigation, negotiation and settlement of any claim or suit as it deems expedient; B. pay all premiums on bonds to release attachments for an amount not in excess of the applicable limit of liability stated herein, all premiums on appeal bonds required in any such defended suit, but without any oblilation to apply for or furnish any such bonds; C. pay all expenses incurred by the Company, all costs taxed against tne Insured in any such suit and all interest accruing after entry of judgment untiltne Company has paid, tendered or deposited in court such part of such judgment as does not exceed lhe limIt 01 the Company's liability thereon; D. reimburse the Insured for all i:asonable expenses. other than loss of earnings, incurred at the Conl'pany's request The amounts incurred hereunder, except settlements 01 claims and suits, are payable by the Company in addition to the applicable limit of liability stated herein. 5. ASSISTANCE AND COOPERATION OF THE INSURED: The Insured shall cooperate with the Company and, upon the Company's request. shall attend , I I I j r I I I I hearings and trials and shall assist in effecting settlement, securing and givin, evidence, obtaining the attendance of witnesses and in tne conduct of SUitS. The Insured shalT not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense. 6. ACTION AGAINST COMPANY: No action shall lie against the Company unless, as a condition precedent tllereto, the Insured shall have fully complied with all the terms hereof, nor until the amount of the Insured's obligation to pay shall have been finally determin!ld either by judgment alainst the Insured after actual trial or by written agreement of the Insured. the claimant and the Company. Any person or organization or the lelal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover llereunder to tne extent of the insurance afforded hereunder. Notninl contained in this policy snail give any person or orlanization any right to join the Company as a co-defendant in any action against the Insured to determine tne Insured's liability. Bankruptcy or insolvency of the Insured or of the Insured's estate snail not relieve tne Company of any of its oblilations hereunder. 7. SUBROGATION: In tne event of any payment under this policy the Company snail be subrogated to all tne Insured's rignts of recovery therefor against any person or organization and tne Insured shall execute and deliver instruments and papers and do wnatever else is necessary to secure such rights. The Insured shall do nothing after loss to prejudice sucn rignts. 8. ASSIGNMENT: Assignment of interest under this policy shall not bind the Company until its consent is endorsed nereon; if, nowever, the named Insured shall die Of be adjudged bankrupt or insolvent within the policy period, this policy, unless canceled, shall, if written notic! be given the Company Within Sixty days after tne date of sucn deatn or adjudication, cover tne named Insured's legal representative as tne named Insured. 9. CHANGES: Notice to any agent or knowledge possessed by any agent or by any other person snail not affect a waiver or a change in any part of this policy or estop tne Company from asserting any right under tne terms of this policy; nor snail the terms of this policy be waived or cnanged, except by endorsement issued to form a part of tnis policy. SECTION III-SPECIAL CONDITIONS APPLICABLE TO THIS COVERAGE ,. NOTICE OF ACCIDENt: When an aCCIdent occurs written nollce shall be liven by or on behalf of the Insured to tne Company or any of its autl10rized apnts as soon as practicable. Sucn notice shall contain particulars sufficient to identify the Insured and also reasonably obtainable informa- CF OX 25 (Ed. 11171 ,~ tion respecting the time, place and circumstances of the accident, the names and addresses of the interested parties and of available witnesses. 2, MonCE OF CLAIM 01 SUIT: If claim is made or suit is broolht alainst tile Insured, the Insured snail immediately forward to the Company every demand, notice, summons or other process received by him or his represen- tative. Page I of 2 I I \...,..., COINSURANCE CONTRACT "I[' . t , . @o., " 1982 REPLACEMENT COST COVERAGE ENDORSEMENT MP 04 20 (Ed, 07 83) 1 ,j i j ',I . .. 1... ...... '1 ...]1 '!,-/ 1IIlis endorsement applies only with reSpect to the premises described in tile following Schedule IlId affords insurance on a repIIc:enleIIt cost basis only on tile property described below. SCHEDULE 1 1 Pnperty c:...I . I ........... Cost ... (SpecIfy ..... or ,..... PNpIItJ of till .... or bIIIl) location Of Premises location No.. Building No, .u8OU1 Pnte"7 \~_...:. 1. Replacement Cost Clause: The provisions of Section , of this poficy appficabIe to tile property described as c:overecl on I rtCIfllC I ,,*,t cost basis are amended It' "itutt tile terlll "replac:ement cost (witllout deductioIllor dIpnlciItion)" for tile term "adlIII CIStl VIfue" wIIIrMr it IfIIlIIfS ill this policy, and tile Coinsurance Cltuse of this endorsement supersedes and replaces all other Coinsurance Clauses otlIerwi1e 1IlIIIicabIe, subject in III other IeSIJICt$ to tile provisions. of this endorsement and 01 Section I 01 this policy. Z. This policy does not COYer the lollowing property on a replacement cost basis: (a) stock (raw, in process or finished) or merchandise, including materials and supplies in connection therewith; (b) property 01 others; (c) household furniture or residential contents; (d) manuscripts; (e) paintings, etchings, pictures, tapestries, statuary, marbles, bronzes, antique furniture, rare books, antique silvef, porcelains. rare glassware and bric-a-brac, or other articles 01 art, ranty or antiquity. 3. The Company shall not be liable under this endorsement for any loss unless and until the damaged or destroyed property is actuafIy repaired or replaced by the insured with due diligence and dispatch. 4, Coinsurance Clause:. This Company shall not be liable lor a greater proportion of any loss or damal8 to the property covered under this policy than tile limit of liabtlity under this policy lor such property bears to the amount produced by multiplying the coinsurance percentage IlIf)IicabIe (specified in this policy) by the total of (a) the r81llacement cost (without deduction for depreciation) of that part 01 said property which is specifically described as covered on a replacement cost basis and (b) the actual cash value 01 that part 01 said property which is covered on an actual cash value basis at tile tillle of loss. In the event that the aggregate clJlm lor any loss is both less than $10,000 and less than S% of the limit of liability lor aU contributing insurance IllIIficabIe to the property involved at the time such loss occurs, no special inventory or appraisement 01 the undamaged property shall be required, provided that nothing herein shall be construed 10 waive application 01 the hrst paragraph 01 this clause. II insurance under Section I 01 thiS policy IS diVIded Into separate limits 01 liability, the loregoing shall apply separately to the property covered under each such limit of liability. The value of property covered under ()tensions 01 Coverage, and the cost 01 the removal of debris, shall not be considered in the determination 01 actual cash value or replacement cosl when JJlplYlng the COinsurance Clause. This Company's liability for loss on a replacement cosl basis, shall not exceed the smallest of the following amounts: (a) the amount of Ihis policy applicable to the damaged or destroyed property; (b) the replacement cost of the property or any part thereol identical with such property on the same premisdl and intended lor ihe same occupancy and use; or (c) the amount actually and necessarily expended in repairing or replacing said property or any part thereol. The insured may elecl to make claim under lhls pohcy in accordance with its provisions, disregarding this endol'sement; and the insured may make lurther claim lor any additional liability brought aboul by thiS endorsement in accordance with its provisions, provided the Company is notified in writing within 180 days alter loss 01 the Insured's Intent 10 make such lurther claim. . '. .' 1 1 '\ .: '] .G' i 1 I 1 S. , l l I 1 .J 5. J 1 .I , .1 I I \ I V IIII'. 111I\10".0.1111'111 IIlId I.' ,11I.lrh",llo Ch,lIIKIl IIItlolS8ft18nl when ISSued ~ft.r the Policy Is written, MP 04 20 (Ed 01 83) , I I ~~ LOSS OF EAP.NINGS ENDORSEMENT MP 15 93 (Ed. 07 77) ) lOCATION OF PREMISES loc.... Blda. No. SECTION I FORMS AIIO ENoORSEMEIlS APPl.ICAIlE LIMIT OF lIA1IUTY EACH 30 DAYS AC8IEUIt 4 1 HrOOl2 NPOU6 HPOU7 2S% '16.001 I :~':~;; V u 1. Subject to all the provisions applicable to Section 101 this policy, except the Coinsurance Clause and the Deductible Clause. this policy is eatended to insure against loss of earnings resulting directly frOI!l necessary interruption of business caused by the perils "UIed alainst dama,nlor destroyin&, dol". ", potlcy geriod. real or personal property (except tinis~ stock' at the premises described in this endorsemeltt, s_t to the limit of liability specified abcM If.' . premises at whiCh the damage or destruclion occurs. For the purposes of this insurance, "penls insured against" shall mean the perils. as defined and hmit~' the forms and endorsements listed above. for each premises specified and also subject to the provisions of this endorsement Z. The Company shall be liable for: . . a. the actual loss sustained by the Insured resulting directly from necessary interruption of business. but not exceeding the reduction in earnings less charges and expenses which do not necessarily continue during the interruplion of bUSiness, for only sucl1length of time as would be required with the exercise of due diligence and dispatch to rebUild. repair or replace such part of the property herein described as has been damaged or destroyed, commencing with the date 01 such damage or destruction and not limited by the date 01 expiration of this policy. Due consideration shall be given to the continuation 01 normal charges and expenses, Including payroll expense. to the extent necessary to resume operations of the insured with the same quality of service which eXISted Immediately preceding the loss: and b. the actual loss sustained by the Insured: resulting directly from an interruption of business as covered herellncler. during the length of time, not exceeding two conseculive weeks. when. as a direct result of damage to or destruction of property adjacent to the premises herein described by the peril(s) insured against. access to such described premises is specifically prohibited by order of civil authority; and c. loss resulting from damage to or destruclion of media for. or programming records pertaining to. electronic data processing or electronically corrtnllled equipment, including data thereon. by the penis insured against. The length of time for which this Company shall be liable her&!,nder shall not ~~- . ()) 30 consecutive calendar days: or (2) the length of time that would be reqUired to rebUild. repair or replace such other property herein describ~ as has been damaged or destroyed: whichever is the greater length of time d. such expenses as are necessarily Incurred lor the purpose of redUCing loss under thiS endo~ement (except expense incurred to extinguish a fire), and such expenses. In excess of normal. as would necessarily be Incurred In replaCing any finished stock used by the insured to reduce loss~ut In no event shall the aggregate of such expenses exceed the amount by which the loss under this endorsement is thereby reduced. 3. The Company shall not be liable for more than the amount set forth In the limits of liability for each premises above as applicable to "Each 30 Days" for loss iI, any 30 consecutive calendar days nor In any event lor more than the amount set forth above as an "Aggregate" limit of liability. 4. Resumption of Operations: illS a condlhon of thIS Insurance that II the Insured could reduce the lOss resulting from the interruption of business: a. by complete or partial r~sumD"cn 01 operation of the property herein descnbed. whether damaged or not. or . b. by making use 01 merchandise or other property at tht'locations descnbed herein or elsewhere, or c. by making use of stock (raw. In process or h",shed) at the loca"ons descnbed herein or elsewhere, such reduction shall be taken Into account In amving at the amount of loss hereunder. oj 5. Definitions: a. For th~ purposes of thiS Insurance. . earnings" are dehned as net proht plus payroll expen.se. taxes. interest, rents and all other operating expenses earned by the bUSiness b. The term '.dlreclly," as applied to loss under thiS endorsement. means loss. as limited and conchtlOned IR this policy. resulting from direct loss to deSCribed property trom the perils IIlsured agaIRst. C. "Normal", Ihe condllion thai would have eXisted had no loss occurred. d. "Raw stock": material In the state In which the rnsured recetves It lor conversion by the insured into finished stock. e. "Stock in process": raw stock whIch has undergone any aging, seasonrng, mechanical or other process of manufacture at the locations herein described but which has not become finished stock. . f. "Finished stock": stock manufactured by the insured wflich in the ordinary course of the insured's business is ready for packin&, shipment or sale. g. "Merchandise": goods kept for sale by tile insured which lie not the product of manufacturing operations conducted by the insured. , 1,~IOfts Ind New Buildings: permiSSIOngra~d to make alterations in or to CXlnstrud additions to any bUlldlg ~escribed herein and to ~ ..;. bcJildings on the descnbed premises. This endorsement IS extended 10 cover, subjeCt to all lIs prOVISions, loss resulting from damage to or destructlOfl of. such alterations. aoditlons or new buildings while In course of construcllon and when completed or occupied. provided that. m the event of damage to or destruction of suth property (including building malertals. supplies. machinery or equipment incident to such construction or occupancy while on the described premises or within 100 feet thereof) so as to delay commencement of bUSiness operations of the insured, the length of time lor which the Company shall be liable shall be determined as otherwise provided herem bul such determined length of time shall be applied and the loss hereunder calculated lrom the date that business operations would have begun had no damage or destruction occurred. 1. AddItllllll bclusiolls Ind Umitltions: '. a. The Company shall not be hable for any increase of loss which may be occasioned by: (I) enforcement 01 any local or state ordmance or law regulating construction. repair or demolition of buikhngs or structures, (2) interference at the descrrbed premises by stnkers or other persons with rebuilding. repairing or replacing the property or with the resumption Of continuation of business. (3) the suspension. lapse or cancellation of any lease or license. contract or order unless such suspension. lapse or cancellation results directly from the interruption 01 business. and then Ihe Company shall be liable lor only such loss as affects the insured's earnings durini, and limited to. the period of idemRlty covered under thiS policy. b. The Company shall nol be hable for any other consequential or remote loss. c. The Company shall not be hable for loss resufting from: (1) damage to or destructIOn 01 fmished stock,llOf for the time required to reproduce said finished stock, (2) theft of any property whIch at the time of loss is not an integral part of a building or structure (except direct loss by pillage atlCIlooting occurring dunng and at the Immediate place of a not or CIVil commotion). unless loss by a peril not excluded in this poficy ensues from theft Of attempted theft, and then this Company shall be hable for only such ensuiftgloss. e. lequlr...ats in Clse Loss Occurs: The Insilled shall give Immediate written notice to the Company of any business interruption loss IS covend brthis policy and protect the 'ropertylrom lurtlll!r damo1ge that might result lR extension of the period of interruption; and withm 60 days lollowiftl the dIte of dam... to or destruction of the real or pmonat prot'Pftydescn~d. unless such hme is extended in writing by the Company. the insured shallrendel' to the Company a proof of loss, signed and sworn to by the Insured stalmg the knliwledgeand behefof the insured as to the following: a. the time and OllglA 01 the property damage or deslruchon causlAg_the Interruption 01 business. b. the interest of the msured and of all olners IA the bustness. c. all other contracts of tnsurance. whether vahd or not. covertng in any manner the loss insured against by this policy. d. any changes in the htle. nature. 10callOn. encumbrance or possession of said business since the Issuing of this policy, and. e. by whom and lor what purpose any bUlldtng herein descnbed and the several parts thereof were occupied at the time of damage or destruction; Ind shall furnish a copy of all the descrtpt10ns and schedules In all pohcles. and the actual amount of business interruption value and loss claimed, accompanied by detltled exhibits 01 all values, costs and esllmates upon which such amounts are based. . . The insured. as often as may be reasonably reqUired. shall eKhlblt to any person designated by the Company all that remains ot any proclIrty herein described. Ind submit to exammatlons under oalh by any person named by Ihe Company. and subscribe the same; and. as often as may be reasonably required, shall produce lor .amlRation III books of account. bills Invotcrs and other vouchers. or cPftilled copies thereof if originals be lost. at such reasonable time Ind place as may be designated by the Company or ItS reprmnlah~e. and shall permll edracts and coptesthereof to be made. " ThiS Endorsem!'nt must be attached to Change Endorsement when issued after the Policy is written. MP 1 5 93 (Ed 01 17 \ Pile 2 of 2 . .... ( u I U t G (..; " \ ' ,--I v Policy No. ~'33 AMERICAN LIBERTY INSURANCE COMPANY we . Bitminrham, AI..IIM DIVISION 0 ST AHDARD WORKMEN'S COMPEHSA T10tol '''0 EMPLOYERS LIABILITY POLICY DECLARA TIOHS . ., ,..... t. .Me.e" ........ .... AoWreu F.deral Employ.... Id.ntificatian Humber: II I14J4JS ~':Cel.a7 1lar1aa a..taurRllt, Inc. ~ lJ.-75 c:.unv .~~J . ,~~"'t:.., cQ",'Y'~~'P Codr) Locations-All _I worlr.plocrs of thr .nsu,ed at 01 from which operatIons co"eo,rd by thiS policy o~ conducted at. located at th(' ; ~e addresl unless otherwise stated herein:. t "0 Individual 0 Partnenh,p l!lCorporotion 0 Other ...... a. hliey'.rio4: From '2'2.'.' to. lUII/M 12;0 I A ~ ','a~6'~~,m" at the address of the .ns.ureod os stoted "'erI,n, ..... ,. Coteroge A of this pollcV applies '0 the workmen's compensation low and any occupatIonal d,sease'aw of ~ofthefollowino sto',,' - .... . ...... 4. CI.lllfie.tion 0' Operotio". PREMIUM BASIS RAT!!S PREMIUMS .. - -.. -_. ENTRIES IN THIS ITEM, EXCEPT A~, SPECIFICALLY PROVIDED CooE ESTIMATED PER SIOO ESTIMATED , ELSEWHERE IN THIS POLICV DO NOT M0D IF'!' ANY OF THE TOTAL ANNUAL or: ANNUAL OTHER PROVISIONS OF THIS P0LICY NUMBER REMUNERA TION RE MUNERAr tON PIlEMIUMS ...t.....t "79 32._ 1.44 U01 Lua 10% .....1atima iii ....... Ceaatut IS . "-.- . EXPERIENCE MODIFICATION MINIMUM PREMIUM S lU TOTAL ESTIMATED ANNUAL PREMIUM -Is -iii' SEMI-ANNUAL.LY I 0 lJJ' A TI.R '.f I MONTHLY DE POSIT PREMIUM - s 102' It.... S. LImIt of Llobllltv lor Co"clOge B .-Emplo'fers' liabililV: $ 100.000 . ~ubW[! 10011 th" 'r;m~ 01 thi, policy having referel'Ce there'" E "do, sem." ts; VClO ')Absence of "n ,""lry m""n, "N., E1tCephons" CounterSloned ot Cleuwat.~. n. 'da ~ ,1914 J thIS day ,f "q' Autho"zed Reopresenfotiye aM.. lu. Au. SG.34 REV. 6' 7 8 D C INSURAN C E. I The designated Insuror (herein called the company) Acrees with the insured, named in the der.larations made a part hereof! .in consideration of the payment .afthe premium and in reliance upon:.. . ,Iements In the declarations and subject to the limits of liability, exclusIOns, conditIOns and other terms of this policy. l, . . INSURING AGREEMENTS ..... I. ewer.1 a-.....mu's Compensation: To pay promptly when due all com- pensation and other benefits: required of the insured by the WOf kmen's com- pensation law. CIftnIp B-l.,loYers' liability: To pay on behalf of the insured all sums which the insured shall become; legally obligated 10 pay as damag1!s because of bodily injury by accident or disease, including death at any time resulting there. from: lal sustained in the United States of America, its territories or possessions, or Canada by any employee of the insured arising out of and in the course of his employment by the insured either in operations in a state desie' nated in Item 3 of the declarations or in operations necessary or inCI- dental thereto, or (b) sustained while temporarily outside the United Slates of America, its territories or possessions, or Canada by any employee of the insured who Is a citizen or resident of the United States or Canada arising out of and in the course of his employment by the insured in connection with op- erations in a state designated in Item 3 of the declarations; but thIS . . . insurance ~t apply to any suit brought in or any judgment rendered by any court outside the United States of America, its territories or pos- sessions, or Canada or to an action on such judgment wherever brought. II. Defense, Setllltllent, Supplementary Payments: As respects the insurance afforded by the other terms of this policy the company shall: lal defend any proceeding against the insured seeking such benefits and any suit against the insured alleging such injury and seeking damages on account thereof, even if such proceeding or suit is groundless, false or fraudulent; but the company may make such investigation, negotiation and settlement of any claim or suit as it deems expedient. Cbl pay all premiums on bonds to release attachments for an amount not In excess of the applicable limit of liability of this policy, all premiums on appeal bonds required in any such defended proceeding or suit, but without any obligation to apply for or furnish any such bonds; ___ EXCLUSIONS nil polky dees not apply: lal under coverages A and B to operations conducted at or Irom any work. pllee not described 1ft Item 1 or 4 of the declarations if the insured has, under the workmen's compensation law, other insuranr.r. for such operations or is a qualified self-insurer therefor; (b) under coverages A and B unless required by law or described in the dec- larations, to domestic employment or to farm or agricultural employment; Icl under coverage B, to liability assumed by the insured under any contract or agreement, but this exclusion does not apply to a warranty that work per- formed by or on behalf of the insured will be done in a workmanlike manner; Id) under coverage B, III to punitive or exemplary dal11a!:cs 011 account of (cl pJY all expenses incurred by the company, all costs taxed against the insured in any such proceeding or suit and all interest accruing after entry of judgment until the company has paid or tendered or deposited in court such part of such judgment as does not exceed the limit of the company's liability thereon; .. :., : Idl . reimburse the insured for all reasonable exPenses, otlier thin loss of earnings, incurred at the company's request. The amounts incurred under this insuring agnlllll8llt, except settlements of claims and suits. are payable by the company in addition to the amounts payable U under coverage A or the applicabl~ limit of liability under coverage B. III. Oefillitions: lal Workmen's COlllpusatlOl Law: The unqualified term "workmen's c0m- pensation law" means the workmen's ~satioIl law and any occu- pational disease law of a state designated 1ft Item 3 of the declarations, but does not include those provisions .of any such law which prOVide non-occupational disability benefits, . . (h) State, The word "state" means any State or Territory 01 the United States of America and the District 01 CoIUlftbla. Ie) Bodily Injufy by Accident; Bodily fnjury Q Dtstae. The contract"'" of disease is not an accident within the meani", of the word "accident" in the term "bodily injury by accident" and only such disease as results directly from a bodily iniury by accident is included within the term "bodily injury by accident.' The)erm "bodily injury by disease" includes only such disease as is not included within the term "bodily injury by accident." (d) Assault and Battery. Under coverage B, assault and battery shall be deemed an accident unless committed by or at the direction of the insured. IV. Application of Policy; This policy applies llnly to .Injury. 11l by accident occurring during the policy. period, or (2) by disease eaused or aggravated by Jt . exposure of which thl! Int day of the last expostlte, in l~e. employment of the insured, to conditions causing the disease occurs during the policy period, bodily injury to or death of any employee elft1)loyed In violation of law, or /2l with respect to any employee employed in violation of law with the knowledge or acquiescence of the insured or any executive officer thereof; (e) under coverage B, to bodily injury by disease unless prior to thirty.six months after the end of the policy period written claim is made or suit is brought against the insured for damages because of such injury or death resulting there- from; lf) under coverage B, to any obligation for which the insured or any carrier as his insurer may be held liable under the workmen's compensation or occu- pational disease law of a state designated in Item 3 of the declarations, any other workmen's compensation or occupational disease law, any unemployment compensation or disability benefits law, or under any similar law, CONDITIONS 1. "'';'ium: The premium bases and rates tor tilt: classdlcations of Spera lions annual basis, lhe insured shall pay the deposit premium to the company upon described in the declarations are as slated therelll and 101 classdwatlOns not the inceplinn "t this policy and thereafter interim premiums shall be computed so described are those applicable in accordallCP wdh the 11I,10uals ill use by the in accordan(.,th the manuals in use by the company and paid by the insured company, This policy is issued by lhe company and acccpti~d by the insured promptly after (he end of each interval specified in the declarations. The deposit .~th the agreement that if an~ change in classifications, rates or rating plans premium shall be retained by the company until termination of this poliCY and IS or becomes applicable to thiS policy under any law regulating this insurance credited to the final premium ad~ustment. or because of any amendmentsalfecting the benefits prOVided by the workmen's compensation law, such change with the effective date thereof shall be stated The insured shall maintain records of the information necessary for premium .in an endorsement issued to form a part of this policy. computation nn the bases stated in the declarations, and shall send copies of such record' I,) the company at the end of the policy period and at sur.h times When used as a premium basis, "remuneration. meaw, tile enllre remuner- during the p':";y period as the company may direct. If the insured dlles not atlC!n, comput~d in accordance with the manuals in use by tliC company, earned furnish recor:; of the remuneration of persons within diYi~'Qn (b) of the defini. ~urlftg the polley penod by (a) all executive officers and ot','~r employees of the tion of remle ,I'on foregoing, the remuneration of such persons shall be com. msured ,engaged in ,!perations covered by this policy, an,ji;. any other person puted in ac ""ce with the manuals in use by the company. . p~rfonnmg work which may rend~r the company !table under this policy for Injury to or death of such lIerson 10 accordance with the workmen's compensa. The PH'",,' stated in the declarations is an estimated premium only. Upon ~~,lawd' "Remuneration" shall not include the remuneration of any perSon t~rtmh inthationlof thiSt POliCYt1 the ,earned pr~mium Sdhall,1?t comput~ in accorl~anbcle 1.., '"URn 'vision Ibl foregoing if the insured maintains evidence satisfactory to WI e ru es, ra es, ra 109 pans, premium an m n,",Ulft premiums app Ica e .- tile company that the payment of compensation and other benefits under such to this in~;Jrance in accordance with the manuals In use by the company. If the . to such per.son is secured by other valid and collectible insurance or by any earned premium thus computed exceeds the premium previously paid, the insured other undertaklOg approved by the governmental agency having jurisdiction '3hall pay the excess to the company; if less, the company shall return to the thereof, insured the unearned portion paid by the insured. All premiums shall be fully earned whether any workmen.s compensation law, or any part thereof, is or shall If the declarations provide for adjustment of premium on other than an be declared invalid or unconstitutional. . ~:tt- THE STATESMAN GROUP SG.34 .... ... . I !., ,,"~, ,''II (. .' ~, ., t\.,~ .....,. .t . .. \;. i.. . . ..... . .: . . \ AMENDMENT ENDORSEMENT AMERICAN LIBERTY INSURANCE COMPANY ThiS. endorsement IS Issued lor attachment 10 Ind lorms a part 01 "It below nUlllbtted policy, e"teh", on lilt dale indic.ted, All 1"11I' Ind condihon. 01 lIII policy (In, cludlnl any endorsemenl thereon) to which thiS endorsement IS allsched rllll.ill ulICh'llItd tlcepl IS .",ended by "'is endorMmellt. d. No, El1eclive Dlte Policy No. Alent Countersilned ICily, S""I T},i,. ;.T'.~:i')n p I r ...' 1, Ipd '" .;1', p_" l- .; .J ,1t .".1 iorm~ Sllneture 01 Alent Nlm" Insured . ':1 .. . ,. II." " Workmen's Compensation and Employers' Liability Policy AMENDATORY ENDORSEMENT Insuring Agreements. III Definitions. (a) Workmen's Compensation Law It is agreed that "Insuring Agreement III - Definition (a)" of the policy is replaced by the following: "(a) Workmen's Compensation Law. The unqualified term "workmen's compensation law" ~. means the workmen's compensation law or workers' compensation law and any occupational disease law of a state designated in Item 3 of the declarations. but does not include those provisions of any such law which provide non-occupational disability benefits." WC-10 (3/15/75) \_/ G ~, '- '"-" ~ \-..., . I I NOIU......Cfl (Attach bdors.ments .Herel 2. lonl Ter. ..licy, If this pohcy is wrlllen lor a penod longer than one year, all the provIsions 01 this policy shall apply separately to each consecutive twelve IlI9nths perIOd, Of, if the IlIst or last consecutive penod IS less than twelve months, to such period olle~s than twelve months, In the ~ame manner as II a separate policy Md ~een wrlllen lor each c..,nsecutlve period. The ear.ned pre. mlum 1000ear.h ~uch pellod shall be compuled as provided by Condition 1 01 this policy, sublect. !!xcept as otherWise provided in the manuals in use by the company WIth respect to classlflcalions 01 operations for which this policy provides a per capita premium basis, to the follOWing .DrovISlons; III The premium rates lor the first consecutive period shall be those stated . in the declarations and those applicable for such penod In accordance with the manuals in use by the company; l~l The premium bases, classillcations 01 operations, rates, rating plans, premiums and minimum premiums lor each such subsequent pI' nod shall be those alllllicable lor such period in accordance with the manuals in use by the company, 3. 'artJltrship or Joint Venture IS Insured: If the insured is a partnership or joint veftture, such insurance as is altorded by this policy applies to each partner or member thereof as an insured only while he is acting wlthi!1 the scope of his duties as such partner or member. 4. Inspection and Audit: T "The Company and MY rating authority having jUllsdictlon by law shall each be permitted but not obligated to Inspect at any Illasonable time the workplaces, oper alions, ",achillery and equip- ment COVel-ed by this policy. Neither the right to make inspections nor the making thereof nOl any report thereon shall constitute an undertaking on behalf 0' or fOl the benefit of the insured or others, to determine or warrant that such workplaces, operations, machinery or Ilquipment are safe 01 healthful, 01 are in compliance with any law, rule or regulation," "The company and any rating authority having jurisdiction by law shall each be permitted to examine and audit the insured's payroll records, general 'edger, disbursements, vouchers: contracts, tax reports and all other books, documents and records of any and every kind at any reasonable time dUfing the policy period and any extension thefeof and within three yelKs after termination of this policy, as tar as they show or tend to show or verify the amount of remuneration or other premium basis, 01 lelate to the subject matter of thi s insurance." 5. ltatice ot Injury: When an injury occurs written notice shall be given by or on behalf of the insured 10 the company or any of Its authoflled agents as soon as practicable Such notice ~haH contain parllculars suflicient to identify the insured and also reasonably obtaln~hlc 1lI1ormallnn respectlnll the tune, place and circumstances 01 the IIl)lIry, thr n,II1l~:, and addre~srs 01 the injured and of available witnesses. e. ltat~e of Claim or Suit II claim is made or suit or other proceeding is brought against the insured. the insured shall Immediately forward to .the co~- pany every demand, !1~tice, summons or other process received by him or hiS representative. 7. Asslstanca and Cooperation 01 the Insured: The InsulI'd shall cooperate with the company and, upon the company's reQue~t. shall allend hearings and trials and shall assist in etlectinl! selllements, sccurinR and I!lvlng evidence, obtain- ing the attendance 01 witnesses and 10 the conduct 01 SUits or proceedings. The insured shall not, exceJlt at his cwn cost. voluntallly make any payment, assume any obligation or iocur any expense other than for such immediate medical and other services at the tllOl~ 01 IOI1Iry as are required by the work- men's compensation law. 8. Statutory Provisions-Coverage A: Ihe company shall be dire~tly and pri. marily liable to any person enlltll'd 1:\ Ihe hpnclit~. of Ihl' workmen s compensa- tion' law un1er thiS policy The Obl'l'dllon5 of the romp,lny may be enlorced ~y such person, or lor hiS benefit hv ,10V Ji'pory authorized by law, whether against the company al(lne or JOllltlV wilh till' "".lIr..d B,lllkruptr.y or Insolvency of the Insured or of the insllrcd's C';l.lt.,. IIr .11lV d"I,1I111 ot Ihe insured, shall not relieve. the company 01 any III Its uhlig.ltl')OS IInder rllvl'rage A. As between the employer and 'h.. company. nollrr or knowledge of the injury on the part 01 the insur..d shall ht~ nlllice or kO(lwl,'c1Rr, as the case may be, on the part 01 the company; the lumdlc'lon ot the IlIsured, tor the purposes of the workmen's compensation law. shall be jurisdiction of the company and the company shall in all things be bound hy and sublect to the findings, judg- ments, awards, decrees, orders or deciSions rendered agamst the insured in the form and manner provided by such law and Within the terms, limitations and provisions of this policy not inconSistent With such law. AIt 01 the provisions 01 the workmen's compensation law shaU-be and remain a part of this policy as fully and completely as il wlitten herein, so far as they apply to compensation and other benelrts provided by thl~ policy and to special tnes, payments into security or other special lunds, and assessments required of or leVied agail\st compensation insuranre r.arners uodPl such law. The insured shall reimburse thr r.OIo11..ny fnr any payments required of the company undtr the workmen's rompl'l1'..lhnn law, in ell:l!SS 01 the benelils reg- ularly provided by sur.h law. solely brc;!u';!' 01 injury to lal any employee by reason of the senous Jnd ",lIlul ml~.l nn<1url 01 the Ins:tr.'<1, or (bl any employee employed by the insured in ViolatIOn of law with the knowledge or acquiescence of the insured or any execulive olllcN thereof. Notbing herein shallrelirve the il1'.lIred of the obli~'.,ltlflns imposed upon the insured by the other ll~nns 01 thiS polllY. . .9. Limits of Liabitlty-Caver8le 8: The words "damages because of bodily injury by accident or disease, including death at any time resulting therefrom," in coverage t3 Include damages for care and loss of services and damages for which the Insured IS liable by reason 01 suits or claims brought against the in. sured by others to recover tne damages obtained from such others because of such bodily Injury sustalRed by employees of the insured arisinl out 01 and in the course ot tnell employment. The limit of liability stated in tne declarations for coverage B IS the total limit ot the company's liability for all dam.s be- cause 01 bodily IOJury by accident, includIRI death at any time resulting there- Irom, sustained by one or more employees in anyone accident. The limit ot liability stated in the declarations for coverage B is the total limit of the com- pany's liability for all damages because of liodily injury by disease, including death at any time resulting therefrom, sustained by one or more employees 01 the insured in opelations IR anyone state designated in Item 30t the declara- tions or in operations necessary or incidental tnereto, The inclusion herein of more than one insured shall not operate to increase the limits of the company's liability. 10. Action AlaiHt COIl,~-eoverlle I: No action shall lie eillnst the company unless, as a condition precedent thereto, the insur~d shalfhave fully complied with all the terms of this policy. nor until the amount of the insured's obli~alion to pay shall have been linally determined either by judgment ~ainst the Insured alter actual trial or by written a.,eement ott~e insured, the claimant and the company, . . Any person or organization or the legal representative thereof who has se. , cured such judgment or written agreement shall thereafter be entitled to recover , under this policy to the extent of the insurance afforded by this policy. Nothing , contained in thiS policy shall give any person or organization illY rilM to join the company as a co-defendant in any action against the insured to determine the insured.s liability, Bankruptcy or insolvency of tbe insured or of the insured's estate shall not relieve the company 01 any 01 its obligations under coverage B, 11. Other Insurance: If the insured has other insurance against a loss covered by this policy, the company shall not be liable to the insured hereunder for a greater proportion 01 such loss than the amount which would have been payable under thiS policy, had no such other insurance existed, bears to the sum of said amount and the amounts which would have been payable under each other policy applicable to such loss, had each such policy been the only policy so applicable. 12. Subrogation: In the event of any payment under this pOlicy, the company shall be subrogated to all rights of recovery there lor of the insured and any person entitled to the benefits of this poliCY against any person or olganiza- tion, and the insured shall execute and dp.liver Instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing alter loss to prejudice such rights. 13. Chanles: Notice to any agent or knowledge possessed by illY agent or by any other person shall not ellect a waiver or a change in any part of this policy or estop the company from asserting any rilht under the terms of this policy, nor shall the terms of this policy be waived 01 changed except by endorsement issued to form a part ot this policy, signed by an authOrized rep- resentative of tbe company. 14. Assignment: Assignment of interest undel this policy shall not bind the company until its consent is endorsed hereon. If, however, during the policy pellod the insured shall die, and writte.n notice is given to the company within thirty days after the date of such death, this policy shall cover the insured's legal representative as insured; provided that notice 01 cancelation addressed to the insured named in the declarations and mailed or delivered, alter such death, to the address shown in this policy shall be suthcient notice to ellect cancelation of this policy. 15. Cancelation: This policy may be canceled by the insured by surrender thereof to the company or any 01 its authorize. agents or by mailing to the company written notice statmB when therealter the cancelation shall b. .ffec. tlve. ThiS policy may he canceled by the company by mailing to the insur.d at the address shown In this policy written notice stating when not less than thirty days Ihrr"Jfler such cancelation shall be ellective. The mailing of notice as aloresJld shall be suffiCient proof 01 nohce. T~e time 01 the 5urrender or the ellecl1ve dale and hour of cancelallon stated in the notice shall become the end 01 the policy period. Delivery 01 such written notice either by the insured or by the company shall be equivalent to mailing. If the insured cancels, unless the mapuals in use by the company otherwise pro~lde, earned premium shall be (l) computed in accordance with the custo. mary short rate table and procedure and (21 not less than the minimum pre- mium stated in the declarations. If the company cancels, earned premium shall be computed pro rata. Premium adjustment may be made at the time cancelation is effected and, if not then made, shall be made as soon as prac- ticable after cancelation becomes effective. The company's check or the check of its representative mailed or delivered as aforesaid shall be a sufficient tender of any relund of premium due to the insured, When the insurance under the workmen's compensation law may not be can. celed except in accordance with such law, this condition so far as it applies fo the insurance under this policy With respect to such law, is amended to : conform to such law. 16 Ter.s of 'olicy Conformed to Statute-taverap l: Terms of this policy which are in conllict with the provisions 01 the workmen's compensation law are hereby amended 40 conform to such law. THE STATeSMAN GROUP SG-34 Rev. 12-73 35 Cl ~_.. t> ~:..~. . - .;. . '. . ~ . . "'-:~~r:-'J.f'".'-_'~-?~'\r:-'.r.::"""::-.~;"' -.. JIIIII';J\"',~~~ 'V~,.'. ~ I 1 I. . ., , "' ," ,. / P ,,.;.:-.) 'L-"...C (/'-" I '--Lr ...._--~- c:d' Ll Rhodes Insurance Agency 1735 Drew. St. Clearwater, Fla. 33515 ..---/ American Liberty Insurance Company 12 : 01 a . Dec. 28, , 83 ___~~'-.: Until Pol icy j sjss ued , . "";j [] Pl,S b':,cj~r 'S 'ss~,:'d to e,.tend CO\le~J62 i1 th2 aOJ," named .' _4~J,,~(3rJ c()rnpa~y ;:,e: e' ~J'''''1l5 pOlir:y ;:; .; t'.':':.' ,"'!"" '1 '..: ~.. "<N J r p'.,~"~ ';.'~~: \'A!L:~..G AQ:;Ri.S::> Cf ::'.S;"';RlD Description of C:p~ration/Vehic!es/Property Colony Marina Restaurant, Inc. 71-75 Causeway Blvd. Clearwater, Fla. 33515 71-75 Causeway Blvd. Clearwater, Fla. 33515 P R o ? Ty~_.nd loc.t;~~~~~ ~ ~O+ --~027;;('/~d~'L~~o/ \if jAJ, _/)f, t>f$'"V // U)?!J 38'~ pC,-A 6 .a; /' S I '-v-f'I'.. -90 I 7 'tf ->- (; iA S ,-z...-l ,/ _ .. _ L{ (f' '1 /] f[ / . ,.,-,{;/J . I 6 L--H I c;., t , ~ ; eon.. Oed.: .. ----L..- c x ~,o;(,/ 7A1j ,t ~ IOO,DnD l"~' r" ! r,' /) ,'" "'5:'- 5n, onn I 100,noo 50,000 x X X Plate Glass xx \'> Slnn,nnn each acci~ent City of Clearwater 25~useway Blvd. Clearwater, Fla. 33515 CITY m: CLEARWATER . j./~: DEe 3 I) lSS.i U$~4~ HARBORMASTERS OFfiCE / I I C()~!~I.'\:"Jl~ ~~ r - I I , I I ! +.1 ~~Ai ..~t;t i:~ '~;:;:d 1f;.--- :J~"".., .~~.'.. COLONY MARINA RESTAURANT, INC. I~ J:J~ 71-75 CAUSEWAY BOULEVARD t I CLEARWATER BEACH, FL 33515 I ,," ~ ;. ': ':.: ~." .... '~:f~I~:?:,~:~~~!o;~l~~~~~~;;"i'~~';~:';;~~'~;';,;~:,'.. ,.,,", ,", .' f:~ A XX ;" ..... ; "I".' I GLA4735900 12/28/81 ...:.~ 't;. ',C'N': I ;~~~ , ,v,.IP\ . . . .L" I ~~~ , it .. ,,".". I' ~ '.:'.''''''Ii.rr: :,;~\d....;; ,'. 'I, ".":.". Ii iff.:~ i " :.'''' ,,: '.. ,.,,:,.. :.~', ;t,i~ ~. .,'" ~."':";.'.T(.c"1 !oft:.' , ,. f~ X PLATE GLASS COVERAGE ;~ r.,jF):.'~J8.-cE '-'-;;SILlT-y"-j-' ------. '~~1 .. II .:Jt;. " , I;;.. ..,."..i ~~;4 , _ __ :1.., ! ~.~~.,-_.$ I '..: EX.C{SS-L-'-h-SlL:Ty-----1-m--------- ---'-.-- -- ,,. o~ '.~ :';}' 't,\ -j;;" ....-.~--.-- .------..--.---- ..---,_____.._ U"_ .:~fl"'(E",[RS' COI.'PU,'3 A TIONI ';~ A """O'f;.;~ L!"",llT~.L~863173 ~i : OHlER I --'-' !~'7":T:7~"~~~ ~;~> ;~~~~T:~~:=:~~~"'~~~L~ ~.:'.'~~~.~:,",~"~~ '.i~~,". ;~. " p~~ - ,~-~ :~1l ;.~ ::.~...' <;, ~ >. - - - - - --- - -- - ----- ----- --- ~_ t" 'l,,; 1:., ..-----.-~,--- . --- _,J ::;.~~il~2:~.:E:Jy?C:':t~~~~{T.t~:]~*iw~r~&~.PJ;M~2~g;~;~S)i';':)',.:::.; ,: ' t'L:; ~'.. .,." " T."nrh,.nnrn ;:Inn Refreshrn~nt Stand. and the Lessee ~ I RHODES INSURANCE AGENCY, POBOX 5164 CLEARWATER FL INC. 33518 ,. '....(1 _ J '.' .. f'r ~_L!. r I ;-;q j :, . . 'l!. ~: ~_ ( L t. __u__________________. ..__.. C('r"c(.:!I~ ~i()r.: ::~-,,'::'.I.:"-! ,~~'11' '_~J~ t~~c ,lC'0ve dc~r"d)!.'.; ~;i_'! :"t~:. l)~: 1f1", !',1", . ,_-~.;,_;I~J\/or to rTjail .3.-0_,_ U..J'j:'") v\ntt~.;rl -l:Jt:C~ :T~_'~ i ~i...ci, nc',+:ce sh:.~l! imposfl r',,') ubl!['"nro'-) r:'r tl,l~';::'\' ci ,OJ: i~~:~;-~~--~:::~-;::-=;;~~:~~~q---------- -------- --- CITY OF CLEARWATER ATTN~ CITY CLERK POBOX 4748 CLEARHATER FL 33518 ~ , :. f' ~-"..........-..!".....-.l~'.l,. -:-~. -- j"d ~ n~(f)!N:~ .(' ';,' C{)'i~'~'", ,;:; t\ GENERAL ACCIDENT FIRE & LIFE : \. ~.:~i .v _" 1-4 {_, 1- \' {"'-' fO'j '1' t~\.".I ;:. ,; ~ t". . . , 1.~.... (,,\7 'V nEe 18 !l:~,O CITY Cl.El~K \'.. --. - l' 100 100 . ~ i ~~{ \ ~. ~ ~~~~.) ~ !! 50 50 L_' l.~,..:;:" ,...,.. ' ~~~~:~~,:.~ :~. ,~' "Il..' , .. . !~i::" . ;'r. L________._,. , I ~~~i~'_:~r . .~\::7.t..\,/ : . ..._~.r-' . ~_.J'1 :"..... ~. " ..' '.'.,Ir ~" ., f;;,'. !' ... , '-".~. , . .. I- i .. p~: ~~iii:;K,0i7.f:".;~{f{~gfi1i']~1::'};;ti~ I f.' .;.~, '..... -(~: f;- ~~~~. --,.- .. 12/28/81 .. -"..~....,~. ., .-_...:...;.'...... ',-'" :. ".:;;.': 7':~; t~~\ ~.... .' ..... ~;?:: !i;...'.; ~';; ~~f ~:{\ 1;;:/ ,,~''7' ~.' fi' ~<\ .;-~;; J~:...._ ~;~. t~:j t. , , , ~ , i r' I'~ ! ~ I :. ,. ~; it , ; , I : ~.-, t; C': r. ..../ i',._ -~ ~11 r" i . \.1,::-1:'1 IJ;~<.fi t1h' CUP'I. ~COECE:%~~ RHfu INSURANCE AGE~-- ~:, .~:~\ , ',.. ;..,.~: . . '. particularly COVt:U(:l.ll~=> . \--:~ Colony'~arina Restaurant, Inc. 71-75 Causeway Boulevard Cleanlater Beach, FL 33515 (-If,.n''',.~jt C I , I I ~ ;.' SfP 1 ~~ 100, 1.)U, Rhodes ~lsurn~ce Agency, Inc. ? .0. ':"ox 5164 Cl~8r...'ater, FL 33518 CO~,~Pf\r:IE'~,~ ,:'-" t.: ii~n:NG CU\:~~:- r '.-.~,; I :, h', : r '~I " A Ohio Casualty Im:urnrlce Ccr.;;nn',' ,t,f,'; :'~~'1 B L f ; 'I H RfrEH/f~.~ ~"'" ..... !'>,.'1,'.t! ".~i: :.' , .-t... : -.~ Jf,-: ~~f f' ------ -------- "----.-----.. ------ .-- ----------,. (t,'.1r..""',.." 0 If II!': COMh.~N y- E t[ 1 TI (~ Thi-s';; i.o--cert~fy-th-a~ poircle~ of insurance listed below havp been i~sued to the inSUrl;d--;;an)L'd-ab")~~ a~rl- i.;c In -f;;;(~-~! tlH~'~-;'ll~--~";;''''''~ ,"':, '"'-:: ~ vI a!1~' contract C" other do.;ument with respect to which this certificate maio he j:isu~.1 Ot may ;;e~tJI,', :ne IfhW,l:<F ;:.~I~!"(Il:J ~). t'le :e':.: ,':' ~_:.c:,~,.-j :'~~t"'~1 terms, e.eluslon, and conditions of such policies. .-crrr.~ ','/:.'" !: 'to; . . ~'f e'f !~'f'-'~:P:"'V [ POI. iC..,' NU~.~iH f? .-----r-- ....~____-- I I.,t,( , -----------_____ L ;_.~:.~.~~!:.~\_... i i I '--l==-=-J.i"1ItS on:I,''''!itYln-Th~lJ~~''~' ;000 A I ~-------~- -- i GENERAL LIABILITY liXJ '."~'L;'l~""::'..( ~~);.<1'.~ !r'Xl ~:';''':''fc:.- '.-':-'~;'):';"::~'~ l[j! .;:~~~~,-_r::.:~ :.!\jD 1>:nL/.PS[ I ......lr.~;J o i.~..~,l ,Jt_.p')t'~::' MAltoRf) !Xlll"~~;I("'Tc:. r:-,:...~p: FTfD [J ,:::f;::','('~'~ ,'~~:~;~~\, [ ! [3 ',:',/:::.~~~,'::': ~': .~':~:'~", ')G' i[~ I _.~ I';~J-.~'''':,~ :",.,;,'c,:,.' :X Plate Glass -....------- --- -----.- ~-..- . AUTOMOBILE LIABiLITY : [J ',';..;~; '., " , -" XLW 156640 ... - i- I 12/28/82 ! ! ' I ~ ;:. . . : "" I \J' " -,urd~' ~...~,." M ~ .. '.' ! '\ ~- -- 5J, j<J, XG9--15_?~4,Q__a_ __ 12/28/82. [J [J ~;~ ':' '- ' ~l.,_: ~ .:.' :':,;-,-; ;- A ~' ~ ' I ~-....,..~_, _-, . 7".,~~;,.;~ f"- ;j 1_- __ _ _______a________ ~ Cance!laticn: [J ',_', .-,,~'- -- ------:---Tx"CESS L1ABiLITv1 n . '.'c'"'..' '~~... ' L :~,,;~~;-~':''',-'''~;:':l~;' . ;--,.,' I .--~-,-------._- __m_ r- WGRK~PS' COMPE/iSUION: I I , ~~n~ .-~ .) "~:' ;.: ~ and TwO 156640 12/28/82 'f3{Jt~i_~;-'7;~~~i'C' ',- · :it .,,"l:,;;. ... ~""- - 'i~~~f, ....r'. :;'3 ~l #l:t .~... i"~";: ......~....... .~ ' ;. IIP-.. .~ , I' ..... I .. ~ ~ ~ ~. ~t' ;. ~ EMPLOYERS' L1~AILlTY ...---------- -- OTHER . .7"~- ."'-' .- .~~- ~i!~'!W~~~~ .:~ ~k~;~- :..;,:_~:~;~~:-"::--.: < .?-:~~"\.":~:.. .. tr.":'.- ".~. '*': ~"~:" E:: S-.:J1;: :;", of tr~e a::>ove desc.r;iaed pOllc,es be canet'i:'cd [Jei,:..-,: th: ,_"!-.,'r.~t,()'l .).;:,' ;:a.... /' \"., ; endeavc;r to mail ~ d.Jys '.,,'ntten nutl, t"- l~J ~;~~ ~-.,e~c,.'" r,;;:~~'.~~; ~ ':': . :-'.;.' SJ::-, notice snaillrTlpose no obll'5Jtlcn or lIaDII,t, :jfy'i k:nJ U;Y;. 'he r:.:,:r;),- ! ',;:'''f_ :....: .:.=:~~:=s c; .:~~rlnC:'~E ""'OLDER ----1 City of Clearwater Attn.: City Clerk P .0. Box 4748 Clearwater, FL 33518 CAn I ,'- 8/31/82 SSA,: _____ .__.__ _H. I1!dff4t~. ~_? y~ I Ar.I)G:J 25 (l,79) '~~,'._~~~'" "~~~~'f:-J"5~'~"'ii<~~i~..a . - ,-..,";i.:~.'r-~.(1j. ..~.~.~,~~._~~~f\::r; ;: . ~, ",__''".'~.~, ~..,,!. ,_.,.~~ ';. 'li~..\1. ~t.~, ~ ..\...... -- \..._-- _ _ ""II 1 _ _ t... _1 : _ .k _.._ - -- - - ... _1._1' ~, .,l .;,; 15 ~: .t;'~..'!. ~. . \.._'.;:'::1..3 , :..' ......-:.~'~!rt~?~'-r:-' -'I~-:':'" - .... ~:=;..;-~ ... - - - - - _eo.__ !. , CITY 'F CLEARWATER Interdepartment Correspondence Sheet TO: lill Burchfield, Karbor...t.r FROM: COPIES: SUBJECT: DATE: '~ce'VEIf , Elizabeth S. Hae.eker, Asa1etaDt City Manager Lucille Willi_, City Clerk / SEP 13 1_1 Leu. - Colony MariDa bataurant September 9,1982 ~n J:I R-. Th. City Clerk aent you . copy of the Certificate of Iu"rance on the abov.-cited ap'....t. '.ragraph nine of the .gr....ut iD4icat.. that the Lea... ..t furDiab. 118 with copi.. of the iIaaunInI;,e . polic1aa theuel..... lave you rev1eve4 th... polici.. aud are they ac:lequat. for our ueecla' A further search of our file indicatea that we do not have a copy of the lease dated May 29, 1979. Will you please sand U8 one aud make certain that the 1neurance requirements have not changed since the origiual 1.... vaa aigned on May 10, 1974. " 'fill'; -""q. TO: FROM: COPIES: SUBJ ECT: DATE: .i". '.'.......,..'. If ,'" ~ ' ,. ..I~ . '.,1 h "" ::' 1. C I TV 0 F C LEA R W ATE R Interdepartment Correspondence Sheet Elizabet.h S. Ha...II..., Au18tant Cit, HaDaser Sue Lallkin, 'u1.-.tQ1t,; .Qlerk ColonY' Marlna Restaurant IDl!IuraDae Certlfloate Sept_ber 1, 1982 We are enol_1DI .OQP~ otUle followina insuranoe oertlt1oate: Colony Marina Restaurant Canoellatlon Date 12/28/82 Copy i. for your f1l... B1l1 Burohtie1d baa a oop, of the oertit1cate. Isa Ene 1. Rhodes'Insurance Agency, Inc. p.O. Box 5164 Clearwater, FL 33518 COMPANIES AFFORDING COVERAGES COMPANY A LETIER COMPANY B LETIER COMPANY C LETTER COMPANY 0 LE ITER COMPANY E LETTER This is to certify that policies of insurance listed below hav!' been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Ohio Casu~1:;y . Insu~ance Company D08~ NAME AND ADDRESS OF INSURED Colony'Marina Restaurant, Inc. 71-75 Causeway Boulevard Clearwater Beach, FL 33515 SEP 1 . TYPE OF INSURANCE Limits of Liability in Thousands ( OCC~~~~NCE AGGREGATE POLICY NUMBER POLICY EXPIRATION DATE GENERAL LIABILITY A IX] COMPREHENSIVE FORM IX] PREMISES-OPERATIONS o EXPLOSION AND COLLAPSE HAZARD o UNDERGROUND HAZARD IX] PRODUCTS/COMPLETED OPERATIONS HAZARD o CONTRACTUAL INSURANCE o BROAD FORM PROPERTY DAMAGE o INDEPENDENT CONTRACTORS o PERSONAL INJURY X Plate Glass AUTOMOBILE LIABILITY o COMPREHENSIVE FORM DOWNED o HIRED o NON-OWNED $ 100, 100, XLW 156640 12/28/82 BODILY INJURY 50, PROPERTY DAMAGE $ 50, BODILY INJURY AND PROPERTY DAMAGE $ COMBINED $ XGO 156640 12 28 82 PERSONAL INJURY BODIL Y INJURY (EACH PERSON) BODILy INJURy (EACH ACCIDENT) $ EXCESS LIABILITY PROPERTY DAMAGE BODIL Y INJURY AND PROPERTY DAMAGE COMBINED o UMBRELLA FORM o OTHER THAN UMBRELLA FORM BODILY INJURY AND PROPERTY DAMAGE COMBINED $ A WORKERS' COMPENSATION and EMPLOYERS'L1ABILlTY OTHER 12/28/82 m XWO 156640 DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES ACORD 25 (1.79) Cancellation: Should any of the above desc.I;~ed policies be cancelled before the expiration date thereof, the issuing com. pany will endeavor to mail -L- days written notice to the below named certificate holder, but failure to mail such notice shall Impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER 8/31/82 City of Clearwater Attn.: City Clerk P.O. Box 4748 Clearwater, FL 33518 DATE ISSUED. RHODES INSURANCE AGENCY~ INC. POBOX 5164 CLEARWATER FL 33518 COMPANIES AFFORDING COVERAGES COLONY M~RINA RESTAURANT, INC, 71-75 CAUSEWAY BOULEVARD CLEARWATER BEACH, FL 33515 COMPANY A LETTER GENERAL ACCIDENT FIRE & LIFE COMPANY B ,V lECEIVED LETTER COMPANY C .~ LETTER DEe 18 19BO COMPANY 0 LETTER COMPANY E CITY CLERK LETTER NAME AND ADDRESS OF INSURED COMPANY LETTER --A This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. TYPE OF INSURANCE POLICY EXPIRATION DATE Limits of Liability in Thousands ( OCCL~~~NCE AGGREGATE POLICY NUMBER A GENERAL LIABILITY ~COMPREHENSIVE FORM GLA4735900 o PFlEMISES--OPERATIONS o EXPLOSION AND COLLAPSE HAZARD o UNDERGROUND HAZARD ~ PRODUCTS/COMPLETED OPERATIONS HAZARD o CONTRACTUAL INSURANCE o BROAD FORM PROPERTY DAMAGE o INDEPENDENT CONTRACTORS o IOERSONAL INJURY X PLATE GLASS CO ERAGE AUTOMOBilE LIABILITY o COMPREHENSIVE FORM DOWNED o HIRED o NON-OWNED BODILY INJURY (EACH PERSON) BODILY INJURY $ (EACH ACCIDENT) PROPERTY DAMAGE BODILY INJURY AND PROPERTY DAMAGE COMBINED 1$ 100 $ 100 12/28/81 BODILY INJURY 50 50 PROPERTY DAMAGE $ BODIL Y INJURY AND PROPERTY DAMAGE $ COMBINED PERSONAL INJURY WORKERS' COMPENSATION -anCl-d-- u~U863173- EMPLOYERS' LIABILITY OTHER 12/28/81 EXCESS LIABILITY o UMBRELLA FORM o OTHER THAN UMBRELLA FORM BODIL Y INJURY AND PROPERTY DAMAGE COMBINED DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES Cancellation: Should any of the above de~6ibed policies be cancelled before the expiration date thereof, the issuing com- pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the Company. NAME AND ADDRESS OF CERTIFICATE HOLDER: CITY OF CLEARWATER ATTN~ CITY CLERK POBOX 4748 CLEARWATER FL 33518 Vl RHODES IN~URANCE AGENCY,INC. P.O. BOX 5164 CLEARWATER,FLA. 33518 COMPANIES AFFORDING COVERAGES COMPANY A LETTER COMPANY B LE TTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER NAME AND ADDRESS OF INSURED COLONY MARINA RESTAURANT ,INC. 71-75 CAUSEWAY BLVD. CLEARWATER BEACH, FLA. 33515 GENERAL ACCIDENT FIRE & LIFE ASS This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. CITY CLERK TYPE OF INSURANCE POLICY EXPIRATION DATE POLICY NUMBER GENERAL LIABILITY GLA 46 665 91 12/28/80 INCL. PLATE GLASS COMPRE. A ~ COMPREHENSIVE FORM D PREMISES-OPERATIONS D EXPLOSION AND COLLAPSE H AZA RD D UNDERGROUND HAZARD D PRODUCTS/COMPLETED OPERATIONS HAZARD D CONTRACTUAL INSURANCE D BROAD FORM PROPERTY DAMAGE D INDEPENDENT CONTRACTORS D PERSONAL INJURY AUTOMOBILE LIABILITY D COMPREHENSIVE FORM DOWNED D HIRED D NON-OWNED EXCESS LIABILITY D UMBRELLA FORM D OTHER THAN UMBRELLA FORM A WORKERS' COMPENSATION and EMPL.OYERS' LIABILITY OTHER 12/28/80 U845655 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES Limits of Liability in Thousands oCCt~~~NCE AGGREGATE BODILY INJURY $ 100,00 PROPERTY DAMAGE $ 50,00 $ BODILY INJURY AND PROPERTY DAMAGE COMBINED $ $ PERSONAL INJURY $ BODILY INJURY (EACH PERSON) BODILY INJURY (EACH ACCIDENT) PROPERTY DAMAGE BODILY INJURY AND PROPERTY DAMAGE COMBINED $ $ BODIL Y INJURY AND PROPERTY DAMAGE COMBINED (31 Lf t{ /....- ...... () Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the issuing com- pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER: p~ , CITY OF CLEARWATER P.O.BOX 4748 A'ITN: CITY CLERK CLEARWATER,FLA. 33518 DATE ISSUED: 12/6/79