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MEMO REGARDING INSURANCE CLAUSES AND INSURANCE CLAUSES ENCLOSED .. . ./ try OF CLEARWATER Inte epartment Correspondence Sheet HE C ti7v-!lD-16-6 ~ TO: '" Elizabeth S. Heseker, i (>-................. FROM: Bill Held, assistant Harbormaster COPIES: Lucille Williams, City Clerk SUBJECT:Clearwater Beach Seafood - Insurance Policy February 7, 1985 FEB 11 1985 DATE: I have received certified endorsements on Mr. Goodwin's insurance policy increasing his property insurance and addi~ liqnor liability insurance effective November 13, 1984. CITY CLERK These indorsements to his existing policy more than meet the requirements of his lease agreement and expires on May 31, 1985 with the rest of his pOlicy. to WCH:mm /0,,,,1 Ir- .1 Th~ 'ENClOSURE is for your records . !. . Date: 1 - 2 3 - 85 .RECEIVED '. . The enclosed contains a Mortgage Clause, or Loss Payable Clause in your favor. Owner: C lea r wa t e r B e a c h Sea f 0 0 d, I n c . FEe 11 198~ Company and Policy No. St. Paul Insurance Company 609NC4155 C11Y PLease slgn the LPR' S to canceL the Thank you. Pam Zeyak ClERK I BulLders rlsk and wlnd poLlcles ~ 0 ~ TO CLty of Clearwater P.O. Box 4748 C learwa ter, F l, 33518 L INSURANCE AGENCY INC, 620 BYPASS DRIVE P. O. BOX 5025 P z CLEARWATER. FLORIDA 33618-4985 Phone: (8131 797-4499 TerncM: 228-8208 , The ENCL;SURE is 10r your records . e ., Date: 1-23-85 The. enclosed contains a Mortgage Clause, or Loss Payable Clause in your favor. Owner: CLearwater Beach Seafood, I nc, Company and Policy No. Ame r Lean Na tLona L F Lre Ins uta nee C ompan\j PRO 6341138 R l:' r< 11:"' I V . ...., \...... L 1J6cf!)k YOU~ O~ r TO CLt\j of CLearwater P.O. Box 4748 CLearwater, FL. 33518 FEe II 198" INSURANCE AGENCY INC. 620 BYPASS DRIVE P z P. O. BOX 5025 CLEARWATER. FLORIDA 33518-4985 Phone: (813) 797-4499 Tampa: 229-8208 L CITY CLERK J [REAT AME leAN INSURANCE COMPANle . 'SUbBidlar. ie, of Amerie:an Flnlncial Corporation . _ 58~ v.7"AlNUT STREET. CINCINNATI, OHIO 45202 . ... .' =============================================================================== Insured CLEARWATER BEACH SEAFOOD, INC. Policy Number: PRO 6 34 11 38 - 00 Effective Date I Policy Period 11 / 13 / 84 05/ 31 / 84 to 05 / 31 / 85 I Authorized Representative AIM INS. CLEARWATER FLORIDA ----------------------------------------------~-------------------------------- 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": l. Insured's Name: 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: X 12. ENDORSING POLICY TO ADD REVISED SCHEDULE A PER ATTACHED F23001G NO CHANGE IN PREMIUM NECESSARY. 03 CNR 01-14-85 This policy is subject otherwise to all its terms. F.14258A (Ed. 12/82) PRO (Page 1 of 1) ORIGINAL COpy X074 1'1/841 JCREAT AME IC:AN INSURANCE COMPANle . .SUblldllr.i..&5 of American Fln.nela' Corporation . . 580 WALNUT STREET. CINCINNATI. OHIO 45202 .. ! . 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 - 00 ============================================================================='== Carrier, policy Number and Period Type of Policy ------------------------ ------------------------ (a) OHIO CASUALTY WCW 4000492 5-31-84/85 Employers' Liability Insurance ------------------------ ------------------------ (b) Comprehensive Automobile Liability including OHIO CASUALTY ACW9646347 5-31-84/85 owned automobiles x x non-owned automobiles ( X ) hired automobiles ------------------------ ( ) garagekeepers' legal liability Applicable Limits ----------------------------- Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ policy limit $ each employee ----------------------------- Bodily Injury Liability $ each person $ each occurrence Property Damage Liability $ each occurrence Bodily Injury and Property Damage Liability Combined $ 300,000 each occurrence ----------------------------- , (c) ----------,-------------- ------------------------ ----------------------------- $ each location Comprehensive General Liability including ST. PAUL 609NC4155 5-31-84/85 products-completed $ operations liabil- $ ity contractual liability X personal injury liability ( ) injury to employees covered ) employees as addi- tional insureds liquor law liability ) Personal or Bodily Injury Liability each occurrence aggregates Property Damage Liability $ $ each occurrence aggregates Personal or Bodily Injury and Property Damage Liability Combined $ 300,000 each occurrence/ aggregates F.2300lG (Ed. 10/84) PRO (Page 1 of 2) ORIGINAL COpy ------------------------------------------------------------------------------- XQ74 111/841 J[REAT AME ISA INSURANCE COMPANle .SUb8Idiar,.S O'f. American Flnanc;ial Corporation ,,56~ W\\LNUT STREET. CINCINNATI, OHIO 45202 . " ~, ". " . ' (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 owned watercraft ( non-owned water- craft Bodily Injury Liability $ each person $ each occurrence Property Damage Liability $ each occurrence Bodily Injury and Property Damage Liability Combined $ each occurrence (f) ------------------------ ------------------------ ----------------------------- EMPLOYERS NATIONAL INSURANCE CO. TBD 11-13-84/85 LIQUOR LIABILIT.Y ----------------------------------------------------------------,--------------- 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 X074 111/841 ~v GENERAL L1ABILlTY.AUTOMOBiLE POLICY '- . ;-. \,' No. GLA 193908 NEW Renewai of Number ~-- STOCK COMPANY DECLARATIONS Item 1. Named Insured and Address: (No., Street, Town or City, County, State) CLEARWATER BEACH SEAFOOD, INC. 37 CAUSEWAY BLVD. CLEARWATER, FLORIDA t1D Agll11ts Name W. DANA ROEHRIC! P.O. Box 12769, St. Petersburg, FL 33733 license Number o~ 3i OU71.N.-O&URANCE AGENCY, INC. Name of Producing Age,. O. BOX 5025 WESTERN WORLD _~CL~ARW:ATER, FLORIDA 33518 .-- ~~JJ-RANCE IS I"SUED PURSUANT TO THE INSURANCE COMPAN~RII~~\SlJR~~~8~~'ir.Jtf~g~fQ~~~84 KEENE. NEW H~f#i,~..: ,lg~ GFn....:...'wt,(~l\I'Oj\ INSUR~J.cr;: .s:;UAI3..- 1;"1'( /' I:'T TU 1 ff~""l.WIJ1lv.l(jF IUJY p.lljIlt1I.iIl F. lal;) ~:',!:;~:'t;~' :;)i!~~eyTI~f~ AN$~'f.L~lfT STATE TAX: 7.08 , Item 2. Policy Period: (Mo. Day Yr.) From 11/13/84 to 5/31/85 12:01 A.M., standard time at the address of the named insured as stated herein. SU BJ ECT TO AUDIT :I The named insured is: D Individual D Partnership Business of the named insured is: (ENTER .ELOW) FISH MARKET I!J Corporation D Joint Venture D Other: Audit Period: Annual, unless otherwise stated. (ENTER .ELOW) Item .3. The insurance afforded is only with respect to the Coverage Part(s) indicated below by specific premium charge(s) and attached to and forming a part of this policy Advance Coverage Coverage Partls) Advance Coverage Coverage Part(s) Premiums . Part No(s). Premiums Part No(s). $ Automobile Medical Payments Insurance $ Hospital Professional Liability Insurance $ Automobile Physical Damage Insurance $ Manufacturers' and Contractors' Liability (Dealers) Insurance $ Automobile Physical Damage Insurance $ Owner's and Contractor's Protective Liability (Fleet Automatic) Insurance $ Automobile Physical Damage Insurance $ ... Owners', Landlords' and Tenants' liability (Non-Fleet) Insurance $ Basic Automobile Liability Insurance $ Personal Injury Liability Insurance $ Completed Operations and Products Liability $ Physicians', Surgeons' and Dentists' Professional Insurance Liability Insurance $ Comprehensive Automobi Ie Liabi lity Insurance $ Premises Medical Payments Insurance $ Comprehensive General Liability Insurance $ Special Protective and Highway liabil ity Insurance $ Comprehensive Personal Insurance New York Department of Transportation $ Contractual Liability Insurance $ Storekeeper's Insurance $ Druggists' Liability Insurance $ Uninsured Motorists Insurance $ Elevator Collision Insurance $ $ Farm Employers' Liability and Farm Employees' 191.00 L9492 LIQUOR LIABILITY Medical Payments Insurance $ $ Farmer's Comprehensive Personal Insurance 20.00 . GL2011 ADDITIONAL INSURED $ Farmer's Medica I Payments Insurance $ $ Garage Insurance Form numbers of endorsements, other than those entered on $ WW-I04 GL2011 Coverage Partlsl, attached at issue $ 211 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 . $ $ $ Item 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: 6101 'Not applicable in Texas ST. PETERSBURG, FLORIDA 12/17/84 mJ. DANA ROF:ffRl!1 & ASSOCIAT~ By {/J &~ ~. Ptd. in U.S.A. . Authorized Representative Countersigned: OKP6300.1.G (6,79) vaERN WORL~ INS~RANCE. COMI'A.i~c~~- KEENE, NEW HAMPSHIRE (A Stock insurance company, herein called the company) 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 liability 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 maintenance 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 appl ies 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 J 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 expected nor intended from the standpoint of the insured; "policy territory" means: (1) the United States of America, its territories or possessions, or Canada, or (2l 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 which was sold 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 (2l 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. r 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 (2l included within the completed operations hazard, or (3l for the named insured by independent contractors, or (3l included within the com- which liability is assumed by the insured under an incidental contract. SUPPLEMENTARY PAYMENTS When used in this policy (induding endorsements forming a part hereofl: "automobile" means a land motor vehicle, trailer or semi.trailer designed for travel on public roads Oncludingany 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" means the 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 (1) arising out of operations performed for the named insured by independent contractors, or (2l included within the completed operations hazard or the underground property damage hazard, or (3l for which Iiabilityis 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 (c) 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 of the company's liability thereon; (bJ premiums on appeal bonds required in any such suit, premiums on bonds to release attachments in any such suit for an amount not in excess of the appticable 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 bond, 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; (dl 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 Joss of earnings not to exceed $25 per day. --- .... eOVERAG{ PART .. LIQUOR LIABILITy.. INSURANCE "? o. .. GLA 193908 , to complete said policy. for attachment to Policy No. . L 9492 (Ed. \-73) 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 300 thousand dollars each common cause X-Liquor Liability $ 211. 00 300 thousand dollars aggregate Form numbers of endorsements attached at issue $ 211.00 Total Advance Prem ium I Advance Code Premium Rate Premium Basis No. Descriptiln of Hazards Designated Insured Premises liquor Liability 191. 00 .35 PER $100. FISH MARKET 37 CAUSEWAY BLVD, RECEIPTS CLEARWATER, FLORIDA pIR FACTOF .545 Receipts $100,000.00 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 namell illSured collects as a separate item, and remits directly to a governmental division, for which accurate records a're maintained apart from other receipts. 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 by any 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 gruundless, false or fraudulent, and may make such investigation and settlement of any claim or sO it 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 cqmpany'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 to 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 the named insured's products or reliance upon a representation or warranty made at any time with respect thereto; but this exclusion does not apply to bodily injury or property damage 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 following 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; (over) (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- ship or joint venture of which the insured is a partner or member and which is not d~signated 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 of 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 more persons as the result of the selling, serving or giving of any alcoholic beverage to anyone person. The limit of 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, O~\'~';:~'~~~ICO ""'D $U~PlY 9IV'<;"O" ." >. 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 for 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 to read as follows: Three Year Policy: If this policy is issued for a period of three~ars: (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 of Injury, Claim or Suit When an injury occurs written 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. ': . '. ... WESTERN WORLD .' . .. ...... INSURANCE COMPANY, INC. This endorsement effective 11/13/84 forms a part of Policy # GLA 193908 (12:01 A.M. Standard Time) WESTERN WORLD INSURANCE COMPANY, INC. COMBINED PROVISIONS ENDORSEMENT LIABILITY POLICIES In consideration of the premium charged, it is agreed that the following special provisions (indicated by "X") shall apply to this policy: Provision included if box marked: 1. D WW 1 DEDUCTIBLE ENDORSEMENT: Amount $ per claim 1. The Company's obligation under the Bodily Injury Liability & Property Damage Liability Coverages to pay damages on behalf of the insured applies only to the amount of damages in excess of deductible amount stated above. 2. The deductible amount applies under the Bodily Injury Liability or Property Damage Liability Coverage, respectively, to all damages because of bodily injury sustained by one person, or to all pro- perty damage sustained by one person or organization, as the result of anyone occurrence. 3. The deductible amount stated shall also apply towards investigation, adjustment and legal ex- penses incurred in the handling and investigation of each claim, whether or not payment is made to claimant, compromise settlement is reached or claim is denied. 4. The terms of the policy, including those with respect to (a) the Company's rights and duties with respect to the defense of suits and (b) the insured's duties in the event of an occurrence apply irrespec- tive of the application of the deductible amount. 5. The Company, at its sole election and option, may either: (a) pay any part or all of the deductible amount to effect settlement of any claim or suit, and upon notification of the action taken, the named insured shall promptly reimburse the Company for such part of the deductible amount as has been paid by the Company; or (b) simultaneously upon receipt of notice of any claim or at any time thereafter, Call upon the insured and request said insured to pay over and deposit with the Company allor, any part of the deductible amount, to be held and applied by the Company as herein provided. The failure of the insured to promp- tly comply with the Company's request, pursuant to this subdivision, shall constitute a breach of the policy contract with the same force and effect as if this policy did not cover the particular accident, in- cident or occurrence which created the particular claim or claims with reference to which the deposit of the deductible amount or amounts had been requested. Nothing herein contained shall be held to vary, waive, alter or extend any of the Declarations, Schedule of Coverages, Insuring agreements, Exclusions and Conditions of the policy other than as stated above. 2. D WW 3 ASSAULT AND BATTERY EXCLUSION: It is agreed that the insurance does not apply to bodily injury or property damage arising out of assault and battery or out of any act or omission in connection with the prevention or suppression of such acts, whether caused by or at the instigation or direction of the insured, his employees, patrons or any other person. 3. D WW 4 MINIMUM EARNED PREMIUM ENDORSEMENT: It is agreed that the total premium indicated under Item 3 of the Declarations is the minimum premium for the Policy Period indicated or less and is not subject to short rate or pro rata adjustment in the event of cancellation by the insured. It is further agreed that cancellation for non-payment of premium shall be deemed a request by the named insured for cancellation of this policy thereby activating the foregoing minimum premium provision. 4. D WW 13 CLASSIFICATION ENDORSEMENT: Coverage under this contract is specifically limited to those codes outlined. All coverages exclude any code or operation not specifically listed in the coverage part of this policy. CONTINUED OTHER SIDE ... .' ..- 5. lIDc . WW 22 SERVICE OF SUIT: It is agreed that service of process in suit may be made upon FRIEDLANDER, GAINES, COHEN, ROSENTHAL & ROSENBERG, ESaS. 1140 AVENUE OF THE AMERICAS NEW YORK, NY 10036 and that any suit instituted against anyone of them upon this contract, the Company will abide by the final decision of such Court or of any Appellate Court in the event of an appeal. The above-named are authorized and directed to accept service of process on behalf of the Company in any such suit and/or upon the request of the insured to give a written undertaking to the insured that they will' enter a general appearance upon the Company behalf in the event such a suit shall be instituted. Further, pursuant to any statute orany state, territory or district of the United States which makes pro- vision therefore the Company hereby designates the Superintendant, Commissioner or Director of Insurance or other officer specified for that purpose in the statute, or his successor or successors in office, as their true and lawful attorney upon whom may be served any lawful process in any action, suit or designate the above-named as the person to whom the said officer is authorized to mail such process or a true copy thereof. " ... -0 6. GPC WW 88 PUNITIVE DAMAGES EXCLUSION: In consideration of the premium charged, it is understood and agreed that this policy excludes any claim for punitive or exemplary damages whether arising out of acts of the insureds, insured's employees or any other person. 7. 0 L201 WATER DAMAGE EXCLUSION: It is agreed that the insurance does not apply to the property damage to buildings or property therein, wherever occurring, arising out of any of the following causes, if such cause occurs on or from premises owned by or rented to the named insured and described above: 1. the discharge, leakage or overflow of water or steam from plumbing, heating, refrigerating or air- conditioning systems, standpipes for fire hose, or industrial or domestic appliances, or any substance from automatic sprinkler systems, 2.. the collapse or fall of tanks or the component parts or supports thereof which form a part of automatic sprinkler systems, or 3. rain or snow admitted directly to the building interior through defective roofs, leaders or spouting, or open or defective doors, windows, skylights, transoms or ventilators; but this exclusion does not apply to property damage due to fire, to the use of elevators or to operations performed by independent contractors. Attached to and forming part of Policy Number Of the Western World Insurance Company, Inc. GLA 193908 WW 104 (3/80) t, em ....-:;,;. .. .. . GL 20 11 (Ed. 07 66) , e This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The fOI~win& information is required only when this endorsement is issued subsequent to preparation of policy.) . 11 13/84 . GLA 193908 Endorsement effective Policy No. Endorsement No. Named Insured CLEARWATER BEACH SEAFOOD, INC. 20.00 Cou ntersigned by Additional Premium $ 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) e 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 arising 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 designat~d below. SCHEDULE Designation of Premises (Part Leased to Named Insured) Name of Person or Organization (Additional Insured) Annual Premiums Bodily Property Injury Damage Liability Liability 37 CAUSEWAY BLVD. CLEARWATER, FLORIDA CITY OF CLEARWATER P.O. BOX 4748 CLEARWATER, FLORIDA 33518 $20.00 INCL. . GL 20 11 07 66 Attach Coverage Part(s) and Endorsement(s) (If Any) Here . .". ~ . .- . 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 pol icy 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 pol icy, 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, ,uch insurance as is afforded by this policy for bodily injury ~iability or for property damage liability shall comply with the provisions of such Jaw 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 wh ich it would not have been obi igated to make under the terms of th is 'policy except for the agreement contained in this paragraph. 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 policy; 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 I ie 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 company be impleaded by the insured or his iegal representative. Bankruptcy fOr insolvency of the insured or of the insured's estate shall not relieve the com- pany of any of 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 appl icable to the loss on an excess or contingent basis, the amount of the company's I iability 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 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, 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 applicable 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 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. 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 (J) 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 fora 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 thereof. 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 thecancellation 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 h is agreements and representations, that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements existing between himself and the company or any of its agents relating to this insurance. In Witness Whereof, the company has caused this policy to be executed and attested, but this policy shall not be valid unless countersigned by a duly authorized representative of the company. ~~~~'iMnt NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) ThiLendorsement 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: .L Th~spolicy~oes notapply:;. _ .' '. '. A. Under any liability Coverage, to bodily injury or property damage (1) with respect to which an insured under this policy is also an insured .under a nuclear energy liability pol.jcyissued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy liability Underwriters or Nuclear Insurance Association' afCana.da, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability: or.. ..... (2) resulting from the hazardous' properties of nuclear material and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the insured is, or had this pol icy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B. Under any Medical Payments Coverage, or under any Supplementary Pay. ments provision relating to first aid, to expenses incurred with respect to bodily injury resulting from the hazardous properties of nuclear material and arising out of the operation of a nuclear facility by any person or organization. C. Under any liability Coverage, to bodily injury or property damage resulting from the hazardous properties of nuclear material, if (1) the nuclear material (a) is at any nuclear facility owned by, or operated by or on behalf of, an insured or (b) has been discharged or dispersed therefrom; (2) the nuclear material is contained in spent fuel or waste at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an insured; or (3) the bodily injury or property damage arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear facility, but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to property damage to such nuclear facility and any property thereat. ,,:.,-:' II. As used in this endorsement: "hazardous properties" include radioactive, toxic or explosive properties; "nuclear material" means source material, special nuclear material or by. product material; "source material", "special nuclear material", and "byproduct material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof; "spent fuel" means any fuel~lerTient or'flJel'tomponelrt; solid or liquid, which has been used or exposed to radiation'inca nucIUr.r.eactor;' "waste" means any waste material(aJ. CQntaining'bY,pro.duct. material other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its source material content, arid (b) .resulting from the operation by anY' person or organization of any nuclear facility included under the first two paragraphs of the defi- nition of nuclear facility; "nuclear facility" means (a) any nuclear reactor, (bl any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing spent fuel, or (3) handl ing, processing or packaging waste, - (cl any equipment or device used for the processing, fabricating or alloying of special nuclear material if at any time th.e total amount of such ma. terial in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235, (d) any structure, basin, excavation, premises or place prepared or used for the storage or disposal of waste, and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations; "nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material; "property damage" includes all forms of radioactive contamination of property. NEW YORK EXCEPTION: The "Nuclear Energy liability Exclusion Endorsement (Broad Form)" does not apply to Automobile liability Insurance in New York. , ~ it-> ." ... . ~ . ~ 1- ,'" 4It FLOODINSUAANCE ... GENERAL CHANGE ENDOASEMEN~AYS COMPLETE CD @ @ @) 0 @ PLUS SECTIONS INVOLVED IN CHANGE. OMB 3067-0022 EMERGENCY AND REGULAR PROGRAMS .@, POLICY NUMBER 1a , FL2-017Q-Q773-1 'INSURED'S NAME FROM POLICY DEC PAGE ad nc ~ o L I C y T I " .. @REASON FOR CHANGE' c:ev.,..g. l ~hQn9tA9 NOTE: TIiE NUMBERED SECTIONS 1-14 CORRESPOND TO INSTRUCTIONS IN THE FLOOD INSURANCE4lANUAL to po..!: fll'"ilt 0". ~Q ~..b- c o .. T I .. T . BASIC LIMITS ADDITIONAL LIMITS I RSNa.LA, ill BILL OTHER (ATTACH MEMO IF ADDITIONAL SPACE IS NEEDED) POLICY PERIOD IS FRQIII ~1' A,4T05 31 851201 A,M LOCAL TIME AT THE @ 0- - ,- - NSURED PROPERTY LOCATION r-;;::.. FOR ADDED COVERAGE, INCLUDE THE WAITING ~ENDORSEMENT 11 - 7 - 84 PERIOO FROM THE ENDORSEMENT APPLICAT10N EFFECTIVE DATE DATE. ~ {;\ NAME OF INSURED IS CHANGED OR CORRECTED AS SHOWN IT] . ~ ADDRESS OF NAMED INSURED IS CHANGED AS SHOWN 0 U " I D UCTIONS TO [] BILL m BILL ill BILL FIRST SECOND LOSS MORTGAGEE MORTGAGEE' PAfEE IF CHANGED, ENTER PAYOR IN G)<I> OR CD AS APPROPRIATE ADDRESS OF LICENSED PROPERTY OR CASUALTY INSURANCE AGENT OR BROKER a 0 ".1 M I As..,,,eAee A,.AGV, IAC_ I N T I N F o " .. A T I o N P.e.Sex S02& CLee.....tar. fl. (813) 7<)7-4499 ADDRESS CHANGED? YESO .. A I L A D o " I . . C..QrWQt.,. a.cae,", SAt'll/nnrl, $ Clty of' Cleor-wote,. 37 Causeway e.vd, CleG,.wQter. Fl. 33515 Inc. 34518 PRIOR INSURED MUST SIGN THIS FORM TO ASSIGN THE POLICY TO ""'.. OWNER WITH TRANSFER OR INSURED PROPERTY ~ @ NAME AND ADDRESS OF FIRST MORTGAGEE " . T .. o " T G A G I I IS COVERAGE REQUIRED FOR DISASTER ASSISTANCE? YES :::1 IF YES, CHECK (.....) GOVERNMENT AGENCY SBA I!J FEMA:!J FHA I!I HHS i4J OTHER (PLEASE SPECIFY) [51 SECOND MORTGAGEE LOSS PAYEE OR OTHER APPLICABLE NAME AND (!ynORESS ADD OJ DELETE IT] CHANGE 0 IDENTIFY THE TYPE NAME AND COMPLETE NAME AND I<ODRESS 2ND MORTGAGEE OJ LOSS PAYEE IT] DISASTER AGENCY 0 IF OTHER, PLEASE SPECIFY ill COMMuNITY FL()()Q.,-., OFFICIAL ill MAP }UJ MORTGAGEE ill OTHER (SPECIFY) [5] (E) IS COVERAGE FOR (HIlS BUILDING INSURED'S CONDOMINIUM UNIT? PRINCIPAL RESIDENCE? YES D NO D YESO NOD FOR CONOO ASS'N ON ONE BUlLOtNG YES D NO D ADO OJ DELETE ill CHANGE rn P L' II 0 OC PA IT II . TO , N @ IS INSURED PROPERTY LOCATION SAME AS INSURED MAILING ADDRESS? YES 0 NO 0 IF NO, IDENTIFY PROPERTY LOCATION NO [j 2 N o .. o " T II A G I I o " r. f,''',~ 1 , > ., 'r' .cIVET) THE LOCATION OF INSURED PROPERTY CANNOT BE CHANGED BY ENDORSEMENT - A NEW APPLICATION IS~ @ NAME OF COUNTY/PARISH? P'n.. I Q$ LOCATED IN AN UNINCORPORA T~Y THe9UNTY? YES 0 NO iii COMMUNITY. NUMBER AND SUFFIX FOR LOCATION OF PROPERTY INSURED: 4" ~6nnn 7 LERK COMMUNITY PROGRAM TYPE IS: REGULA~ EMERGENCY [!I IS BUILDING IN SPECIAL flOOD HAZARD AREA? YES Ii NO 0 c o .. .. U N I T Y FLOOD. INSURANCE RATE MAP ZONE @ (A) BUILDING OCCUPANCY 1 0 IlIIlDINTUlL r.1 SINGLE FAUlL Y L!J 2.. FAMILY ill OTHER RESIDENTIAL NON-RESIDENTIAL ill INCLUDING HOTELIMOTEL (C) BASEMENT OR ENCLOSED AREA BELOW AN ELEVATED BUILDING: NONE FINISHED INFORMATION SOURCE: CBl BUILDING TYPE (INCUJOING BASEMENT IF ANY), ONE FLOOR twO FLOORS THREE OR MORE FLOORS SPLIT LEVEL MOBILE HOME ON FOUNDATION (F) IS INSURED PROPERTY OWNED BY STATE GOVERNMENT? YES D NO D (G) IS BUIlDING IN THE COURSE OF CONSTRUCTION? YESD NOD (COVERAGE EFFECTIVE WHEN WALlED AND ROOFED) N S U R E o rn OJ ill rn m ill ? H I " Frs 11 1985 . U I L o I N G @.I OJ ill NOD (M) DESCRIBE BUILDING AND USE IFNOT A SINGLE FAMILY DWELLING. (FOR ANY II08ILE HOME,INSERTMAKE, MODEL & SERIAL NUMBER AND WHETHER OR NOT LOCATED IN MOBILE HOME PARK) (01 DOES INSUflED OUALIFY AS A SMALL BUSINESS RISK? YES 0 (II ESTIMATED REPLACEMENT COST OF THE BUILDING IS S (L) IS BUILDING ELEVATED? (REFER TO NFIP MANUAL) YESO NOD IF YES, AREA BELOW IS (CHECK ALL THAT APPL YI FREE OF OBSTRUCTION ITJ WITH OBSTRUCTION -~~~~ ~~~~:~~~ ~;LLS 0 -~T~~:;A~A~~~':;ALLS 0 - WITH MACHINERY OR EOUIPMENT ATTACHED TO BUILDING BELOW LOWEST ELEVATED FLOOR 0 NON-BREAKAWAY WALLS ill y UNFINISHED (Jl IF NOT A SINGLE FAMILY DWELLING. THE NUMBER OF OCCUPANCIES ARE c o p (K) DEDUCTIBLE BUILDING !!J $ CONTENTS ~ $ @CONTENTS LOCATED IN IS PERSONAL PROPERTY HOUSEHOLD CONTENTS? BASEMENT ONL Y OJ BASEMENT AND ABOVE ill LOWEST FLOOR ONLY rn ABOVE GROUND LEVEL IF NO. PLEASE DESCRIBE BELOW LOWEST FLOOR ABOVE GROUND LEVEL AND HIGHER FLOORS~ ABOVE GROUND LEVEL MORE THAN ONE FULL FLOOR m (IF SINGLE FAMILY, CONTENTS IS RATED THROUGHOUT THE BUILDING) @BUILDlNG PERMIT DATE OR DATE CONSTRUCTION STARTED 11-6-84 (DATE OF PERMANENT PLACEMENT IF MOBILE HOME) IS BUILDING POST FIRM CONSTRUCTION OR SUBSTANTIAL IMPROVEMENT? VES I) NO 0 (SEiO REVERSE SIDE FOR DEFINITION, IF POST FIRM CONSTRUCTION IN ZONES A. Al_, AO. AH, V. Vl-V30, OR IF PRE-FlAM CONSTRuCTION IS ELEVATION RATED. COMPLETE ELEVATION DATA BELOW LOWEST FLOOR ELEVATION , L 5 (-I BASE FLOOD ELEVATION 10 (=) DIFFERENCE TO NEAREST FOOT -4.5 (+ OR _, IF ZONES V AND V1-V30 ONLY: DOES BASE FLOOD ELEVATION INCLUDE AFFECTS OF WAVE ACTION? 0 YES 0 NO IS BUILDING FLOOO-PAooFED? YES 0 NO 1XI ATTACH ELEVATION OR FLool}PROOFING CERTIFICATION (SEE FLOOD INSURANCE MANUAL FOR SUGGESTED CERTIFICATE FORM.) IF PREVIOUSLY SUBMITTED INDICATE POLICY NUMBER TO WHICH CERTIFICATION WAS ATTACHED. FL f13\ ~1NSURANCE COVERAGE 1'0 , i ~ . A C .. o D' Y I I II II A A T O. I .. G AMOUNT RATE PREMIUM AMOUNT RATE PRO RATA FACTOR @ IF RETURN PREMIUM, MAIL REFUND TO: INSURED I!J AGENT ~ PAYER ~ THE ABOVE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDG OR IMPRISONMENT UNDER APPLICABLE FEDERAL LAW. . , II N A T U = FEMA 81-18 (4-84) . YESO NOD PREMIUM DEDUCTIBLE DISCOUNT ANNUAL PREMIUM REDUCTION DIFFERENCE PREMIUM TOTALS ONE YEAR 3 YEARS TOTAL NEW AMOUNT PAO-RATA AMOUNT FROM ADD. COVERAGE END ATIACHED' NET PREMIUM DIFFERENCE' 'SEE REVERSE SIDE E STATEMENTS MAY BE PUNISHABLE BY FINE SIGNATURE OF INSUREQ AND DATE PLEASE ATTACH TO NAP COPY OF ENDORSE"~"" TO THE NATION"' - - KEEP SECOND ... 11-7-84 -- DATED THIS . . ii -c9 (I) FEDERAL EMERGENCY IllANAG&QENT AGENCY NAnONAL FLOOD INSURANCE PROGRAM GENERAL CHANGE ENDORSEMENT REFER TO THE GENERAL CHANGE ENDORSEMENT CHAPTER OF niE FLOOD INSURANCE MANUAL FOR DETAILED INSTRUCTIONS ON COMPLETING niE GENERAL CHANGE ENDORSE- MENT FORM, The General Change Endorsement cannot be used to renew, extend or change the term of a pOlicy. When a General Change Endorsement Is submItted toward the end of a poncy term. the agent/broker should examine the Ren~w~t Premium Notice upon receIpt to determIne If the changes were recorded in time to be reflected on the PremIum Notice, POST FIRM CONSTRUCTION OR SUBSTANTIAL IMPROVEMENT (Formerly caned New Construc- tion) POST FIRM ConstrucUon or Substantial Improvement means buildings whose construction or Substsntlallmpl'O\"'mlent started after December 31, 1974 or on or attar.. deClIve date of the initial Flood InsuranCe Rate Map (FIRM), whichever Is later. Substantial Improvement Is Sfr/l8pa1r, reconstruc- tion, or Improvement of a bundlng, the cost of whIch equals or exceeds 60% of the market value of the building. DATE OF CONSTRUCTION. The start of ConstructIon or Substantial Improvement for Insurance purposes means the date the buDdIng pennlt was Issued provided the acIUaI start of construction, repair. reconstruction or Improvement was withIn 180 days following the inItial permit date. WARNING TO AGENTS AND INSURANCE APPLICANTS. The National Flood Insurance Act of 1968. as amended, prohibits the payment of flood Insurance on properUes ofIicIdy decIar8cI to be In violation of Section 1318 oftha Nfl. Therefore, If the Ioweatftoorelevatlon of POST FIRM ConstrucIIonorSubstantial Improvement Is below the base tIood elevation forlhe area, the eppDcant. for his own pn:DcUon. should obtain aoerllftcatlon (e.g., a copy of the variance) from the appropdate communltyoftldalthatthe property has not been officlany declared to be In vlolatton of state or local flood plain management requirements. NONDISCRIMINATION. No person or organization shall be excluded from parUclpatlng In, denIed the benefit of, or subjected to dlscrlmlnatton under the Program authorized by the Act, on the ground of race, color, creed, sex, age or national origIn. - - - --- . PRIVACY ACT. ThEnrifonnatton request8d1s necessary to process your General Change Endorsement. The authority to coDectthe information Is TltJe42, U,S. Code, SecUon4001 to 4028. It Is voluntary on your part to tumIeh the Infennatton. It wID not be disclosed outsIde the Federal Emergency Management Agency except to the servicing office, acting as the Govemmenfs fiscal agent, to routine users, to your agent and any mortgagee named on your poDcy. SURE ecords . ,. ,. . Date: 2 - 2 7 - 85 ndosed contains a Mortgage Clause, or Loss Payable Clause Ir favor. r: CLearwater Beach Seafood, I nc, 3ny and Policy No. Am e r L can N a t Lon a L F L rei n sur a n c e Co, PRO 6: RECEIVED Thank ~ou, Pam Zel &D~ of CLearwater Box 4748 ('water, FL. 33518 MAR 4 198~ INSURANCE AGENC' 620 BYPASS DRIVE P. O. BOX 5025 ClEARWATER, FLORIDA 3361 Phone: 18131 797-4<499 Tempa: 229-8208 CITY: CLERK 37*02/19/85 JUREAT AMERICAN INSURANCE COMPANle ... S. U'bsldiaries of American Financial Corporation 580 WALNUT STREET. CINCINNATI. OHIO 45202 _ ." . . =============================.======================================'============ Insured CLEARWATER BEACH SEAFOOD INC Policy Number: PRO 6 34 11 38 - 00 -------'------------------------------------------------------------------------ Effective Date I Policy Period 11 / 13 / 84 05 / 31 / 84 to 05 / 31 / 85 I Authorized Representative AIM INSURANCE AGENCY ------------------------------------------------------------------------------- Complete the above spaces if this endorsement is not attached to the policy when issued. =============================================================================== GENERAL ENDORSEMENT HECEIVED ------------------------------------------- PREMIUM CHANGE (if any) I ----------------------------------------- Addi tional $ I Return $ I MAR 4 19~~ ------------------------------------------- CITY CLERK It is agreed that this policy is hereby amended as indicated below by an "X": 1. Insured's Name: ) 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. ENDORSING TO AMEND FORM: F2300lG-SCHEDULE A. This policy is subject otherwise to all its terms. F.14258A (Ed. 12/82) PRO (Page 1 of 1) ORIGINAL COpy 03 2-19-85 LRE ----I 11 i.l 3-4 \ 37*02/19/85 J tREAT AMERICAN INSURANCE COMPANle '. SUbSidiar..ieS of Am.erican Financial Corporation . 580 WALNUT STREET. CINCINNATI. OHIO 45202 _. .. ; SCHEDULE A SCHEDULE OF UNDERLYING POLICIES e ===============.================================================================ Insured Effective On and After " 12:01 A.M. Standard Time This Schedule Forms Part of Policy Number PRO 6 34 11 38 - 00 =====~=='==============================================================.========.= Carrier, Policy Number and Period Type of Policy Applicable Limits (a) ------------------------ ------------------------ ----------------------------- WEST AMERICAN INS CO wcw 4000492 5-31-84/85 Employers' Liability Insurance Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit $ 100,000 each employee (b) ------------------------ ------------------------ ----------------------------- WEST AMERICAN INS CO ACW 9646347 5-31-84/85 Comprehensive Automobile Liability including ( X ) owned automobiles ( X ) non-owned automobiles ( X ) hired automobiles ) garagekeepers' legal liability Bodily Injury Liability $ each person $ each occurrence Property Damage Liability $ each occurrence Bodily Injury and Property Damage Liability Combined $ 300,000 each occurrence (c) ------------------------ ------------------------ ----------------------------- $ each location ST PAUL 609NC4l55 5-31-84/85 Comprehensive General Liability including products-completed $ operations liabil- $ ity contractual liability X ) personal injury liability ( ) injury to employees covered employees as addi- tional insureds liauor law ~ 1 3- 1:' 1 _. :. -= .~~ Personal or Bodily Injury Liability each occurrence aggregates Property Damage Liability $ $ each. Qcc:urrenc.e aggregates Personal or Bodily Injury and Property Damage Liability Combined , , each occurrence/ aggregates F.23001G (Ed. 10/84) PRO ------------------------------------------------------------------------------- 03 2-19-85 LRE (Page 1 of 2) ORIGlhn';" CvPi X,D 7...-: ! 1 ~ is!) 37*02/19/85 jUREAT AMERICAN INSURANCE COMPANle . 5",~bSidi8r.',., S Of, American Financial Corporation 580 WALNUT STREET. CINCINNATI. OHIO 45202 . " . ------------------------------------------------------------------------------- (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 ) owned watercraft non-owned water- craft Bodily Injury Liability $ each person $ each occurrence Property Damage Liability $ each occur r-ence Bodily Injury and Property Damage Liability Combined $ each occurrence ------------------------ ------------------------ ----------------------------- (0 WESTERN WORLD INS CO INC GLA 193908 11-13-84/85 LIQUOR LIAB. $ 300,000 CSL -------_._---------------------------------------------------------------------- An "X" marked in the parentheses indicates the coverage is provided in the Underlying Policies. ==========~==='================================================================= F.23001G (Ed. lO/8~) PRO (Page 2 of 2) ORIGINAL COPY )(074 f11/8A\ JY- ---.--------.------------.-...-.--..-1 @ WestHOM~[fler.!s~Ql~?,N~ra!:!s~cA~g~pany I i I I I ! Administrative Office Hamilton, Ohio 45026 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY "'-'r-~'F~~~~~~~~.!.-,~"".., ...~;--~.,"'f-Wl~'~~~.-..~-~~ .'......""'.,.,t'" WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE BEGINNING ON Page Information Page ......................................................................... . General Section - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 A. The Policy. . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 B. Who is Insured. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 C. Workers Compensation Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 D. State.........................................................;.................... 1 E. Locations.......................................................................... 1 PART ONE - WORKERS COMPENSATION INSURANCE.................................... 1 A. How This Insurance Applies ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 B. We Will Pay ... . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 C. We Will Defend .................................................................. .. 1 D. We Will Also Pay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1 E. Other Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 F. Payments You Must Make. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 G. Recovery From Others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 H. Statutory Provisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 PART TWO - EMPLOYERS LIABILITY INSURANCE ...................................... .. 2 A. How This Insurance Applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 B. We Will Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 C. Exclusions......................................................................... 3 D. We Will Defend.................................................................. .. 3 E. We Will Also Pay . . . . . . . . . . . . . . .. .. . . . ;. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 F. Other Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 G. Limits of Liability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 H. Recovery From Others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 I. Actions Against Us .............................................................. . .. 4 Form No. CW 3000 (4-84) Copyright 1982 National Council on Compensation Insurance. we 00 00 00 (Standard) QUICK REFERENCE - CONTINUED BEGINNING ON Page PART THREE - OTHER STATES INSURANCE. . .. . .. . . . . . . . . . .. . . . . .. . .. . . . .. . . . . . . . .. .. , .. 4 A. How This Insurance Applies .. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 4 B. Notice............................................................................. 4 PART FOUR - YOUR DUTIES IF INJURY OCCURS. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 4 PART FIVE - PREMIUM .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 A. Our Manuals. . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . ... . . . . .....: ... .. .. . . . . . . . . ... . . . .. 4 B. Classifications............................................................ . . . . . . . . .. 4 C. Remuneration............................................................... ..... . . .. 5 D. Premium Payments. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,..' 5 E. Final Premium ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5 F. Records........................................................................... 5 G. Audit........................................................... .................. .. 5 PART SIX - CONDITIONS ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . .. .. 5 A. Inspection......................................................................... 5 B. Long Term Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . ... . ., .. . . ... . . .. . .. . . . . . . .. 5 C. Transfer of Your Rights and Duties.............................; ..........,........ .. 6 D. Cancelation................................................................,...... ~ 6 E. Sole Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. 6 IMPORTANT: This Quick Reference is not part of the Workers Compensation and Employers Liability Polley and does not provide coverage. ~efer to the Workers Compensation and. Employers Liability Policy itself for actual contractual provisions. PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. Copyright 1982 National Council on Compensation In$urance. Issued by The Stock Company Herein calle. Company W~ST AMERICAN INSURANCE COMPANY 2600 EAST NUTWOOD Ave ~ULU:R.TOl\l CAlI.F .'12631 INCORPORATED UNDER THE LAWS OF CA l r FORN I A !. ~ .NT NUMBER POLICY NUMBER - I 09-00-13CiltJCW (d6) 4U'J-~)"-'i2 ~ ~ ~ Jb2,a~~i~pa~:;sualty Group Item 1. NAMED INSURED & MAILING ADDRESS INFORMATION PAGE WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY PRODUCER'S NAME & MAILING ADDRESS CLEARWATER BEACH SEAFOOD INC 37 CAUSEWAY BLVD CLEARWATER FL ArM INSURANCE AG~~cY LNC PObOX 5025 33~1~ CLEARWATER FL 33513 INSURED IS CORPORATION PREVIOUS POLICY NUMBER wCw (85) 400-04-92 Locations - All usual workplaces of the insured at or from which operations covered by this policy are conducted are located at the above address unless otherwise stated herein. SEE ATTACHED SCHEDULES OF OPERATIONS. Item 2. POLICY PERIOD ~l;~~i~~~;e~t~~ds~~~e~meattheaddress FROM 05/31/85 TO 05/31/86 Item 1 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: FlA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item lA. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, OOOeach accident Bodily Injury by Disease $ 500,OOOpolicy limit Bodily Injury by Disease $ 100 ,OOOeach employee . C. Other States Insurance: Part Three of the policy. SEE ATTACHED ENDORSEMENT NONE Item 4. CLASSIFICATION OF OPERATIONS Estimated Total Rate per Entries in this item, except as specifically provided elsewhere in this policy, do not modify any of the Remuneration $100 of RE- other provisions of this policy. MJ Annual 0 3 Year muneration !{ESTMIRANT NOC 26,000 Estimated Premium MI Annual 0 3-Year .STORE: MEAT, FISH OR POULTRY - RETAIL 02 d031 5.70 I, "';:82 05 '-1019 30,000 3.91 1,191 PREMIUM DEVIATION (20.0%) PREMIUM AFTER DEVIATION TOTAL ESTIMATED ANNUAL STANDARD PREMIUM S35 2,138 2,138 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) 35.00 MINIMUM PREMIUM $ 292 FlOR IDA If indicated below, interim adjustments of premium shall be made. o Semi-Annually Quarterly Monthly ENDORSEMENTS (FORM NUMBER) WC000308 TOTAL ESTIMATED PREMIUM '::,1-/3.00 Deposit Premium $ 2173.GO INSURED'S COpy Issue Date04/16/l35 3 sr PETERS8WH,; 3RANCH OFFICE C. 3010 (WC 00 00 01) u h iz d R resentative COpyright 1983 NStional Council on Compensation Insurance. :. " . . WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY " ~ .. WC 00 03 08 (Ed. 4-84) PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT The policy does not cover bodily injury to any person described in the Schedule. Thepremium basis for the policy does not include the remuneration of such persons. You will reimburse us for any.payment we must make because of bodily injury to such persons. Schedule Partners Officers WILLIAM F. GOODWIN PRESIDENT JOAN V. GOODWIN SECRETARY/TREASURER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation. of the policy Endorsement Effective 05/31/85 Policy No. WCW (86) 40 4-92 Endo ement o. Insured CLEARWATER BEACH SEAFOOD INC P e i m $ Countersigned By WC 00 03 08 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. ~ Others klt '" . . ATTACH'FORM AND ENDORSEMENTS (IF ANY) HERE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows. GENERAL SECTION A. The Policy This policy includes at its effective date the In- formation Page and all endorsements and sched- ules listed there. It is a contract of insurance be- tween you (the employer named in item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements re- lating to this insurance are stated in this policy. The. terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured You are insured if you are an employer named in item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's empl<;>yees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupa- tional disease law of each state or territory named in item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the. District of Columbia. E. Locations This policy covers all of your workplaces listed in items 1 or 4 of the Information Page; and it cov- ers all other workplaces in item 3.A. states unless you have other insurance or are self-insured for such workplaces. PART ONE - WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by dis- ease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employ- ment. The employee's last day of last expo- sure to the conditions causing or aggravat- ing such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits re- quired of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our ex- pense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not cc)Vered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our re- quest, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law un- til we offer the amount due under this in- surance; and 5. expenses we incur. Copyright 1982 National Council on Compensation Insurance. y Page 1 of 6 . E. Other Insurance We will not pay more than our share of benefits and costs covered by t.his insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self- insurance is exhausted, the shares of all remain- ing insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required be- cause: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in viola- tion of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discrimi- nate against any employee in violation of the workers compensation law. If we make any payments in excess of the bene- fits regularly provided. by the workers compensa- tion law on your behalf, you will reimburse us promptly. G. Recovery FrornoOthers We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. . ,H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement maybe against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO -- EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by acci,dent or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employ- ment by you. 2. The employment must be necessary or in- cidental to your work in a state or territory listed in item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employ- ment. The employee's last day of last expo- sure to the conditions causing or aggravating such bodily injury by disease must occur dur- ing the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. Copyright 1982 National Council on Compensation Insurance. Page 20f6 . . B. We Will Pay We will pay all sums you legally must pay as damages because of bodily injury to your em- ployees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is per- mitted by law, include damages: 1 . for which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. for care and loss of services; and 3. for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct con- sequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. because of bodily injury to your employee that arises out of and in the course of em- ployment, claimed against you in a capacity other than as employer. · C. Exclusions This insurance does not cover: 1. liability assumed under a contract. This ex- clusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3. bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your ex- ecutive officers; 4. any obligation imposed by a workers com- pensation, oc.cupational disease, unemploy- ment compensation, or disability benefits law, or any similar law; 5. bodily injury intentionally caused or ag- gravated by you; 6. bodily injury occurring outside the United States of America, its territories or posses- sions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; " . . 7. damages arising out of the discharge of, coercion of, or discrimination against any employee in violation of law. D. We Will Defend We have the right and duty to defend, at our ex- pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition fo other amounts payable under this insurance, as part of any claim, proceeding or suit we defend; 1. reasonable expenses incurred at our re- quest; but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law un- til we offer the amount due under this in- surance; and 5. expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self- insurance is exhausted, the shares of all remain- ing insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in item 3.B. of the In- formation Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident-each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in anyone accident. Copyright 1982 National Council on Compensation Insurance. Page 3 of 6 . A disease is not bodily injury by accident 'Un- less it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease-policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily in- jury by disease, regardless of the number of employees who sustain bodily injury by dis- ease. The limit shown for "bodily injury by disease-each employee" is the most we will pay for all damages because of bodily injury by disease to anyone employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liabil- ity under this insurance. . . H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insur- ance. You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1 . You have complied with all the terms of this policy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in item 3.C. of the Information Page. 2. If you begin work in anyone of those states and are not insured or are not self-insured for such work, the policy will apply as though that state were listed in item 3.A. of the In- formation Page. 3. We will reimburse you for the benefits re- quired by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. B. Notice Tell us at once if you begin work in any state listed in item 3.C. of the Information Page. PART FOUR - YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1 . Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and addres- ses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal papers related to the injury, claim, pro- ceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE - PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this in- su rance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work Copyright 1982 National Council on Compensation Insurance. Page 4 of 6 . . classifications. These classifications were' assigned based on an estimate of the exposures you would have during the policy period. If your actual expoSures are not properly described by those classifications, we will assign proper classi- fications, rates and premium basis by endorse- ment to this policy. C. Remuneration Premium for each work classification is deter- mined by multiplying a rate times a premium basis. Remuneration is the most common pre- mium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers com- pensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers com- pensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the esti- mated, premium basis and the proper classifica- " . tions and rates that lawfully apply to the business and work covered by this policy. If the final pre- mium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise. 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this pol- icy was in force, and increased by our short rate cancelation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to compute premium. YOU will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, VOuchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. PART SIX - CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the in- surability of the workplaces and the premiums to be charged. We may give you reports on the con- ditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any per- son to provide for the health or safety of your em- ployees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or stand- ards. Insurance rate service organizations have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. , Copyright 1982 National Council on Compen'Sation Insurance. Page 5 of 6 . C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal repre- sentative as insured. D. Cancelation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at . your mailing address shown in item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflicts with a law that controls the cancelation of the insur- ance in this policy is changed by this state- ment to comply with that law. E. Sole Representative The insured first named in item 1 of the Informa- tion Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. In Witness Whereof, this Company has executed and attested these presents; but this policy shall not be valid unless countersigned by the duly authorized Agent of this Company at the agency hereinbefore mentioned. 9frH--~ Secretary err ;L. ~aA.C'lI_.i President Copyrighl1982 National Councii on Compensation Insurance. 'f Page 6 of 6 The ~ClOSURE .:: is for your records 1 I Date: 6-6-85 The enclosed contains a Mortgage Clause, or Loss Payable Clause in your favor. Owner: CLearwater Beach Seafood, Inc. Company and Policy No. . West AmerLcan Insurance Company WCW400-04-92 Thank you, Pam Zeyak &D~ I CLty of CLearwater TO P.o. Box 4748 CLearwater, FL. 33518 L INSURANCE AGENCY INC. 620 BYPASS DRIVE P. O. BOX 5025 P z CLEARWATER, FLORIDA 335~8-4985 Phone: (813) 797-4499 Tampa: 229-8208 <~' ... t , ATTACHED TO AND'ORMING PART OF EFFECTIVE DATE POLICY NUMBER .. Nt.W (86) 400-04-92 05/31/85 POLICY ATTACHING DATE POLICY EXPIRATION DATE ENDORSEMENT .; 0~/311'85 05/31/86 NAME OF COMPANY WE ST AMERICAN INSURANCE COMPANY INSURED'S NAME & ADDRESS ENDORSEMENT NUMBER AGENT NUMBER 09-00-1301 PRODUCER'S NAME & ADDRESS LEARWATER BEACH SEAFOOD 1He 37 CAUSEWAY BLVD 'LEAR WA1ER Fl AIM INSURANCE AGENCY INe POBOX 5025 3351 CLEARWATER Fl 33518 IN CONSIOERATION Q,F ADDITIONAL PREMIUM DUE NOW $2.914.00 IT IS AGREf:U THAl lME: POLICY IS AMENDED AS FOllOWS: CLASS 8031 (02) (SCH. NO. 010900) IS AMENDED TO READ: 5.70 30,000 $1,710.00 CLASS 9079 (05) (SCH. NO. 010900) IS AMENDED TO READ: 3.97 116,000 $4,605.00 RECEIVED JUN .J 0 198~ Cf l'y CLEBK ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. fltr' I J-f ~ () (] OS/29/85 STP 03 C ~)G /~ AUTHORIZED REPRESENTATIVE' '_ INSURED'S COpy 1/90/6 -/6