LETTER RE INSURANCE POLICY AND POLICY
..
TO:
FROM:
COPIES:
SUBJECT:
DATE:
1
C I T Y I) F C LEA R W ATE R
Interdeptrtment Correspondence Sheet
Elizabeth S. Haeseker, Assistant Ci~y,M:fi~
William C. Held, Jr., Harbormaster ()lI~'
Cyndie Goudeau, City Clerk
Insurance Policy - Marina Gift Shop
April 10, 1987
I have received and reviewed the insu~ance policy for the Marina Gift
Shop. This policy meets the requirements of. their lease agreement with
the city. Expiration date is March 14, 1988.
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,-. "8 - ::Jvu I M I...AKVLlI\.IA 11\.I:'UKAI'Jl.l:: l.UMI-'ANY
_'+-CONSOLlDATED AMERICAN INSURANCE COMPANY
. +- CATAWBA INSURANCE IOMPANY
, +- -
Policy No. SMP 474 72 23
POLICY PE RIOO':
DECLARATIONS
PREVIOUS COVERAGE:
SPECIAL MULTI-PERIL POLICY
FROM
TO
CO
3-14-87 3-14-88 05 SMP474 72 23 1059
MO OA. YR. MO. OA. YR.
lIem 1. Named Insured and Mailing Address (No. Slreet. Town. County. Slate. Zip)
. M. Alfred Gregory dba Marina Gift
· Souveni ers
.75 Causeway Blvd.. Rooms 5 & 9
. Clearwater, FL 33515
ANlJ FU~MS ANlJ fNOO~Si:MF.N rs. If ANY. ISSUElJ fa fORM A PA~ r IHI:~fOf.
COMPLETES THE BfLOW NUMBERLD POLICY.
SEIBFls
BRUCE GROUP
88
P.O. BOX 1. COLUMBIA. SOUTH CAROLINA 29202
SINCE leeg
POLICY NO.
AGENCY:
NO.
P
lIem 7, Mortgagee. Servicing Company
CITY Of CLEARWATER
APR 9 1987
ttARBORMASTERS of,f\CE.
lIem 2. Policy Period: 12:01 A.M., Standard Time at location of designated premises
lIem 3. The Named a Individual 0 Corporation 0 Other:
Insured is: 0 Partnership 0 Joint Venture
Item 4. Designated Premises lENT" ULowl Occupancy of Premises
NO.1 Same . Gift Shop
No.2
No.3
o Additional buildings or premises as designated on Supplemental Declarations attached.
lIem 5. In Consideration of the premium. Insurance is provided the named insured with respect to the designated premises shown in Item 4 above and with respect 10 those
coverages and kinds of property lor which a specific limit of liability is shown. subject to all of the terms of this policy including forms and endorsements made a part
hereof.
Loc. No. Bldg No
(.0 n<;ura".
A phcable
LIMITS
SECTION I - PROPERTY COVERAGE SECTION II - LIABILITY COVERAGE
Building(s),
% S
% $
% $
90 % $
90 % $
Peril s
Personal Property of the Insured
Personal Property of
Add'l. Cov. (Specify) Glass; Optional
DEDUCTIBLE:
each occurrence aggregate each occurrence
$ ~J 1$ P.
If no deducl1b1t~tated above. I~nf~ctible shall be
$100 $1.000
each occurrence a re ate each occurrence
SECTION III -- CRIME COVERAGE
SECTION IV - BOILER AND MACHINERY COVERAGE
Audit Period: Annual, Un. 0 Monthly 0 Semi.Annual
less Otherwise Stated: 0 Quarterly 0 Other
Item 6. Forms and Endorsements made part of this policy at time of issoe:
SMp.L1ABILlTY INSURANCE
Bodily Injury and Property Damage Liability
Combined Single Limit
LIMITS
$ 1,000,000
$
$
$
each occurrence
aggregate
each person
each accidenl
Premises Medical Payments
1,000
Bodily Injury Liability
Property Damage Liability
Premises Medical Payments
Add'l. Cov. (Specify) GL2011 Additional Insured
UND60l Employers Non Ownership Auto liability
L642l Premises Medical Payn~nts
L9260 Comprehensive General Liability
IF NO LIMIT SHOWN FOR SMP
LIABILITY INSURANCE REFER TO
COVERAGE PART OR ENDORSEMENT
As slaied In the endorsement. made part of this Policy. if indicated by (X]
A Section I -
P
P
L Section II -
I T
CO
A Section III -
B
L Section IV -
E
~
\
. and IS payable f 998.00
."...-..-. ~... T"""
Item 8. The Total ProvIsional PremIUm is'
s 998.00 ')
tlN.Eft' NO. AND IDITION DATI"l
}-
at inception. and S
i.
at each anOlversary
',. . ......-
o NOT APPLICABLE Unless indicated by an X in the box as "NOT APPLICABLE". the premium for installments subsequent to the initial installment
shall be subject to adjustment on the basis of the rates in effect at each anniversary date.
Agenit Clearwater, Fl
JDL 193-X-A (Spec.)
(Ed.5-79)
SlM/bb 3/20/87 Burke-Lehman In~ur'lnce
AUTHORIZED 910~ATUR!
DATE
AGENT'S COpy
mt ' GLASS COVERAGE ENDORSEMENT
~ I I
In consideration of the payment of premium and subject to all the terms of this endorsement: -
1. PROPERTY COVERED
This endorsement covers damage to the glass described in the schedule and to the lettering and ornamentation separately described therein, by breakage of the
glass or by chemicals accidently or maliciously applied.
The Company will pay for:
a. repairing or replacing frames immediately encasing and contiguous to such glass when necessary because of such damage:
b. installing temporary plates in or boarding up openings containing such glass when necessary because of unavoidable delay in repairing or replacing such
damaged glass:
c. removing or replacing any obstructions, other than window displays, when necessary in replacing such damaged glass, lettering or ornamentation.
2. SCHEDULE
MP 04 60
(Ed. 07 71)
Description of Glass, Lettering and
Number Length Width Ornamentation: Position In Building. Specific
Loc. Bldg. of In In The glass Is plain flat glass with all edges limit, Premium
No. No. Plates Inches Inches set In frames, unless otherwise stated herein. If any
1 1 53 Li near Feet I nc 1 .
,
.
Total Premium $
Incl.
3. EXCLUSION
Insurance provided by this Endorsement does not apply to loss caused by or due to fire.
4. CONDITIONS
limits of liability and Settlement Options: The limit of the Company's liability for damage shall not exceed the actual cash value of the property at time of loss.
nor what it would then cost to repair or replace the damaged property with other of the nearest obtainable kind and Quality, nor the applicable limit of insurance
stated in the schedule; provided. however, the limit of the Company's liability under each of paragraphs (la), (lb) and (lc) above, is $75 with respect to loss due
to anyone occurrence at anyone location separately occupied or designed for separate occupancy.
The Company may pay for the loss in money or may repair or replace the property. Any property so paid for or replaced shall become the property of the Company.
5. OTHER PROVISIONS APPLICABLE TO THIS ENDORSEMENT
The following conditions contained in the SMP Policy Conditions and Definitions Form are also applicable to this endorsement: Cancellation; Duties
of the Named Insured Alter a Loss; Inspection and Audit; liberalization Clause; Nuclear Exclusion; Other Insurance; Policy Period. Territory; Protective
Safeguards; Subrogation; Suit; Time of Inception; War Risk and Governmental Action Exclusion.
This Endorsement must be attached to Change Endorsement when issued after the Policy is written.
MP 04 60 (Ed. 07 77)
tm
I SEIBELS BRUCE INSURANCE GRO'iP
EMFtOYER'S NON.OWNERSHIP AUTOMOBILI LIABILITY
INSURANCE ENDORSEMENT
SCHEDULE
UNO 601
3/82
The limits 01 the Company's liability are on the basis and for the amounts designated below:
Limits of Liability
Bodily Injury Liability $ 100 t 000 each person.
$ 300.000 each occurrence.
Property Damage Liability $ 50.000 each occurrence. Advance Premium $ I Rt 1 .
In consideration 01 the payment 01 premium and subject to all the terms ollhis endorsement, the Company agrees with the named insured as lollows:
I. BODILY INJURY OR PROPERTY DAMAGE LIABILITY COVERAGE
The Company will pay on behalf 01 the insured all sums which the in-
sured shall become legally obligated to pay as damages because 01
bodily injury or
properly damage
to which this insurance applies. cause by an occurrence and arising oul of
the use, including loading and unloading, 01 any non-owned automobile in
the business 01 the named Insured by any person other than the named
insured, and the Company shall have Ihe right and duty to delend any suit
against the insured seeking damages on account of such bodily injury or
property damage, even il any 01 the allegations 01 the suit are groundless,
lalse or Iraudulent, and may make such investigation and selllement 01
any claim or suit as it deems expedient, bul the company shall not be
obligated 10 pay any claim or judgment or 10 delend any suit alter the
applicable limit of the Company's liability has been exhuasted by payment
of judgments or settlements.
Exclusions
This insurance does not apply:
(a) to liability assumed by the insured under any conlract or agreement;
(b) 10 any obligation for which the Insured or any carrier as his Insurer
may be held liable under any workmen's compensation. unemploy.
ment compensation or disability benelits law, or under any similar law;
(c) 10 bodily Injury to any employee 01 the insured arising out 01 and in
the course 01 his employment by the insured or to any obligation 01
the Insured to indemnily another because of damages arising out 01
such injury; but Ihis exclusion does not apply to any such injury arising
out 01 and in the course 01 domestic employment by the insured unless
benefits therelor are in whole or in part either payable or required to
be provided under any workmen's compensation law;
(d) to properly damage to
(I) properly owned or being transported by the insured, or
(2) property rented to or in the care, custody or control 01 the Insured,
or as to which the Insured is lor any purpose exercising physical
control, other than properly damage to a residence or private
garage by a private passenger automobile covered by this insurance;
(e) to bodily injury or properly damage arising out 01 the ownership,
maintenance, operation, use, loading or unloading ot any non-owned
automobile used in the conduct ot any partnership or joint venture 01
which the insured is a partner or member and which is not designated
in the policy as a named Insured;
(I) to bodily injury or properly damage arising out 01 the discharge. dis.
persal, release or escape 01 smoke. vapors. soot. lumes, acids, alkalis,
toxic chemicals, . liquids or gases, waste materials or other irritants,
contaminants or pollutanls into or upon land, the atmosphere or any
watercourse or body 01 water: but this exclusion does not apply il such
discharge, dispersal, release or escape is sudden and accidental;
(g) to bodily injury or properly damage due to war, whether or not de.
clared, civil war, insurrection, rebellion or revolution or to any act or
condition incident to any ollhe loregoing, with respect to expenses lor
lirst aid under Ihe Supplementary Payments provision.
II. PERSONS INSURED
Each of the lollowing is an insured under this insurance to the extent
set forlh below:
(a) the named insured;
(b) any partner or executive ollicer thereol, but only while the automobile
is being used in the business ollhe named insured;
(c) any other person or organization but only with respect to his or its
liability because 01 acts or omissions ot an insured under (a) or (b)
above.
None 01 the follOWing is an Insured:
(i) any person while engaged in the business of his employer with reo
spect to bodily injury to any lellow employee 01 such person injured
in Ihe course 01 his employment;
(ii) the owner 01 such automobile nor any agent or employee 01 such
owner;
(iii)an executive ollicer or partner ot the named insured with respect
to an automobile owned by him or by a member 01 his household;
(iv)any person while employed in or otherwise engaged in duties in
connection with an automobile business, other than an automobile
business operated by the named Insured.
III. LIMITS OF LIABILITY
Regardless 01 the number 01 (I) Insureds under this policy, (2) per-
sons or organizations who sustain bOdily injury or property damage, (3)
claims made or suits brought on account 01 bodily Injury or properly dam-
age, or (4) automobiles to which this policy applies, the Company's lia.
bility is limited as lollows:
The limit 01 bodily injury liability staled in the schedule as applicable to
"each person" is Ihe limit 01 the Company's liability lor all damages. in.
cluding damages lor care and loss 01 services, because of bodily Inlury
sustained by one person as the result ot anyone occurrence; but subject
10 the above prOVision respecting "each person", the total liability 01 the
company lor all damages, including damages lor care and loss of services,
because 01 bodily injury sustained by two or more persons as the result
01 anyone occurrence shall not exceed the limit 01 bodily injury liability
stated in the schedule as applicable to "each occurrence".
The total liability 01 the Company for all damages because 01 all property
damage sustained by one or more persons or organizations as the result
01 anyone occurrence shall not exceed the limit ot properly damage lia.
bility stated in the schedule as applicable to "each occurrence".
IV. POLICY TERRITORY
This insurance applies only to bodily injury or property damaee which
. occurs within the territory described in paragraph (I) or (2) ot the defini-
tion 01 policy territory.
V. ADDITIONAL DEFINITIONS
When used in relerence to lhis insurance (including endorsements
lorming a part olthe policy):
"automobile business" means the business or occupation 01 selling,
repairing, servicing, storing or parking automobiles;
"non-owned automobile" means an automobile not owned by, regis.
tered in the name 01. hired by (or used under contract in behalf 01),
or loaned to the named insured; provided thaI, il the named Insured
is a partnership, such automobile is nol owned by or registered in the
name 01 a partner thereol.
VI. OTHER PROVISIONS APPLICABLE TO THIS ENDORSEMENT
The General Conditions and Conditions and Definitions Applicable to
Section II are applicable to this endorsement.
VII. ADDITIONAL CONDITION
hcesslnsurance-Non-Owned Automobiles
This insurance shall be excess insurance over any other valid and col.
lectible insurance available to the insured.
......... ......"'"
Contains Copyrighted Malerial of the Insurance Services Office with its Permission
Copyright, Insurance Services Office, 1979
<m
I
I
INSURED'S CONSENT TO 0 EXCESS RATE [] FORMS RESTRICTIONS
Form 38-F
(Ed. 2.75)
M Alfred Gr:goryd~~:s~~~l~~ Gift
Souveni ers
Name and Address of Insurance Company
South Carolina Insuran
75 Causewa Blvd. Room 5 & 9
C1ea FL
p
Special Multi-Peril
Type of Policy
<;MP474 72 23
Policy No.
3- 14-87
Effective Date
3-14-88
Expiration Date
The insured hereby gives written consent, as required by Section 627.171 of Florida Statutes, for the insurance company to charge a rate in excess of thai
otherwise applicable for this risk.
Item
No.
RATES AND PREMIUMS
Amounts
or limits
Perils or
Coverages
Rates
Premiums
Consented Manual
Consented Manual
1.
$
$
$
$
Premium at
Manual Rates $
Premium at
Excess Rates $
Difference $
FORMS RESTRICTIONS-DESCRIBE AND ATTACH COPIES
$500 Windstorm deductible applies to Building, Contents and Signs
ADEQUA~ELY DESCRIBE RISK
G1f~ Shop
NAME AND ADDRESS OF INSURANCE AGENCY
Burke-Lehman Insurance
2173 N.E. Coachman Road
Clearwater, FL 33575
CERTIFICATION
Agent:
I have:explained this form to the insured and to the best
of my knowledge and belief he understands and ac.
cepts it.
Insured:
I understand and accept the Excess Rate and/or form
restrictions indicated hereon.
Signed
Signed
Date
Form 38.F (Ed. ~..'Sl
'"
Title
Date
Title
COVERAGE PARJ
I
L 6421
(Ed 1.7 J)
rREMISES MEDICAL PAYMENTS INSURANCE
F
)
For attachment to Policy No.
, to complete said policy,
SCHEDULE
The insurance afforded is only with respect to the following Coverage indicated by specific premium charge or charges. 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 Premiums Limits of Liability Coverale
X X Xl, 000 dollars 10 000 dollars E-Premlses Medical Payments
$ nc. each person each accident (a) Premises and operations
$ (b) Escalators
$ NA (c) Sports activities
$ Form numbers of endorsements _"ached at Issue
$ I n Total Advance Premium
I. COVERAGE E-PREMISES MEDICAL PAYMENTS
The company will pay to or for each person who sustains bOdily injury caused
by accident all reasonable medical expense incurred within one year from the
date of the accident on account of such bodily Injury, provided such bOdily In.
Jury arises out of (a) a condition in the Insured premises or (b) operations with
respect to which the named Insured is afforded coverage for bOdily Injury
liability under this policy.
Exclusions
This Insurance does not apply:
(a) to bodily injury
(l) arising out of the ownership, maintenance, operation, use, loading or un-
loading of
(j) any automobile or aircraft owned or operated by or rented or loaned
to any Insured, or
(ii) any other automobile or aircraft operated by any person In the course
of his employment by any insured;
but this exclusion does not apply to the parking of an automobile on the
Insured premises, if such automobile is not owned by or rented or loaned
to any insured;
(2) arising out of (j) the ownership, maintenance, operation, use, loading or
unloading of any mobile equipment while being used in any prearran~ed
or organized racing, speed or demolition contest or in any stunting
activity or in practice or preparation for any such contest or activity or
(ii) the operation or use of any snowmobile or trailer designed for use
therewith;
(3) arising out of the ownership, maintenance, operation, use, loading or
unloading of
(j) any watercraft owned or operated by or rented or loaned to any
insured, or
(il) any other watercraft operated by any person in the course of his
employment by any insured;
but this exclusion does not apply to watercraft while ashore on the
insured pr~mlses; or
(4) arising out of and in the course of the transportation of mobile equipment
by an automobile owned or operated by or rented or loaned to any insured;
(bl to bodily injury
(l) included within the completed operations hazard or the prOducts hazard;
(2) arising out of operations performed for the named Insured by independent
contractors other than (j) maintenance and repair of the insured premises
or (ii) structural alterations at such premises which do not involve chang-
ing the size of or moving buildings or other structures;
(3) resulting from the selling, serving or giving of any alcoholic beverage (j)
in violation of any statute, ordinance or regulation, (Ii) to a minor, (iii)
to a person under the influence of alcohol or (jv) which causes or con.
tributes to the intoxication of any person, if the named Insured Is a
person or or~anization engaged in the business of manufacturing, dis-
tributing, selling or serving alcoholic beverages or, If not so engaged, is
an owner or lessor of premises used for such purposes but only part (j)
of this exclusion (b) (3) applies when the named insured is such an owner
or lessor;
(4) due to war, whether or not declared, civil war, insurrection, rebellion or
revolution, or to any act or condition incident to any of the foregoing;
(e) to bodily injury .
(1) to the named Insured, any partner therein, any tenant or other person regu-
larly residing on the insured premises or any employee of any of the
.,-"'-:;:'':.~ ~,.
AUTHENTIC
'-r '";~. ,I"~ e
-".
......
-
foregoing if the bodily Injury arises out of and in the course of his employ.
ment therewith;
(2) to any other tenant if the bOdily Injury occurs on that part of the Insured
premises rented from the named Insured or to any employee of such a ten.
ant if the bodily injury occurs on the tenant's part of the Insured premises
and arises out of and in the course of his employment for the tenant;
(3) to any person while engaged in maintenance and repair of the Insured
premises or alteration, demolition or new construction at such premises;
(4) to any person If any benefits for such bodily Injury are payable or required
to be provided under any workmen's compensation, unemployment compen-
sation or disability benefits law, or under any similar law;
(5) to any person practicing, Instructing or participating In any physical train.
ing, sport, athletic activity or contest unless a premium charge is entered
for sport activities in the policy with respect to Premises Medical Payments
Coverage;
Cd) to any medical expense for services by the named Insured, any employee thereof
or any person or organization under contract to the named insured to provide
such services.
II. LIMITS OF LIABILITY
The limit of liability for .Premises Medical Payments Coverage stated in the
schedule as arplicable to "each person" is the limit of the company's liability
for all medica upense for bodily Injury to anyone person as the result of any
one accident; but subject to the above provision respecting "each person", the
total liability of the company under Premises Medical Payments Covera,e for all
medical upense for bodily Injury to two or more persons as the result 0 anyone
accident shall not exceed the limit of liability stated in the schedule as applicable
to "each accident".
When more than one medical payments coverage afforded by this policy applies
to the loss, the company shall not be liable for more than the amount of the highest
applicable limit of liability.
III. ADDITIONAL DEFINITIONS
When used in reference to this Insurance (includina endorsements forming a
part of the policy!:
"Insured premises" means all premises owned by or rented to the named Insured
with respect to which the named Insured is afforded coverage for bodily injury
liability under this policy, and includes the ways immediately adjoining on land;
"medical expense" means expenses for necessary medical, surgical, Hay and
dental services, Including prosthetic devices, and necessary ambulance, hospital,
professional nursing and funeral services,
IV. POLICY PERIOD; TERRITORY
This insurance applies only to accidents which occur during the policy period
within the United States of America, its territories or possessions, or Canada.
V. ADDITIONAL CONDITION
MediCI' Reports; Proof and Plyment of Claim
As soon as practicable the injured person or someone on his behalf shall give
to the company written proof of claim, IJ1IIder oath if required, and shall, after
each request from the company, execute authorization to enable the company to
obtain medical reports and copies of records. The injured person shall submit
to physical examination by physicians selected by the company when and as often
as the company may reasonably require. The company may pay the injured person
or any person or organization rendering the services and the payment shall reduce
the amount payable hereunder for such injury. Payment hereunder shall not con.
stitute an admission of liability of any person or, except hereunder, of the company.
,~
/ticAGE PAllT
I PERSONAL INJURY LIABILITY INSURANCE .\ ( ,I
L 9287
(Ed. 1-73)
For attachment to Policy No.
, to complete said policy.
SCHEDULE
Limits of Liability Coverale '.
30n thousand dollars aggregate P-Personallnjury Liability
0 % Insured's Participation
The insurance afforded is only with respect to personal injury arising out of an offense included within such of the following groups of offenses
as are indicated by specifiC premium charge or charges.
Advance Premiums Groups of Offenses
$ 1nc1 A. False Arrest, Detention or Imprisonment, or Malicious Prosecution
$ Tnc-l B. Libel, Slander, Defamation or Violation of Right 01 Privacy
$ 1nc1 C. Wronglul Entry or Eviction or Other Invasion 01 Right of Private Occupancy
Form numbers of endorsements attached at Issue
$
$ 1nc1 Total Advance Premium I
$ Minimum Premium 1
I. COVERAGE P-PERSONAL INJURY 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 (herein called
"personal Injury") sustained by any person or organization and arising out of one
or more of the following offenses committed in the conduct of the named Insured's
business:
Group A-false arrest, detention or Imprisonment, or malicious prosecution;
Group B-the publication or utterance of a libel or slander or of other delama.
tory or disparaging material, or a publication or utterance In violation
of an individual's right 01 privacy; except publications or utterances
in the course of or related to advertising, broadcasting or telecasting
activities conducted by or on behalf 01 the named Insured;
Group C-wronglul entry or eviction, or other invasion 01 the right 01 private
occupancy;
il such offense is committed during the policy period within the United States of
America, its territories or possessions, or Canada, and the company shall have the
right and duty to defend any suit against the Insured seeking damages on account
01 such personal Injury even il any 01 the allegations 01 the suit are groundless,
lalseor fraudulent, and may make such Investigation and settlement of any claim
or suit as it deems expedient, but the company shall not be obligated to pay any
claim or judgment or to defend any suit alter the applicable limit 01 the company's
liability has been exhausted by payment of Judgments or settlements.
Exclusions
This insurance does not apply:
(a) to liability assumed by the insured under any contract or agreement;
(b) to personal Injury arising out of the wilful violation of a penal statute or
ordinance committed by or with the knowledge or consent of any Insured;
(c) to personal Injury sustained by any person as a result of an offense directly
or Indirectly related to the employment of such person by the named Insured;
(d) to personal Injury arising out 01 any publication or utterance described in
Group e, if the first Injurious publication or utterance 01 the same or similar
material by or on behalf of the named Insured was made prior to the effective
date 01 thiS insurance; .
,0""",
OA'UTHENTicO
." I",,, .,.."'.-
.
(e) to personal injury arising out 01 a publication or utterance described in Group e
concerning any organization or business enterprise. or its products or services.
made by or at the direction of any insured with knowledge 01 the falsity thereof.
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;
(b) II 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 indi-
vidual, partnership or joint venture, the organization so designated and any
executive officer, director or stockholder thereof while acting within the
scope 01 his duties es such.
This insurance does not apply to personal injury arising out of the conduct
of any partnership or joint venture 01 which the Insured Is a partner or member
and which Is not designated In this policy as a named Insured.
III. LIMITS OF LIABILITY; INSURED'S PARTICIPATION
Regardless 01 the number of (1) Insureds under this policy, (2) persons or
organizations who sustain personal Injury, or (3) claims made or suits brought
on account 01 personal Injury, the total limit of the comp'any's liability under
this coverage lor all damages shall not exceed the limit 01 personal Injury
liability stated in the schedule as "aggregate".
If a participation percentage Is stated in the schedule lor the insured, the
company shall not be liable for a greater proportion of any loss than the difference
between such percentage and one hundred percent and the balance 01 the loss
shall be borne by the Insured; provided, the company may pay the insured's
portion of a loss to effect settlement of the loss, and, upon notification 01 the
action taken, the named Insured shall pr.omptly reimburse the company therefor.
IV. ADDITIONAL DEFINITION
When used in relerence to this insurance:
"damages" means only those damages which are payable because of personal
Injury arising out 01 an offense to which this insurance applies.
AGENT'S COpy
~
.~~ j'<D). .
I
I
GL 20 11
(Ed. 07 66)
This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.
(The following information is required only when this endorsement is issued subsequent to prepantion of policy.)
Endorsement effective Policy No. Endorsement No.
Named Insured
Additional Premium $
Countersigned by
(Authorized Representative)
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS. LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
ADDITIONAL INSURED
(Premises leased to the Named Insured)
It is agreed that the "Persons Insured" provision is amended to include as an Insured the person or organization designated below, but only with respect
to liability 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
lollowing 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
75 Causeway Blvd.
Rooms 5 & 9
Clearwater, FL 33515
City of Clearwater
P.O. Box 4748
Clearwater, FL 33518
Incl.
Incl.
GL 20 11 07 66