EVIDENCE OF PROPERTY INSURANCE AND ADDITIONAL INSURED CLAUSES
At~~jllrj@
DATE (MM/DDiYY)
07/01/99
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER
AU.EY REHBAUM & CAPES
ASSURANCE, INC.
P. O. BOX 4620
CLEARWATER
COMPANY
Catawba Insurance Company
RECEIVED
JUl 0 6 1~~9
FL
33758
CODE:
CUSTOMER ID #:
INSURED
SUB CODE:
RISK MANAGEMENT
Clearwater Beach Seafoods
Restaurant, Inc.
37 Causeway Blvd.
Clearwater
EFFECTIVE DATE
05/31 J99
POLICY NUMBER
FLD1308769
EXPIRATION DATE
05/31/00
CONTINUED UNTIL
TERMINATED IF CHECKED
LOAN NUMBER
FL 33767
THIS REPLACES PRIOR EVIDENCE DATED:
location: 37 Causeway Blvd., Clearwater, FL
COVERAGElPERILSlFORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
Building - Rood
22??oo
5000
. EMARK&l'(lncludlngISpeclabCondliiQns)
.tlfION,.. ....
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
fli~Dj"rl..m"'UNTERES' t
llW.t1,.,I"tNI!. ....
NAME AND ADDRESS
. '.--.--..
City of Clearwater
clo Risk Management
P. O. Box 4748
Clearwater
FL 33758
'SURE
records
I
Date: (
8-29-~j
....
Additional Insured
ndosed contains a ~iIiC~&~~Clause
Jr favor.
;HEC
!r:
Clearwa ter
SEP
~ny and Policy No.
-" fi ',j
,,\ i:j
Insurance Cdm~any
',; i: P q 1985 "
'.' ~,' Thank
21UUCRB84~TY
you, Pam Zeyak
~DC
....\L._.. -.._-""".~-~..
C l1"Y N: J.~ i\: ". >...... : j
of Clearwater
Box 4748
water, Fl. 33518
INSURANCE AGE
620 BYPASS OF
p, O. BOX 50~
CLEARWATER, FLORIDA
Phone: (813) 797-
Tampa: 229-82
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LOSS PAYABLE CLAUSE
CF 12 18
(Ed, 05 77)
em
I COMPANY POLICY NO. AGENCY
. 21 vue RB8476
Loss, if any, shall be adjusted with the Insured and shall be payable to the Insured and Public Leasing
130 S. University Dr., Ste. E & F, Plantation, Fl. 33324 as their interests may appear.
Attn: Mickey
This Endorsement must be attached to Chance Endorsement when issued alter the Policy is written.
Applicable to Ice Machines
CF 12 18 (Ed. 05 77)
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37*08/07/85
J UREA,' AMERICAN INSURANCE COMPANll
_ Subsidiaries of American Financial Corporation
580 WALNUT STREET, CINC~NNATI. OHIO 45202 ,_
I
---------------------------------------------------------------------------,----
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Insured CLEARWATER BEACH SEAFOOD INC.
Policy Number:
PRO 6 34 11 38 - 01
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Effective Date I policy Period
05 / 31 / 85 05 / 31 / 85 to 05 / 31 / 86
I Authorized Representative
AIM INS. AGCY. CLEARWATER F
Complete the above spaces if this endorsement is not attached to the
policy when issued. .
===============================================================================
GENERAL ENDORSEMENT
-------------------------------------------
PREMIUM CHANGE (if any)
-----------------------------------------
Additional $
I Return $
-------------------------------------------
It is agreed that this policy is hereby amended as indicated below by
an "X":
1. Insured's Name:
ENDORSING POLICY TO REVISE SCHEDULE "A"
FORM F23001G, AND AMENDING ZIP CODE TO READ
33515.
SIXTY (60) DAYS WRITTEN NOTICE OF
CANCELLATION APPLIES TO THIS POLICY.
2. Insured's AddresS:
3. Location:
4. Limit(s) of Liability:
5. Amount(s) of Insurance:
6. Description of
Property:
( ) 7. Policy Period:
( ) 8. Audit Period:
( ) 9. Premium:
( ) 10. Rate:
( ) 11. Loss Payee:
12.
RECEIVED
.~ ~
, ',) . ~~ ~) J
1- :.t
~G 16 lM~
CITY CLERK
This policy is subject otherwise to all its terms.
F.14258A (Ed. 12/82) PRO
(Page 1 of 1)
ORIGINAL COPY
)(07~ 111/84\
~ 37*08/07/85
JUREAT"AMERICAN INSURANCE COMPANIEI
\ ;:iubsidiaries 'of American Financial Corporation .
580' WALNUT STREET, CINCINNATI, OHIO 45202 _
I
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Insured CLEARWARTER BEACH SEAFOOD INC.
I Policy No.
PRO 6 34 11 38 - 01
-------------------------------------------------------------------------------
Effective Date
05 / 31 / 85
Policy Period
05 / 31 / 85 to 05 / 31 / 86
Authorized Representative
AIM INS. AGCY.
CLEARWATER, FLORIDA
-------------------------------------------------------------------------------
Complete the above spaces if this endorsement is not attached to the
policy when issued.
-------------------------------------------------------------------,-------'-----
-------------------------------------------------------------------------------
.
NOTICE OF CANCELLATION
It is agreed that condition "Cancellation" is amended to read as follows:
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
sixty (60) days thereafter such cancellation shall be effective. However, if
cancellation results from non-payment of premium, the statutory cancellation
provision will apply.
THIS POLICY IS SUBJECT OTHERWISE TO ALL ITS TERMS
P.3203 (Ed. 11/83) PRO
(Page 1 of 1)
ORIGINAL COpy
X074 111/841
37*08/07/85
J UREAT~AMERICAN INSURANCE COMPANIEI
. ,.sub"sidls.ries of American Financial Corporation
580 WALNUT STREET, CINCINNATI, OHIO 45202 _
I
SCHEDULE A
SCHEDULE OF UNDERLYING POLICIES
,
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Insured
Effective On and After " 12:01 A.M. Standard Time
This Schedule Forms Part of Policy Number PRO 6 34 11 38 - 01
-------------------------------------------------------------------------------
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Carrier, Policy Number
and Period Type of Policy Applicable Limits
------------------------ ------------------------ -----------------------------
(a) WEST AMERICAN INS.
CO.
WCW 400 04 92
5-31-85/86
Employers' Liability
Insurance
Bodily Injury by Accident
$ 100,000 each accident
Bodily Injury by Disease
$ 500, 000 . po 1 icy 1 i m it
$ 100,000 each employee
------------------------ ------------------------ -------------------,----------
(b) WEST AMERICAN INS.
CO_._____ _ .
ACW 9646347
5-31-85/86
(c) HARTFORD INS. CO.
21UUCRB 8476
5-31-85/86
Comprehensive
Automobile._Liability
including
X ) owned automobiles
X ) non-owned
automobiles
( X ) hired automobiles
) garagekeepers'
legal liability
Comprehensive
General Liability
including
( X ) products-completed $
operations liabil- $
ity
contractual
liability
( X ) personal injury
liability
( ) injury to
employees
covered
X
Bodily Injury Liability
$ each person
$ each occurrence
Property Damage Liability
$ each occurrence
Bodily Injury and Property
Damage Liability Combined
$ 300,000 each occurrence
$
each location
Personal or Bodily Injury
Liability
each occurrence
aggregates
Property Damage Liability
$-
$
-eachocc u rrence
aggregates
X employees as addi- Personal or Bodily Injury
LIQUOR LIAB. POL. tional insureds and Property Damage
CRCL 05489. Liability Combined
HOST X liquor law
liability $ 300,000 each occurrence/
aggregates
X BFCGL
F.2300lG (Ed. 10/84) PRO
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(Page 1 of 2)
ORIGINAL COpy
X074 111/841
37*08/07/85
JUGREAT.AMERI.CAN INSURANCE COMPANll
" ,Subsidiaries of American Fmanclal Corporation .
580 WALNUT STREET. CINCINNATI. OHIO <5202
I
(d)
-------------------------------------------------------------------------------
Aircraft Liability
including
) owned aircraft
) non-owned aircraft
) passenger bodily
injury
Bodily Injury Liability
$ each person
$ each occurrence
Property Damage Liability
$ each occurrence
Bodily Injury and Property
Damage Liability Combined
$ each occurrence
(e)
------------------------ ------------------------ -----------------------------
Watercraft Liability
including
_Lown~c1 }\'~J~rc ra f t
non-owned water-
craft
Bodily Injury Liability
$ each person
$ each occurrence
Prope(ty ])a.IIlClg~ LiapiljtYH
$ each occurrence
Bodily Injury and Property
Damage Liability Combined
$ each occurrence
(f)
------------------------ ------------------------ -----------------------------
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An "X" marked in the parentheses indicates the coverage is provided in the
Underlying Policies.
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
F.23001G (Ed. 10/84) PRO
(Page 2 of 2)
ORIGINAL COPY
X07^ 111/841
,
r'..;"-
IENDOHSEMEN'f
111
,
In consideration of the Additional Premium of $75.00 and Additional
State Tax of $2.25, it is hereby understood and agreed that the attached
Additional Insured Endorsement, GL2011, is added and made a part of
this policy as follows:
City Of clearwater
P.O. Box 4748
Clearwater, Florida 33518
ADDITIONAL PREMIUM: RETURN PREMIUM:
Agents r;2me W. DfN.^ Ro::ymG
By reason of above change in premium the premium payment schedule isPamenaetJlt~. rebdbl!(5l,ft!llfOWs:
Date Payment Due LiLrrrc'dl'd:'Pa-~ment C,j 1 :., 1 :JCAr;;l.b-&n~ of Change New Payment
Additional or Return Down Payment XXXXXXXXXXXXXX l;sr.x~k~Jl!XXI)(I~Xot XXXXXXXXXXX
State File: #02713-85
Address __u._
1 '.!i~; 1:",IJAt.<hMs 1iJ:~[j ~g~ ,Tci[1!l~50
Fl.0'.'..'.tJ,'.. S""f;.;.U:; .,t1~.s foAA.'h' ,p[RSON~ INS..i..'~[D
!J\{ ~;~J?\-JLul5.L'+t,fE~;~Blf'~gn NOT HA\/E THE
f'R OTECTi CltN1(),f", Tj~"~d}l,QfiJ DA ,wSURI',N{(!:, <n.JAR-
ANTl' ".CT "'~t:t~~'I")\<['Efq~ VF JA-NV n~.:P ~ RE.
CG\'bIW For THE OflllGATION OF AN INSOLVENT
U/JLlCENSED INSUREH.
Additional Premium: $75.00
Additional State Tax: $2.25
TOTAL OF ENDORSEMENT
This endorsement to be effective as of
12: 01 A.M.
12:01 A.M,
of the 31 s t
day of May
1985
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
Attached to and forming a part of Policy No. CRCL 05489
Expiring 5/31/86
issued by the
CANAL INDEMNITY COMPANY, Greenville, S.C" to Clearwater Beach Seafood, Inc.
~ . Secretary
President
Countersigned and issued at St. Petersburg, Florida
this 30th
day of July
1985
Form 2-1-E
End. #1 7/30/85
TM
By ~/ A~- fluA/if-
DANA ROEHRIG & ASSOCIATES, INC. .
.
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ztt~
"
... " . ..
GL 20 11 >
(Ed. 07 66)
This endorsement forms a part of the pOlicy to which attached, effective on the inception date of the policy unless otherwise stated herein.
(The following information is required only when this endorsement is issued subsequent to preparation of policy,)
Endorsement effective Policy No, Endorsement No.
Named Insured
Additional Premium $
Countersigned by
(Authorized Representative)
This endorsement modifies such insurance as is afforded by the provisions of the pOlicy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
ADDITIONAL INSURED
(Premises leased to the Named Insured)
It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated below, but only with respect
to liability arismg out of the ownership, maintenance or use of that part of the premises deSignated below leased to the named insured, and subject to the
following additional exclusions:
The insurance does not apply:
1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises:
2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated below,
SCHEDULE
Designation of Premises
(Part leased to Named Insured)
Name of Person or Organization
(Additional Insured)
Annual Premiums
Bodily Property
I njury Damage
liability liability
P.o. Box 4748
Clearwater,FI6iida335I8
City Of Clearwater
Incl.
Incl.
GL 20 11 07 66
Is
.
Date:
7-3-'
ld contains a Mortgage Clause, or Loss Payable Clause
Jr.
Learwater Beach Seafood, Inc.
nd Policy No. Cana L I ndemn Lty Company CRC L05489
Thank
you, Pam Zeyak
~D~
CLearwater
x 4748
ter, FL. 33518
INSURANCE AGENCY
620 BYPASS DRIVE
P. O. BOX 5025
CLEARWATER. FLORIDA 335H
Phone: (813) 797-4499
Tampa: 229-8208
-
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GENERAL LIABILITY POLICY
No. CRCL 0 5 4 8 9
~
~l~w
RENEWAL OF NUMBER
STOCK COMPANY
''',' - " -,
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DECLARATIONS
Item 1. Named Insured and Address: (No" street, Town or City, County, State)
. Clearwater Beach Seafood, Inc.
37 Causeway Blvd.
Clearwater, Florida 33515
Item 2. Policy Period: (Mo. Day Yr,)
From 5/31/85 to 5/31/86
12:01 A.M., standard time at the address of the named insured as stated herein,
"FLAT CANCELLATION NOT ALLOWED"
SUBJECT
TO AUDIT
:I
"
The named insured is:
o Individual 0 Partnership
Business of the named insured is: (--. ML.OW)
Restaurant
Item 3. The insurance afforded is only with respect to the Coverage Partes) indicated below by specific premium charge(s) and attached to and forming a part of
this policy.
~ Corporation
o Joint Venture 0 Other:
Audit Period: Annual, unless otherwise stated, <-n.. ..LOW)
Advance Coverale Coverage Partls) Advance Coverale Coverale Partes)
Premiums Part Ho(s). Premiums Part No(s).
$ Complefed Operations and Products Liability S Hospital Professional Liability Insurance
Insurance $ Manufacturers' and Contractors' Liability
$ Comprehensive General Liability Insurance Insurance
S Comprehensive Personal Insurance $ Owner's and Contractor's Protective Liability
$ Contractual Liability Insurance Insurance
$ Druggists' Liability Insurance , $ Owners', Landlords' and Tenants' Liability
$ Elevator Collision Insurance Insurance
$ Farm Employers' Liability and Farm Employees' $ Personal Injury Liability Insurance
Medical Payments Insurance $ Physicians', Surgeons' and Dentists' Professional
A itnu Ma.. V . DANA R~~r's ComD(e~ Personal Insurance Liability Insurance
l $.n.. 11 'm~"" ~ :.j '.1";00271:08' armer's Medical Payments Insurance $ Premises Medical Payments Insurance
$ _A. . T .M.. .J Insurance l2:V . Inc. $ Storekeeper's Insurance
-
$ P.O. Box 5 025 $750.00 L9492 Liauor Liabilitv
~ llroClear FT, 11 'i.' Q $
$ THIS lNSlI~,~~C IS,.!~~~~~ P 1~~'1~~5
$ 8::4- S Ifr.r '-I.ISI b I ~ ~ Oil toNC!T Hf~.v~, ,'"H,,": $
$ ~~~'GI~ ~ 7~lM., OF ~ 'i "'GHT OF RE-
. \. :", r . dl _ _ L' ,:ON ( F AN INSOLVENT
Pi!l-H~[lF~~ ~HE~25. 00 $
$ State Tax: $23.25
$ $
$
L9492, Service Of Suit, Punitive Damages Excl. Form nuriillers of endorsements,
other than those entered on
$ Coverage PartCs), attached at issue
$750.00 Total Advance Premium for this policy, I
* If the Policy Period is more than one year and the premium is to be paid in installments, premium is payable on:
Effective Date 1st Anniversary 2nd Anniversary
$ $ $
JPIm 4. During the past three years no insurer has cancelled insurance, issued to the named Insured. similar to that afforded hereunder, unless otherwise stated herein:
:;ountersigned: St. Petersburg, Florida
6/28/85 TM
DANA ROEHRIG & ASSOCIATES, INC.
I
CR 100
( 11-1-79)
By
ptd. In U.S.A.
'4UI~J.uk~?<&~
p, O. BOX 1 GREfNVHlf, SOUTH CAROliNA 29602
In consideration of the payment of the premium, in reliance upon the statements in the declarations made a part hereof and subject to all of the terms of this policy,
agrees with the named insured as follows:
DEFINITIONS
pleted operations hazard or the underground property damage hazard, or (4) for
which I iability is assumed by the insured under an incidental contract;
"incidental contract" means any written (1) lease of premises, (2) easement
agreement, except in connection with construction or demolition operations on or
adjacent to a railroad, (3) undertaking to indemnify a municipality required by
municipal ordinance, except in connection with work for the municipality, (4) side-
track agreement, or (5) elevator ma intenance agreement;
"insured" means any person or org~nization qualifying as an insured in the "Per-
sons Insured" provision of the applicable insurance coverage, The insurance
afforded applies separately to each insured against whom claim is made or suit
is brought, except with respect to the limits of the company's liability;
"mobile equipment" means a land vehicle (including any machinery or apparatus
attached thereto), whether or not self-propelled, (1) not subject to motor vehicle
registration, or (2) maintained for use exclusively on premises owned by or rented
to the named insured, including the ways immediately adjoining, or (3) designed
for use principally off public roads, or (4) designed or maintained for the sole
purpose of affording mobility to equipment of the following types forming an in-
tegral part of or permanently attached to such vehicle: power cranes, shovels,
loaders, diggers and drills; concrete mixers (other than the mix-in-transit type);
graders, scrapers, rollers and other road construction or repair equipment; air-
compressors, pumps and generators, including spraying, welding and building
cleaning equipment; and geophysical exploration and well servicing equipment;
"named insured" means the person or organization named in Item 1. of the decla-
rations of this policy;
"named insured's products" means goods or products manufactured, sold, handled
or distributed by the named insured or by others trading under his name, including
any container thereof (other than a vehicle), but "named insured's products" shall
not include a vending machine or any property other than such container, rented
to or located for use of others but not sold;
"occurrence" means an accident, including continuous or repeated exposure to
conditions, which results in bodily injury or property damage neither expecte~
nor intended from the standpoint of the insured; ·
"policy territory" means:
(1) the United States of America, its territories or possessions, or Canada, or,
(2) international waters or air space, provided the bodily injury or property dam:
age does not occur in the course of travel or transportation to or from any
other country, state or nation, or
(3) anywhere in the world with respect to damages. because of bodily injury or
property damage arising out of a product w~ichwassold for use or consump-
tion within the territory described in paragraph (1) above, provided the original
suit for such damages is brought within such territory;
"products hazard" includes bodily injury and property damage arising out of the
named insured's products or reliance upon a representation or warranty made at
any time with respect thereto, but only if the bodily injury or property damage
occurs away from premises owned by or rented to the named insured and after
physical possession of such products has been relinquished to others;
"property damage" means (1) physical injury to or destruction of tangible prop-
erty which occurs during the policy period, including the loss of use .thereof at
any time resulting therefrom, or (2) loss of use of tangible property which has
not been physically injured or destroyed provided such loss of use is caused by
an occurrence during the policy period;
"underground property damage hazard" includes underground property damage as
defined herein and property damage to any other property at any time resulting
therefrom. "Underground property damage" means property damage to wires,
conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any
apparatus in connection therewith, beneath the surface of the ground or water,
caused by and occurring during the use of mechanical equipment for the purpose
"explosion hazard" includes property damage arising out of blasting or explosion, of grading land, paving, excavating, drilling, borrowing, filling, back-filling or pile
The explosion hazard does not include property damage (1) arising out of the ex- driving. The underground property damage hazard does not include property dam-
plosion of air or steam vessels, piping under pressure, prime movers, machinery age (1) arising out of operations performed for the named insured by independent
or power transmitting equipment, or (2) arising out of operations performed for contractors, or (2) included within the completed operations hazard, or (3) for
the named insured by independent contractors, or (3) included within the com. which liability is assumed by the insured under an incidental contract.
SUPPLEMENTARY PAYMENTS
When used in this policy (including endorsements forming a part hereof),
"automobile" means a land motor vehicle, trailer or semi-trailer designed for
travel on public roads (including any machinery or apparatus attached thereto),
but does not include mobile equipment;
"bodily injury" means bodily injury, sickness or disease sustained by any person
which occurs during the policy period, including death at any time resulting
therefrom;
"collapse hazard" includes "structural property damage" as defined herein and
property damage to any other property at any time resulting therefrom, "Structural
property damage" meanslhe collapse of or structural injury to any building or
structure due to (1) grading of land, excavating, borrowing, filling, back-filling,
tunnelling, pile driving, cofferdam work or caisson work or (2) moving, shoring,
underpinning, raising or demolition of any building or structure or removal or
rebuilding of any structural support thereof. The collapse hazard does not include
property damage (I) arising out of operations performed for the named insured by
independent contractors, or (2) included within the completed operations hazard
or the underground property damage hazard, or (3) for which liability is assumed
by the insured under an incidental contract;
"completed operations hazard" includes bodily injury and property damage arising
out of operations or reliance upon a representation or warranty made at any time
with respect thereto, but only if the bodily injury or property damage occurs after
such operations have been completed or abandoned and occurs away from premises
owned by or rented to the named insured. "Operations" include materials, parts
or equipment furnished in connection therewith. Operations shall be deemed com-
pleted at the earliest of the following times:
(1) when all operations to be performed by or on behalf of the named insured
under the contract have been completed,
(2) when all operations to be performed by or on behalf of the named insured at
the site of the operations have been completed, or
(3) when the portion of the work out of which the injury or damage arises has
been put to its intended use by any person or organization other than another
contractor or subcontractor engaged in performing operations for a principal
as a part of the same project.
Operations which may require further service or maintenance work, or correc-
tion, repair or replacement because of any defect or deficiency, but which are
otherwise complete, shall be deemed completed.
The completed operations hazard does not include bodily injury or property
damage arising out of
(a) operations in connection with the transportation of property, unless the bodily
injury or property damage arises out of a condition in or on a vehicle created
by the loading or unloading thereof,
(b) the existence of tools, uninstalled equipment or abandoned or unused ma-
terials, or
Ic) operations for which the classification stated in the policy or in the company's
manual specifies "including completed operations";
"elevator" means any hoisting or lowering device to connect floors or landings,
whether or not in service, and all appliances thereof including any car, platform,
shaft, hoistway, stairway, runway, power equipment and machinery; but does not
include an automobile servicing hoist, or a hoist without a platform outside a
building if without mechanical power or if not attached to building walls, or a
hod or material hoist used in alteration, construction or demolition operations, or
an inclined conveyor used exclusively for carrying property or a dumbwaiter used
exclusively for carrying property and having a compartment height not exceeding
four feet;
The company will pay, in addition to the applicable limit of liability:
(a) all expenses incurred by the company, all costs taxed against the insured in
any suit defended by the company and all interest on the entire amount of any
judgment therein which accrues after entry of the judgment and before the
company has paid or tendered or deposited in court that part of the judgment
which does not exceed the limit bf the company's liability thereon;
(b) premiums on appeal bonds required in any such suit, premiums on bOAds to
release attachments in any such suit for an amount not in excess of the
applicable limit of liability of this policy, and the cost of bail bonds required
of the insured because of accident or traffic law violation arising out of the use
of any vehicle to which this policy applies, not to exceed $250 per bail bondt
but the company shall have no obligation to apply for or furnish any such
bonds;
(c) expenses incurred by the insured for first aid to others at the time of an acci.
dent, for bodily injury to which this policy applies; ·
(d) reasonable expenses incurred by the insured at the company's request in
assisting the company in the investigation or defense of any claim or suit"
including actual loss of earnings not to exceed $25 per day,
COVERAGE PART
.
LIQUOR LIABILITY INSURANCE
For attachment to Policy No. r.Rr.T. O'i4RQ
, to complete said policy.
.
l 9492
(Ed. ).13)
. ,
SCHEDULE
The insurance afforded is only with respect to the following Coverage as indicated by specific premium charge. The limit of the company's liability against such
Coverage shall be as stated herein. subject to all the terms of this policy having reference thereto.
Advance Premium Limits of Liability Coverage
500, thousand dollars each common cause X-Liquor Liability
$ 750.00 500, thousand dollars aggregate
Form numbers of endorsements attach~d at issue
$ 750.00 Total Advance Premium I
Advance Code
Premium Rate Premium Basis Description of Hazards Designated Insured Premises -
No.
Liquor Liability
$750.00 $.85 Per $100 Restaurant 37 Causeway Blvd.
Receipts Clearwater, Florida 33515
.
..
,.
$50,000.0::> . , '..
,
Receipts
When used as a premium basis:
"receipts" means gross amount of money charged by the named insured or by others during the policy period for the sale of all alcoholic beverages, and of other
beverages used in connection therewith, including taxes, except taxes which the named insured collects as a separate item, and remits directly to a governmental
division, for which accurate records are maintained apart from other receipts.
"
-<'f.-
,..
r
I. COVERAGE X - LIQUOR LIABILITY
The company will pay on behalf of the insured all sums which the insured shall
become legally obligated to pay as damages because of injury to which this insurance
applies, sustained byany person if such liability is imposed upon the insured by reason
of the selling, serving or giving of any alcoholic beverage at or from the insured
premises, and the company shall have the right and duty to defend any suit against
the insured seeking such damages, even if any of the allegations of the suit are
groundless, false or fraudulent. and may make such investigation and selllement of
any claim or suit as it deems expedient, but the company shall not be obligated to
pay any claim or judgment or to defend any suit after the applicable limit of the
company's liability has been exhausted by payment of judgments or settlements.
Exclusions
, This insurance does not apply:
(a) to any obligation for which the insured or any carrier as his insurer may be
held liable under any workmen's compensation, unemployment compensation or
disability benefits law, or under any similar law;
· (b) to bodily injury to any employee of the insured arising out of and in the course
of his employment by the insured or to any obligation of the insured 10 in-
demnify another because of damages arising out of such injury;
(c) to injury arising out of any alcoholic beverage sold, served or given while any
license therefor, required by law, is suspended or after such license expires,
is cancelled or revoked;
(d) to bodily injury or property damage ariSing out of Ihe named insured's products
or reliance upon a representation or warranty made at any lime with respect
thereto; but this exclusion does not apply to bodily injury or property dama~e
for which the insured or his indemnitee may be held liable if such liability IS
imposed
(1) by, or because of the violation of, any statute, ordinance or regulation
pertaining to the sale, gift, distribution or use of any alcoholic beverage, or
(2) by reason of the selling, serving or giving of any alcoholic beverage to a
minor or to a person under the influence of alcohol or which causes or
contributes to the intoxication of any person.
II. PERSONS INSURED
Each of the follo.ving is an insured under this insurance to the extent set forth
below:
(a) if the named insured is designated in the declarations as an individual, the
person so designated and his spouse;
lover)
(b) if the named insured is designated in the declarations as a partnership or
joint venture, the partnership or joint venture so designated and any partner
or member thereof but only with respect to his liability as such;
'(c) if the named insured is designated in the declarations as other than an in-
dividual,partnership or joint venture, the organization so designated and any
executive officer, director or stockholder thereof while acting within the scope
of his duties as such.
This insurance does not apply to injury arising out of the conduct of any partner-
s\'lip or joint venture of whichlhe insured is a. partner or member and which is not
.designated in this policy as a named insured.
III. LIMITS OF LIABILITY
Regardless of the number of insureds under this insurance, the company's
liability is limited as follows:
The limit 01 liability stated in the schedule as applicable to "each common
cause" is the total liability of the company for all damages sustained by one or
mare persons as the result of the selling, serving or giving of any alcoholic beverage
to anyone person,
The limit 01 liability stated in the schedule as "aggregate" is, subject to the above
provisions respecting "each common cause", the total limit of the company's liability
hereunder for all damages. Such aggregate limit of liability shall apply separately to
each insured premises.
IV. POLICY PERIOD; TERRITORY
This insurance applies only to injury which occurs during the policy period within
the policy territory. ,-
V. ADDITIONAL DEFINITIONS.
When used in reference to this insurance (including endorsements forming a part
of this policy):
'. "damages" means all damages, including damages for death, care, loss of services,
,I..."'."
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loss of support. or loss of use of property, which are payable because of injury to
which this insurance applies.
"insured premises" means:
(a) the premises designated in the schedule; and,
(b) any premises which the named insured acquires during the policy period f(lr
use in manufacturing, distributing, selling, serving or giving alcoholic beverages
if (1) the named insured notifies the company within 30 days after such
acquisition and (2) the named insured has no other valid and collectible in.
surance applicable to the loss.
VI. AMENDED CONDITION
When used in reference to this insurance the Three Year Policy Condition is
amended 10 read as follows:
Three Year Policy: If this policy is issued for a period of three years:
(a) The policy period is comprised of three consecutive annual periods;
(b) The rates are subject to amendment for the second and third annual periods, in
accordance with the company's rules and rating plans, Amended rates shall be
stated by endorsement issued to form a part of this policy;
(c) The aggregate limit of liability shall apply separately to each annual period.
VII. ADDITIONAL CONDITIONS
A. Insured's Duties in the Event 01 Injury, Claim Dr Suit
When an injury occurs wrillen notice shall be given by or on behalf of the insured
in accordance with the "Insured's Duties in the Event of Occurrence, Claim or
Suit" Condition.
B. Limitation of Coverage - Other Liability Insurance
The insurance afforded by this Part does not apply to any injury with respect to
which insurance is otherwise afforded by, or would be afforded but for the ex-
haustion of the limits of, the policy, '
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.ND@mlSEMEN.
SERVICE OF SUIT (U.S.A.)
THE COMPANY HEREBY DESIGNATES DANA ROEHRIG & ASSOCIATES, INC., P.O.
BOX 12769, ST. PETERSBURG, FLORIDA UPON WHOM MAY BE SERVED ANY LAWFUL
PROCESS IN ANY ACTION, SUIT OR PROCEEDING INSTITUTED BY OR IN BEHALF
OF THE INSURED OR ANY BENEFICIARY HEREUNDER, ARISING OUT OF AGREEMENT
OF INSURANCE.
ADDITIONAL PREMIUM: RETURN PREMIUM:
....dy reason of above change in premium the premium payment schedule is amended to read as follows:
.' - I Date Payment Due Old Payment Amount of Change New Payment
f" Additional or Return Down Payment XXXXXXXXXXXXXX XXXXXXXXXXX XXXXXXXXXXX
TOTAL OF ENDORSEMENT
This endorsement to be effective as of
of the
day of
19
12:01 A.M.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
Attached to and forming a part of Policy No.
Expiring
issued by the
CANAL INDEMNITY COMPANY, Greenville. S.C., to
~.
Secretary President
Countersigned and issued at
this day of 19
By~(.)QI ,{(~ \U'-'<
) Authorized Agent
Form 2-'-E
.NJJD@lRlSEMJEN.
PUNITIVE DAMAGES EXCLUSION
IT IS AGREED THAT NEITHER COVERAGE NOR DEFENSE IS PROVIDED BY THIS
POLICY FOR CLAIMS, SUITS, ACTIONS OR PROCEEDINGS AGAINST THE INSURED
WHICH ARE PUNITIVE OR EXEMPLARY IN NATURE.
.
ADDITIONAL PREMIUM:
RETURN PREMIUM:
-'..8y reason of above change in premium the premium payment schedule is amended to read as follows:
Date Payment Due Old Payment Amount of Change New Payment
Additional or Return Down Payment XXXXXXXXXXXXXX XXXXXXXXXXX XXXXXXXXXXX
TOTAL OF ENDORSEMENT
This endorsement to be effective as of
of the
day of
19
12:01 A.M.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
Attached to and forming a part of Policy No.
Expiring
issued by the
CANAL INDEMNITY COMPANY. Greenville, S.C., to
7 . Secretary
President
Countersigned and issued at
this
day of
19
By fDLh~ l?~~
)uthorlzed Agent
Form 2.'.E
.Ch Coverage par~(S).and ~,ndorsement(S) (If Any).
1. Premium: All premiums for this policy shall be computed in accordance with
the company's rules, rates, rating plans, premiums and minimum premiums appli.
cable to the insurance afforded herein.
Premium designated in this policy as "advance premium" is a deposit premium
only which shall be credited to the amount of the earned premium due at the
end of the policy period. At the close of each period (or part thereof terminating
with the end of the policy period) designated in the declarations as the audit
period the earned premium shall be computed for such period and, upon notice
thereof to the named insured, shall become due and payable. If the total earned
premium for the policy period is less than the premium previously paid, the
company shall return to the named insured the unearned portion paid by the
named insured.
The named insured shall maintain records of such information as is necessary
for premium computation, and shall send copies of such records to the company
at the end of the policy period and at such times during the policy period as the
company may direct.
2. Inspection and Audit: The company shall be permitted but not obligated to
inspect the named insured's property and operations at any time. Neither the
company's right to make inspections nor the making thereof nor any report there.
on shall constitute an undertaking, on behalf of or for the benefit of the named
insured or others, to determine or warrant that such property or operations are
safe or healthful, or are in compliance with any law, rule or regulation.
The company may examine and audit the named insured's books and records at
any time during the policy period and extensions thereof and within three years
after the final termination of this policy, as far as they relate to the subject
matter of this insurance.
3. Financial Responsibility Laws: When this policy is certified as proof of financial
responsibility for the future under the provisions of any motor vehicle financial
responsibility law, such insurance as is afforded by this policy for bodily injury
liability or for property damage liability shall comply with the provisions of such
law to the extent of the coverage and limits of liability required by such law.
The insured agrees to reimburse the company for any payment made by the com.
pany which it would not have been obligated to make under the terms of this
";llicy except for the agreement contained in this paragraph.
1 4. Insured's Duties in the Event of Occurrence, Claim or Suit:
'(a) In the event of an occurrence, written notice containing particulars sufficient
to identify the insured and also reasonably obtainable information with respect
to the time, place and circumstances thereof, and the names and addresses of
the injured and of available witnesses, shall be given by or for the insured to
the company or any of its authorized agents as soon as practicable,
(b) If claim is made or suit is brought against the insured, the insured shall im.
mediately forward to the company every demand, notice, summons or other
process received by him or his representative.
(c) The Insured shall cooperate with the company and, upon the company's
request, assist in making settlements, in the conduct of suits and in
enforcing any right of contribution or indemnity against any person or
organization who may be liable to the Insured because of injury or damage
with respect to which insurance is afforded under this policYi and the Insured
shall attend hearings and trials and assist in securing and giving evidence
and obtaining the attendance of witnesses. The Insured shall not, except at
his own cost, voluntarily make any payment, assume any obligation or Incur
any expense other than for first aid to others at the time of accident.
5. Action Against Company: No action shall lie against the company unless, as a
condition precedent thereto, there shall have been full compliance with all of the
terms of this policy, nor until the amount of the insured's obligation to pay shall
have been finally determined either by judgment against the insured after actual
trial or by written agreement of the insured, the claimant and the company,
Any person or organization or the legal representative thereof who has secured
such judgment or written agreement shall thereafter be entitled to recover under
this policy to the .extent of the insurance afforded by this 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 compeny be impleaded by the insured or his legal representative, Bankruptcy
or insolvency 01 the Insured or of the Insured', estate shall not relieve the com.
pany 01 any 01 its obligations hereunder.
CONDITIONS
6. Other Insurance: The insurance afforded by this policy is primary insurance,
except when stated to apply in excess of or contingent upon the absence of other
insurance. When this insurance is primary and the insured has other insurance
which is stated to be applicable to the loss on an excess or contingent basis, the
amount of the company's liability under this policy shall not be reduced by the
existence of such other insurance,
When both this insurance and other insurance 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:
(a) Contribution by Equal Shares. If all of such other valid and collectible insur.
ance provides for contribution by equal shares, the company shall not be liable
for a greater proportion of such loss than would be payable if each insurer
contributes an equal share until the share of each insurer equals the lowest
applicable limit of liability under anyone policy or the full amount of the loss
is paid, and with respect to any amount of loss not so paid the remaining
insurers then continue to contribute equal shares of the remaining amount
of the loss until each such iR5urer ha9 paid its limit in full or the full amount
of the loss is paid.
(bl Contribution by Limits. If any of such other insurance does not provide for
contribution by equal shares, the company shall not be liable for a greater
proportion of such loss than the applicable limit of liability under this policy
for such loss bears to the total applicdble limit of liability of all valid and
collectible insurance against such loss,
7. Subrogation: In the event of any payment under this policy, the company shall
be subrogated to all the insured's rights of recovery therefor against any person
or organization and the insured shall execute and deliver instruments and papers
and do whatever else is necessary to secure such rights. The insured shall do
nothing after loss to prejUdice such rights,
8. Changes: Notice to any agent or knowledge possessed by any agent or by any
other person shall not effect a waiver or a change in any part of this policy or
estop the company Irom asserting any right under the terms 01 this policy; nor
shall the terms of this policy be waived or changed, except by endorsement issued
to lorm a part of this policy.
9. Assignment: Assignment of interest under this policy shall not bind the com.
pany until its consent is endorsed hereon; if, however, the named insured shall
die, such insurance as is afforded by this policy shall apply C1l to the named
insured's legal representative, as the named insured, but only while acting within
the scope of his duties as such, and (2) with respect to the property of the
named insured. to the person having proper temporary custody thereof, as insured,
but only until the appointment and qualification of the legal representative,
10. Three Year Policy: If this policy is issued for a period of three years any
limit of the company's liability stated in this policy as "aggregate" shall apply
separately to each consecutive annual period thereot.
11. Cancellation: This policy may be cancelled by the named insured by sur.
render thereof to the company or any of its authorized agents or by mailing to
the company written notice stating when thereafter the cancellation 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 ten days thereafter such cancellation shall be effective. The mailing of notice
as aforesaid shall be sufficient proof of notice. The time of surrender or the ef.
fective date and hour of cancellation stated in the notice shall become the end
of the policy period. Delivery of such written notice either by the named 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 company cancels,
earned premium shall be computed pro rata. Premium adjustment may be made
either at the time cancellation is effected or as soon as practicable after cancel.
lation becomes effective, but payment or tender of unearned premium is not a
condition of cancellation,
12. Declarations: By acceptance of this policy, the named insured agrees that
the statements in the declarations are his agreements and representations, that
this policy is issued in reliance upon the truth of such representations and that
this polley embodies all agreements existing between himself and the company
or any of its agents relating to this insurance.
. In Witne.. Whereof, the company has caused this policy to be executed and attested, but this policy sholl not be valid unless countersigned
- by a duly authorized representative of the company.
~.
Secretary
~
~p Presidml
. .'
NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT , ,
(BROAD FORM)
This endorsement modifies the provisions of this policy relating to All AUTOMOBILE LIABILITY: GENERAL LIABILITY AND MEDICAL. PAYMENTS INSURANCE
OTHER THAN FAMILY AUTOMOBILE, SPECIAL PACKAGE AUTOMOBILE, COMPREHENSIVE PERSONAL AND FARMER'S COMPREHENSIVE PERSONAL INSURANCE.
It is agreed that: II. As used in this endorsement: . '
I" This policy does not apply: "hazardous propertles"include radioaCtive, toxic or explosive properties;
A, Under any Liability Coverage,to bodily Injury or property dam ale "nuclear material" means source material, special, nuclear material or by.
(1) with respect to which an Insured under this policy is also an insured product material;
under a nuclear energy liability policy issued by Nuclear Energy Liability
Insurance Association, Mutual Atomic Energy Liability Underwriters or "source material", "special nuclear material", 'and "byproduct material" have'
Nuclear Insurance Association of Canada, or would be an insured under the meanings given them in the Atomic Energy Act of 1954 or in any law
ant such policy but for its termination upon exhaustion of its limit of amendatory thereof; , '
lia ility; or "spent fuel" means any fuel element or fuel component, 'solid or liquid, which
(2) r.esulting from the hazardous properties of nuclear material and with has been used or exposed to radiation, in a n,uclear r,~~tor; ,,'
respect to which (a) any person or organization is required to ma.intain
, financial protection pursuant to the Atomic Energy Act of 1954. or any "waste" means any waste material (1) containing byproduct material and
law amendatory thereof, or (b) the insured is, or had this policy not (2) resulting from the operation by any person or org~nization of any nuclear
been issued would be, entitled to indemnity from the United States of facility included within the, definition of nuclear facility und~r paragraph
America, or any agency thereof, under any agreement entered into by (a) or (b) thereof;
the United States of America, or any agency thereof, with any person or
organization. "nuclear facility" means
B. Under any Medical Payments Coverage,. or under any Supplementary Pay. (a) any nuclear reactor,
ments provision relating to first aid, to expenses incurred with respect to lb) any equipment or device designed or used for (1) separating the isotopes
bodily injury resulting from the hazardous properties of nuclear material ,of uranium or plutonium, (2) processing or utilizing spent fuel, or (3)
and arising out of the operation of a nuclear facility by any person or handling, processing or packaging waste,
. organization. II '
(c) any equipment or device used for the. processing, fabricating or a OYlng
C. Under any Liability Coverage, to bodily InJury or r.roperty damale resulting of special nuclear material if at any time the total amount of such ma.
from the hazardous properties. of nuclear materia, if terial in the custody of the insured at the premises where such equipment
11l the nuclear material (a) is at any nuclear facility owned by, or operated or device is located consists of or contains more than 25 grams of
'by or on behalf of, an insured or lb) has been discharged or dispersed plutonium or uranium 233 or any combination thereof, or more than 250
therefrom; grams of uranium 235,
(2) the nuclear material is contained in spent fuel or waste at any time (d) any structure, basin, excavation, premises or place prepared or used for
. possessed, handled). used, processed, stored, transported or disposed the storage or disposal of waite,', ,
of by or on behalf or an Insured; or
(3) the bodily injury or property damage arises out of the furnishing by an and includes the site on which any of the foregoing is located, all operations
Insured of services, materials, parts or equipment in connection with conducted on such site and all premises used for such operations;
the planning, construction, maintenance, operation or use of any nuclear "nuclear reactor" means any apparatus designed or used to sustain nuclear
facility, but if such facility is located within the United States of fission in a self.supporting chain reaction or to contain a criti~al maSf"'of
America, its territories or possessions or Canada, this exclusion (3) fissionable material; , ' . . "
applies only to property damale to such nuclear facility and any
property thereat. "property damage" includes all forms of radioactive contamination of propey.
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