SPECIAL MUTI PERIL POLICY # 30 10 81
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SPECIAL MULTI-PERIL. POLICY
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-RECEIVED
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MAR 16 1981
INSURANCE COMPANY OF NEW YORK
SYRACUSE NEW YORK 13221
';ITY CLERK.
00 NEW
o RENEWAL Of
Policy No. MP 3 :,:: ,:::j ?:; DECLARA TIONS
(No, Street, Town, county,)
Item 1. Named Insured and Mailing Address State and Zip Code
M. Alfred Cn~F~ory d/h/..
MitrJ.nn (:lft' ~;ouvi'nl"r:;
75 Causeway Boulevard
Clearwater, Florida 33515
Item 2. Policy Period: n01 A,M" Standard Time at location of Designated Premises
From: 3/14/81 To: 3/14/84
Representative
.Tack Ransom Agency
09-168
Clearwater, Florida 33515
Audit Period: Annual, unless otherwise stated below:
In Consideration of the premium Insurance is provided the named insured with respect to the designated premises shown in Item 4 below and with respect to those
coverages and kinds of property for 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:
. r::lIND1- DPARTNER- DCORPDRA'DJOINT 0
Item 3. The Named Insured IS LAJ VIDUAL SHIP TION VENTURE OTHER
Item 4. Designated Premises (ENTER "SAME" IF SAME LOCATION AS ITEM 1 ABOVE)
1. Same (rooms 5 & 9 )
2.
3.
Occupancy of Premises
Fire Resistive Gift Shop-Ret~il
Pinellas CGunty
Item 5.
D Multiple buildings or premises as designated on Supplemental Declarations attached,
Insurance is provided with respect to the designated premises and with respect to those coverages and kinds of property for which a specific limit of
liability is shown, subject to all the terms of this policy including forms and endorsements made a part hereof.
SJ~~NCE LI M I T 0 F LI A Bill T Y
AP~LI~ Loc.
CABLE No,
COVERAGE
Bldg. Loc,
0, No,
Bldg, Loc.
No. No,
Bldg, oc.
No. No.
Bldg.
No.
SECTION
II
LIABILITY
COVERAGE
..~.I:l_i~di~~(s)________________ $
,f~~onaIP_rop~rtL of th~_lnsur_e~____._,__BO..%._, ~_--.32.illl~_
~.~o..n~,Yr_op_c!lyoJQlt:t:rs_____________ __ J,_____
Add!. Gov_ (Specify)
Loss of Earnin s 25% 15 000
Deductible: $ Form Attached each occurrence, $ aggregate each occurrence~
If no deductible staled above, the deductible shall be $100 each occurrence, $1,000 aggregate each occurrence.
Bodily Injury and Property Damage ~
Liabili!il.9.rm MP.200 Combined Single Limit $ each occurrence $
Premi~es Medical Payments $ each person ___ $
Bodily Injury Liability
Property Damage Liability
Pre~s~_~!:dical Payments
Add!. Cov, (Specify)
Storekeepers
$ ___ 1-_
$------ $
$ $
$
$
$
SECTION
I
PROPERTY
COVERAGE
ag,®ate
each accident
bU REFER TO COVERAGE PART
SECT. III
SECT. IV
Liability see
CRIME COVERAGE 0
BOILER AND MACHINERY COVERAGE D
Form L4087s(1/73)
As stated in the endorsement, made part of this Policy, if indicated by [8].
Item 6. Forms and Endorsements made part of this policy at time of issue (Insert No, and Ed. Date):
a. Section I - Forms and Endorsements only:
MP0127(12/79),MP0090(7/77),MP9950(7/77),MP0336(7/78),
~88~~f~~~~~,~1593(7/77),MP0466(12/79),MP0460(7/77),
c. SectIOn III - Forms and Endorsements only: d, Section IV. Forms and Endorsements only:
JACK RANSOM AGEN
Item 7. Mortgagee: (Name and Address) C Y
b. Section II. Forms and Endorsements only:
MP0090(7/77),MP9950(7/77),L9141(7/66)
L4087s0/73)
Item 8.
TOTAL
ADVANCE PREMIUM
P. O. BOX 3344 Payable at Inception
CLEARWATER. FL. 33615 Pa abl at Each Anniversar
Unless indicated by an X in the box below as "NOT APPLICABLE", the pre mium for installments subsequen the initial installment shall be SUbject to
adjustment on the basis of the rates in effect at each anniversary date, [] NOT APPLICABLE.
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None
~ 446-1365
71-76 CAUSEWAY BLVD.
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Authorized Representative
Form No. M 7150 8177
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GLASS COVERAGE ENDORSEMENT ..
MP 04 60
(Ed. 07 77)
In consideration of the payment of premium and subject to all the terms of this endorsement:
1. PROPERTY COVERED
Thi~; endorsement covers d~ma&e 10 I he glass described in the schedule and to the lottering and ornamentation separately described ther&in, bv brellkllgll of tho
l(lassof by cherTllcals accidelllly or IlIaliclollsly applied,
Hie Company will pay for
a, repairing or replacing frames immediately encasing and contiguous to such glass when necessary because of such damage;
b, IrIstalling 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.
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2. SCHEDULE
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. Premim
No. No. Plates Inches Inches set in frames, unless otherwise stated herein. it any
1 1 8 78 36 Plain Plate Fronts
1 1 7 78 38 " II Fronts
1 1 9 78 40 " II Fronts
1 1 5 34 36 II " Fronts
1 1 2 60 26 II II Doors
3. WtMON 3/11/81
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 $75 with respect to loss dUe
to anyone occurrence at anyone location separately occupied or designed for separate occupancy,
The Company may pay for the los$ In mon~y or may repair or replace the property, Any property so paid for or replaced shall become the properly 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 After 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.
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This Endorsement must be attached to Change Endorsement when issued after the Policy i~ written.
MP 04 60 (Ed, 07 7l)
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~IORFKrn)rR'S It\)SUR^NCT (CNEr~^c:.E' l'Ai
SCHEDULE
COVERAGES
S. Storekeeper's liability
1. Storekeeper's Medical Payments
Additional Charges
$ 300 000
$ 250.
$
For attachment to Policy No. MP 3 73 33 23
LIMITS OF LIABILITY
, to complete said policy.
PRWIUIiS
each occurrence
each person
each accident
$
$
1
$
_L___
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____________________________.-.!.~al Premium.
,If Policy Period more than one year: Gross Premium $ Discount $ Net Premium
!rcmium_ is payabl~ On effective date of Policy $ 1st AnnI~ersary $ 2nd Annhle~ary
STOREKEEPER'S HAZARDS
PREMISES-PURPOSES OF USE~ODE NO.
Retail Stores NOe
AREA
RA YES
PREMIUMS
59991
a) 1640
incl
rn "Reneral lessee" or
o ''tenant''
Interest of named Insured in insured premises D nowner",
Part occupied by named insured 1640 s . ft.
KS/jf 3/11/81
I. COVERAGE $-STOREKEEPER'S LIABILITY
The company will pay on ,behalf of the Insured all sums which the Insured shall
become legally obligated to pay as damages because of bod II, InJurJ or propertJ
dama!e to which this Insurance applies, caused by an occurrence and arising out
of the ownership, maintenance or use of the Insured preml$lS and all operations
necessary or incidental thereto, and the company shall have the right and duty to
defend any suit against the Insured seeking damages on account of such bodily
inJurJ or propertJ damage, even if any of the allegations of the suit are groundless,
false or fraudulent, and may make such investigation and settlement of any claim
_ or suit asH deems expedient, but the cor~Danyshall not-be obligated to pay any
claim or judgment or to defend any suit after the applicable limit of the company's
liability has been exhausted by payment of judgments or settlements.
txcluslonl
This coverage does not apply:
(a) to liability assumed by the Insured under any contract or agreement except an
Incidental contract; but this exclusion does not apply to a warranty of fitness or
quality of the named Insured's products or a warranty that work performed by or on
behalf of the named insured will be done in a workmanlike manner;
(bJ to bodil, inJurJ or propertJ dam'le arising out of the ownership, maintenance,
operation, use, loading or unloading of
(1) any automobile or aircraft owned or operated by or rented or loaned to any
lasund, or
(2) 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 Insured
premises, If such automobile is not owned by or rented or loaned to any Insured;
(e) to bodily lajurJ or propertJ damare arising out of (1) the ownership, maintenance,
operation, use, loading or unloading of any mobile equlplDlnt while being used in
any prearranged or organized racin~, speed or demolition contest or in any stunting
activity or In practice or preparation for any such contest or activity or (2) the
operation or use of any snowmobile or trailer designed for use therewith;
(d) to bodily Injury or property darnar' arising out of and in the course 01 the
transportation of mobU. Iqlllpment by an automobile owned or operated by or
rented or loaned to any Insured;
(e) to bodily InjlrJ or preptrty d2lll111 arising out of the ownership, maintenance,
operation, use, loading or unloading of
(1) any watercraft owned or operated by or rented or loaned to any Insured, or
(2) any other watercraft operated by any person In the course of his employment
by any luUlllll;
Forwl No. LAOI7S Ed. 10-1.a6 ..". 1.1.73
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but this exclusion does not apply to watercraft while ashore on the il:salrd
premises;
(f) to bodily injurJ or propertJ dlllll(l arising out of the discharge, dispersal, r~
lease or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
liquids or gases, waste materials or other irritants, contaminants or pollutllllts into
or upon land, the atmosphere or any water course or body of water; but this exclu-
sion does not apply if such discharge, dispersal, release or escape is .sudden and
accidental; ,
(g) to bodily injurJ or prop.rtJ dama" due' to war,whether or, not declared, civil
war, insurrection,rebellion or rovolutlon or to any actor condi'ion, incident to allY
of the foregoing. with respect to
(1) liability assumed by the Insured under an incidental contract, or
(2) expenses for first aid under the Supplementary Payments provision;
(h) to bodily Injury or propertJ damare for which the Insured or his indemnitee
may be held liable ,.
(1) as a person or organization enga~ed in the business of manufacturing; dis-
tributing, selling or serving alcoholic beverages, or
(2) if not so engaged, as an owner or lessor of premises used for such purposes,
if such liability is imposed
(i) by, or because of the violation of, any statute, ordinance or regulation per-
taining to the sale, gift, distribution or use of allY alccholic beverage, or
(ii) 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 ClllSlS or c0n-
tributes to the intoxication of any person;
but part (ij) of this exclusion does not apply with respect to liability ofth. hlSlrell
or his indemnitee as an owner or lessor described in (2) .bove;
(i) to any obligation for which the huurerj or any carrier as his insurer rr.ay be
held liable under any workmen's comp'ensation, unemployment comptllllticl'l or
disability benefits law, or under any similar taw; .
(j) to bodily InjurJ to .ny employee of the Insured arising out of and in the COlltst
of his employment by the Insured or to any obligation of the iMIl," to indemnJfy
another because of damages arising out of such Injury; but this exclusion does
not apply to liability assumed by the iasured under an iltldental tlIatra1:t;
(k) to propertJ 1I11llap to
(1) property owned or occupied by or rented to the IIsn,
(2) property used by the Insmd, or
(3) r.ropertJ in the care, custody or control of the IaImI or IS, to which tile
uured is for any purpose exercisllll physical control; ,".
but parts (2) and (3) of this exclusion do not apply with respect to 1i~i1ity imder
(over)
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