MEMO OF SPECIAL PERIL POLICY # 30 10 81
(Q The Ohip Casuak:y IF1surancr Co~p~ny
136 North Third Street, Hamilton, Ohio 45025
MEMORANDUM OF SPECIAL MULTI-PERil POliCY
Item
DECLARATIONS POLICY NUMBER SMP 30 10 81
IN CONSIDERATION OF THE PREMIUM INSURANCE IS PROVIDED THE NAMED INSURED WITH RESPECT TO THE DESIGNAT 0 PR ISES SHOWN IN ITEM 3 BE-
LOW 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:
Named
Insured
RENEWAL OF NUMBER
2.
3.
and Mailing Address
(No., Street,
Town or City,
County, State,
Zip Code)
Policy Period: From:
Designated Premises (Enter "Same" if same location as
Loc. No. 1. S_ C "'~
Loc. No.2. .,:..
Loc. No.3. ." .
INSURANCE IS PROVIDED WITH RESRitV~Tlt"T~'L l.ltEb"PREMISts ~D'WlRi RESIlE'lT TO THOSE COV~~~ S ~ ~~D .~PROPERTY FOR WHICH
A SPECIFIC LIMIT OF LIABILITY IS SHOWN, SUBJECT.TO ALL of:'fjJ~ TERMS OF 'fftlS P.oLlCY 1116bOOlNG F '.' N~M(NrS MADE A PART HEREOF.
Coinsurance UMlT ore Am. '.
Percentage
Applicable
JL AUncl Gn&or7
....: .JWiITlI4. ClIft SOUV81l1:1fi1l
75Cauewq B1ft.
Clean.tier, J'.L '3515
j(] Individual
o Partnership
o Corporation
o Joint Venture
1.
fEa 24 \91~
To:
t.-1' c. 1..l!.p.\C. 12,01 A.M. STANOARD TIME AT
. 1 . LOCATION OF DESIGNATED PREMISES
Occupancy of Premises
Gift ..~~
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4.
SECTION
COVERAGE
Lac.
No.
Bldg.
No.
I
PROPERTY
COVERAGE
Building{sl
Personal Property of the Insured
Personal Property of Others
Add'l. Coverage (Specify)
Jio.. .~ .......~
$
$
$
2_
"~5,~
Deductible: $ See lIP 5& each occurren~"':~i:__ ...)~ aggregate each occurrence.
If no deductible stated above, the deductible sh~ I?e cjo ~ 011\ ~~4'ence, $1,000 aggregate each occurrence.
LIMIT OF LIABILITY
each occurrence $
each occurrence $
each occurrence $
each person $
aggregate
aggregate
aggregate
each accident
((
LIABILITY
COVERAGE
COVERAGE \-'
Bodily Injury Liability
Property Damage Liability
Bodily Injury and Property Dama e~1abilj(Ho
Premises Medical Payments
Add'l. Cov. (Specify) '','':). (/ _,G' .{'~,'
,,(\ \ .'.' \.. (A..
~"ji~li_
---::~\" (5 .
AUditper-iet. : n~l, ~~"S.o ' wise stated: 0 Monthly
0';.' .0:' .6> .;","';.
o Quarterly
o Semi-Annual
o (Other)
5.
b.
6. Mortgagee:
(Name and Address)
7. The Total Advance Premium IS $ and is payable $ at inception, and $
UNLESS INDICATED BY AN X IN BELOW AS "NOT APPLlCABL , HE PREMIUM FOR INSTALLME
SHALL BE SUBJECT TO ADJUSTMENT ON THE BASIS OF THE RATES IN EFFECT AT EACH ANNIVERSARY DATE.
Agent: ack Ag8JlQ' Countersignature Date:
Address: QJ.4NlZ'Water, J'.L
09~'lO C6ilR.t~;;;:lJ by
Date Issued 2-9-'18 By NQL
at each anniversary.
UBSEQUENT TO THE INITIAL INSTALLMENT
NOT APPLICABLE.
t 1978
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Authorized Representative
Form No. MP 1000 (8.77)
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ENDORSEMENT
AMENDMENT OF LIMITS OF LIABILITY PROVISION
SECTION 11- BODILY INJURY LIABILITY AND PROPERTY DAMAGE LIABILITY
If separate limits of liability are shown in the Declarations for (1) Bodily Injury Liability and, (2) Property Damage Liability, the following endorsement applies
to Section II of t.his pOlicy:
Provision III, L1MtTS OF LIABILITY, is deleted and replaced by the following,
Regardless of the number of (1) insureds under this policy, (2) persons or organizations who sustain bodily injury or property damage, or (3) claims made
or suits brought on aCetlun.t rifbodily injUfY or property damage, the Company's liability is limited as follows:
Bodily Injury Liability - The total liability of the Company for all damages, including damages fOr care and loss of services, because of bodily injury sus-
tained by one or more persons as the result of anyone occurrence shall not exceed the limit of bodily injury liability stated in the Declarations as applicable
to "each occurrence".
Subject to the above provisions respecting "each occurrence" the total liability of the Company for all damages because of (1) all bodily injury included
within the completed operations hazard and (2) all bodily injury included within the products hazard shall not exceed the limits of bodily injury liability stated
in the Declarations as "aggregate".
Property Damage Liability - The total liability of the Company for all damages because of all property damage sustained by one or more persons or organi-
zations as the result of any one. occurrence shall not exceed the limit of property damage liability stated in the Declarations as applicable to "each occurrence".
Subject to the above prOVision respecting "each occurrence", the total liability of the Company for all damages because of all property damage to which
this coverage applies and described in any of the numbered subparagraphs below shall. not exceed the limit of property :damage liability stated in the
Declarations as "aggregate". J . ..l .
(1) all property damage arising out of premises or operations rated ana remuneration basis or contractors equipment rated on a receipts basis,
including property damage for which liability is assumed under any incidental contract relating to such premises or operations, but excluding property
damage included in subparagraph (2) below;
(2) all property damage arising out of and occurring in the course of operations performed for the named insured by independent contractors and general
supervision thereof by the named insured, including any such property damage for which liability is assumed under any incidental contract relating to
such operations, but this subparagraph (2) does not include property damage arising out of maintenance or repairs at premises owned by or rented to
the named insured or structural alterations at such premises which do not involve changing the size of or moving buildings or other structures;
(3) all property damage included within the products hazard and all property damage included within the completed operations hazard.
Such aggregate limit shall apply separately to the property damage described in subparagraphs (1), (2) and (3) above, and under subparagraphs (1) and (2),
separately with respect to each project away from premises owned by or rented to the named insured.
Bodily Injury and Property Damage Liability - For the purpose of determining the limit of the Company's liability, all bodily injury and property damage
arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence.
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J LOSS OF EARNINGS ENDORSEMENT I
Form MP-143
(Ed. ]-77)
LOCATION OF PREMISES
SECTION I FORMS AND
ENDORSEMENTS
APPLICABLE
LIMIT OF LIABILITY
Loc. No.
Bldg. No.
EACH 30 DAYS
AGGREGATE
1
1
lIP 100 A
2"
15,000
1. Subject to all the provisions applicable to Section I of this policy, except the Coinsurance Clause and the Deductible Clause, this policy is extended to
insure against loss of earnings resulting directly from necessary interruption of business caused by the perils insured against damaging or destroying, during the
policy period, real or personal property (except finished stock) at the premises described in this endorsement, subject to the limit of liability specified above for the
premises at which the damage or destruction occurs. For the purposes of this insurance, "perils insured against" shall mean the perils, as defined and limited in
the forms and endorsements listed above, for each premises specified and also subject to the provisions of this endorsement.
2. The Company shall be liable for:
a. the actual loss sustained by the insured resulting directly from necessary interruption of business, but not exceeding the reduction in earnings less
charges and expenses which do not necessarily continue during the interruption of business, for only such length of time as would be required with the
exercise of due diligence and dispatch to rebuild, repair or replace such part of the property herein described as has been damaged or destroyed,
commencing with the date of such damage or destruction and not limited by the date of expiration of this policy. Due consideration shall be given to the
continuation of normal charges and expenses, including payroll expense, to the extent necessary to resume operations of the insured with the same
quality of service which existed immediately preceding the loss; and
b. the actual loss sustained by the insured, resulting directly from an interruption of business as covered hereunder, during the length of time, not
exceeding two consecutive weeks, when, as a direct result of damage to or destruction of property adjacent to the premises herein described by the
peril(s) insured against, access to such described premises is specifically prohibited by order of civil authority; and
c. loss resulting from damage to or destruction of media for, or programming records pertaining to, electronic data processing or electronically controlled
equipment, including data thereon, by the perils insured against. The length of time for which this Company shall be liable hereunder shall not
exceed-
(1) 30 consecutive calendar days; or
(2) the length of time that would be required to rebuild, repair or replace such other property herein described as has been damaged or destroyed;
whichever is the greater length of time.
d. such expenses as are necessarily incurred for the purpose of reducing loss under this endorsement (except expense incurred to extinguish a fire), and
such expenses, in excess of normal, as would necessarily be incurred in replacing any finished stock used by the insured to reduce loss but in no event
shall the aggregate of such expenses exceed the amount by which the loss under this endorsement is thereby reduced.
3. The Company shall not be liable for more than the amount set forth in the limits of liability for each premises above as applicable to "Each 30 Days" for
loss in any 30 consecutive calendar days, nor in any event for more than the amount set forth above as an "Aggregate" limit of liability.
4. Resumption of Operations: It is a condition of this insurance that if the insured could reduce the loss resulting from the interruption of business:
a. by complete or partial resumption of operation of the property herein described, whether damaged or not, or
b. by making use of merchandise or other property at the locations described herein or elsewhere, or
c. by making use of stock (raw, in process or finished) at the locations described herein or elsewhere,
such reduction shall be taken into account in arriving at the amount of loss hereunder.
5. Definitions:
a. For the purposes of this insurance, "earnings" are defined as net profit plus payroll expense, taxes, interest, rents and all other operating expenses
earned by the business.
b. The term "directly," as applied to loss under this endorsement, means loss, as limited and conditioned in this policy, resulting from direct loss to
described property from the perils insured against;
c. "Normal": the condition that would have existed had no loss occurred.
d. "Raw stock": material in the state in which the insured receives it for conversion by the insured into finished stock.
e. "Stock in process": raw stock which has undergone any aging, seasoning, mechanical or other process of manufacture at the locations herein
described but which has not become finished stock.
f. "Finished stock": stock manufactured by the insured which in the ordinary course of the insured's business is ready for packing, shipment or sale.
g. "Merchandise": goods kept for sale by the insured which are not the product of manufacturing operations conducted by the insured.
Form MP-143 (Ed. ]-77)
Page 1 of 2
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6. Alterations and New Buildings: Perm Is ion granted to make alterations in or to construct additions tIny building described herein and. to construct new
buildings on the described premises. This en rsement is extended to cover, subject to all its provisions, lo! resulting from damage to or destruction of such
alterations, additions or new buildings while in course of construction and when completed or occupied, provided that, in the event of damage to or destruction of
such property (including building materials, supplies, machinery or equipment incident to such construction or occupancy while on the described premises or
within 100 feet thereof) so as to delay commencement of business operations of the insured, the length of time for which the Company shall be liable shall be'
determined as otherwise provided herein but such determined length of time shall be applied and the loss hereunder calculated from the date that business ..
operations would have begun had no damage or destruction occurred. ..
7. Additional Exctusions and li mitations:
a. The Company shall not be liable for any increase of loss which may be occasioned by:
(1) enforcement of any local or state ordinance or law regulating construction, repair or demolition of buildings or structures,
(2) interference at the described premises by strikers or other persons with rebuilding, repairing or replacing the property or with the resumption or
continuation of business,
(3) the suspension, lapse or cancellation of any lease or license, contract or order unless such suspension, lapse or cancellation results directly from
the interruption of business, and then the Company shall be liable for only such loss as affects the insured's earnings during, and limited to, the
period of indemnity covered under this policy.
b. The Company shall not be liable for any other consequential or remote loss.
c. The Company shall not be liable for loss resulting from:
(1) damage to or destruction of finished stock, nor for the time required to reproduce said finished stock,
(2) theft of any property which at the time of loss is not an integral part of a building or structure (except direct loss by pillage and looting occurring
during and at the immediate place of a riot or civil commotion), unless loss by a peril not excluded in this policy ensues from theft or attempted
theft, and then this Company shall be liable for only such ensuing loss.
" 8. Requirements In Case Loss Occurs: The insured shall give immediate written 'notice to the Company of any'bU5iness interruption loss as covered by this
policy and protect the property from further damage that might result in extension of the period of interruption; and within 60 days following the date of damage to
or destruction of the real or personal property described, unless such time is extended in writing by the Company, the insured shall render to the Company a proof of
loss, signed and sworn to by the insured, stating the knowledge and belief of the insured as to the following:
a. the time and origin of the property damage or destruction causing the interruption of business,
b. the interest of the insured and of all others in the business,
c. all other contracts of insurance, whether valid or not, covering in any manner the loss insured against by this policy,
d. any changes in the title, nature, location, encumbrance or possession of said business since the issuing of this policy, and
e. by whom and for what purpose any building herein described and the several parts thereof were occupied at the time of damage or destruction;
and shall furnish a copy of all the descriptions and schedules in all policies, and the actual amount of business interruption value and loss claimed, accompanied
by detailed exhibits of all values, costs and estimates upon which such amounts are based.
The insured, as often as may be reasonably required, shall exhibit to any person designated by the Company all that remains of any property herein described, ..
and submit to examinations under oath by any person named by the Company, and subscribe the same; and, as often as may be reasonably required, shall produce ..
for examination all books of account, bills, invoices and other vouchers, or certified copies thereof if originals be lost, at such reasonable time and place as may be
designated by the Company or its representative, and shall permit extracts and copies thereof to be made.
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This Endorsement must be attached to Change Endorsement MP-20 when issued after the Policy is written.
Form MP-143 (Ed. ]-77)
Page 2 of 2
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GLASS COVERAGE ENDORSEMENT I
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Form MP-179
(Ed. 7-77)
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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
Description of Glass. Lettering and
Number Length Width Ornamentation; Position in Building. Specific
Lac. 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 1 78 36 heat 4.28
7 78 ,. "at. 31.64-
2 60 26 IDe. 4.56
2 71 40 :JzltU. 9.52
7 '18 .'M) .... 33.32
4 ?8 JI ....... 17.12
e 2 ?8 36 .... 8.56
1 '18 36 ..... 4.28
5 34- . ....
hfta.
105.03
KG x .
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 Ii mit of insurance
stated in the schedule; provided, however, the limit of the Company's liability under each of paragraphs (Ia), (Ib) and (Ic) 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.
Total Premium $ ".00
5. OTHER PROVISIONS APPLICABLE TO THIS ENDORSEMENT
The following conditions contained in the form Mp.4 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 MP-2D when issued after the Policy is written.
Form MP-179 (Ed. 7-77)
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,,~. TENTAT1YE RATE ENDORSEMENT ,. Fprm MP-192
SW.! - I '--~'. I . . . (Ed.l-H)
The rate used in the devejopment~t the premium for this policy is tentative.lt IS a condition of tf,rspolicy that NhenJherate is promuig3ted. the premium
shall be adjusted effectIve from the commencement date of this policy.
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'15 c_.,. Blft.
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Form MP-192 (Ed, ],77)
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SIOREKEEPER'S INSURANCtCOVERAGE PAT
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SCHEDULE
S. Storekeeper's liability
T. Storekeeper's Medical Payments
For attachment to Pol icy No.
LIMITS OF LIABILITY
each occurrence
each person
each accident
$ Incl.
$ IDel.
Total Premium $ Iaol.
Net Premium $
2nd Anniversary $
COVERAGES
Additional Charges
, to complete said policy.
PREMIUMS
If Policy. Period more than one year: Gross Premium $ Discount $
Premium is payable: On effective date of Policy $ 1st Anniversary $
STOREKEEPER'S HAZARDS
PREMISES--PURPOSES OF USE--CODE NO. AREA RATES PREMIUMS
Per 100 sq. It. 01 Area
8M1'M - ...ail ... me 59991 lMO 8.746 14~
Interest of named insured in insured premises D I'owner", o "general lessee" or am "tenant"
Part occupied by named insured
I. COVERAGE S--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 bodily injury or property
damage to which this insurance applies, caused by an occurrence and arising out
of the ownership, maintenance or use of the insured premises 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
injury or property 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 as it deems expedient, but the company shall not be obligated to pay any
claim or judgment or to defend any suit after the applicable limit of the company's
liability has been exhausted by payment of judgments or settlements.
Exclusions
This 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;
(b) to bodily injury or property damage 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
insured, 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;
(c) to bodily injury or property damage arising out of (1) the ownership, maintenance,
operation, use, loading or unloading of any mobile equipment while being used in
any prearranged or organized racing, 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;
(dl to bodily injury or property damage 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;
(el to bodily injury or property damage 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 insured;
Form No. L4087S Ed. 10-1-66 Rev. 1.1-73
but this exclusion does not apply to watercraft while ashore on the insured
premises;
(fl to bodily injury or property damage arising out of the discharge, dispersal, re-
lease or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
liquids or gases, waste materials or other irritants, contaminants or pollutants 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 injury or property damage 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, 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 property damage for which the insured or his indemnitee
may be held liable
(1) as a person or organization engaged. in the business of manufacturing, dis-
tributing, selling or serving alcoholic beverages, or
(2) if not so engaged, as an owner or lessor of prem ises used for such purposes,
if such liability is imposed
(jj by, or because of the violation of, any statute, ordinance or regulation per-
taining to the sale, gift, distribution or use of any. alcoholic beverage, or
(jj) 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 con-
tributes to the intoxication of any person;
but part (lj) of this exclusion does not apply with respect to liability of the insured
or his indemnitee as an owner or lessor described in (2) above;
(i) 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;
(j) to bodily injury to any employee of the insured arising out of and in the course
of his employment by the illSUred or to any obligation of the insured to indemnify
another because of damages arising out of such injury; but this exclusion does
not apply to liability assumed by the insured under an incidental contract;
(k) to property damage to
(1) property owned or occupied by or rented to the insured,
(2) property used by the insured, or
(3) property in the care, custody or control of the insured or as to which the
insured is for any purpose exercising physical control;
but parts (2) and (3) of this exclusion do not apply with respect to liability under
(over)
a written sidetrack agreement and part (3) of this exclusion does not apply with
respect to property damage (other than to elevators) arising out of the use of an
elevator at the insured premises;
(I) to property damage to premises alienated by the named insured arising out of
such premises or any part thereof;
(m) to loss of use of tangible property which has not been physically injured or
destroyed resulting from
(1) a delay in or lack of performance by or on behalf of the named insured of any
contract or agreement, or
(2) the failure of the named insured's products or work performed by or on behalf
of the named insured to meet the level of performance, quality, fitness or
durability warranted or represented by the named insured;
but this exclusion does not apply to loss of use of other tangible property resulting
from the sudden and accidental physical injury to or destruction of the named
insured's products or work performed by or on behalf of the named insured after
such products or work have been put to use by any person or organization other
than an insured;
(n) to property damage to the named insured's products arising out of such products
or any part of such products;
(0) to property damage to work performed by or on behalf of the named insured
arising out of the work or any portion thereof, or out of materials, parts or equip-
ment furnished in connection therewith;
(p) to bodily injury or property damage arising out of the ownership, maintenance,
operation, use, loading or unloading of any escalator at the insured premises, unless
the named insured owns, rents or controls only a part of the building and does
not operate, maintain or control the escalator;
(q) to bodily injury or property damage (1) arising out of the demolition of any
building or (2) included within the completed operations hazard or the products
hazard if the bodily injury or property damage arises out of (j) gas used for heat or
power (other than gas in non-refillable aerosol cans) or (jj) heating or cooking
appliances (other than portable camp stoves or blow torches) operated by gas or
liquid fuel or (iij) the installation, servicing or repair of such appliances.
II. COVERAGE T-STOREKEEPER'S 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 injury arises
out of a condition in the insured premises or operations necessary or incidental
thereto.
Exclusions
This coverage does not apply:
(a) to bodily injury
(1) arising out of the ownership, maintenance, operation, use, loading or unloading
of any escalator at the insured premises, unless the named insured owns, rents
or controls only a part of the building and does not operate, maintain or control
the escalator;
(2) arising out of the ownership, maintenance, operation, use, loading or unloading of
(j) any automobile or aircraft owned or operated by or rented or loaned to any
insured, or
(ij) 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;
(3) arising out of (i) the ownership, maintenance, operation, use, loading or unloading
of any mobile equipment while being used in any prearranged 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;
(4) 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
(ii) 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
prem ises; or
(5) arising ,out of and in the cours~ of the transportation of mobile equipment by
an automobile ownelf or operated. by or- rented or loaned to any insured;
(b) to bodily injury
(1) included within the completed operations hazard or the products hazard;
(2) arising out of operations performed for the named insured by independent con-
tractors other than (i) maintenance and repair of the insured premises or (ji)
structural alterations at such premises which do not involve changing the size
of or moving buildings or other structures;
(3) resulting from the selling, serving or llivin~ of any alcoholic beverage (j) in
violation of any statute, ordinance or regulation, (ji) to a minor, (jii) to a person
under the influence of alcohol or (jv) which causes or contributes to the intoxica-
tion of any person, if the named insured is a person or organization engaged
in the business of manufacturing, distributing, selling or serving alcoholic
beverages or, if not so engaged, is an owner or lessor of premises used for
such purposes but only part (i) 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 revoS
lution, or to any act or condition incident to any of the foregoing;
(c) to bodily injury
(1) to the named insured, any partner therein or any employee of any of the fore-
going if the bodily injury arises out of and in the course of his employment
therewith;
(2) to any tenant of the insured premises or any employee of such tenSlnt while
engaged in the employment thereof, if the bodily injury occurs on that part of
the insured premises rented to such tenant; ,
(3) to any person w~i1e ~ngaged in maintenan~e and r air of ~he insured premises
or alteratlO'i'i', demo.l:'tion or new construction at s 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 compensation or
disability benefits law, or under any similar law;
(5) to any person practicing, instructing or participating in any physical training,
sport, athletic activity or contest;
(d) 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.
III. PERSONS INSURED
Each of the following is an insured under Ccverage S-Storekeeper's Liability to
the extent set forth below:
(a) if the named insured is designated in the declarations as an individual, the
person so designated but only with respect to the conduct of a business of which
he is the sole proprietor, and the spouse of the named insured with respect to
the conduct of such a business;
(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 individual,
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; and
(d) any person (other than an employee of the named insured) or organization while
acting as real estate manager for the named insured.
IV. LIMITS OF LIABILITY
Regardless of the number of (1) insureds under this pOlicy, (2) persons or organi-
zations who sustain bodily injury or property damage, or (3) claims made or suits
brought on account of bodily injury or property damage, the company's liability is
limited as follows:
Coverage S-The limit of liability stated in the schedule as applicable to "each
occurrence" is the total limit of the company's liability under Coverage S for all
damages as the result of anyone occurrence. For the purpose of determining the
limit of the company's liability, all bodily injury and property damage arising out
of continuous or repeated exposure to substantially the same general conditions
shall be considered as arising out of one occurrence.
Coverage T-The limit of liability stated in the schedule as applicable to "each
person" is the limit of the company's liability under Coverage T for all medical
expense incurred by or on behalf of each person who sustains bodily injury as the
,result of anyone accident; the limit of such liability stated in the schedule as
applicable to "each accident" is, subject to the above provision respecting "each
person", the total limit of the company's liability under Coverage T for all medical
expense incurred by or on behalf of two or more persons who sustain bodily injury
as the result of anyone accident.
When more than one medical payments or medical expense 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.
V. ADDITIONAL DEFINITIONS
When used in reference to this insurance (including endorsements forming a part
of the policy):
"insured premises" means
(1) the retail store premises designated in the declarations,
(2) premises, including warehouses in connection therewith, of which the named
insured acquires ownership or which he rents to be occupied by him for the
purpose of a retail store if the named insured reports his intention to insure
such premises under this policy and no other within 30 days after such
acquisition, or rental,
(3) other premises, if used in connection with retail store premises described in
paragraphs 1 or 2 and if such other prem ises are
(a) parking areas where no charge is made by the named insured, or
(b) private storage garages, or
(c) booths or exhibits at any fair or exposition, or
(d) premises not owned by .the named insured while the named insured is
temporarily using such premises for meetings or employee recreation, or
(e) with respect to the products hazard, premises previously operated by the
named insured as a retail sto~,
(4) premises alienated by the named insured (other than premises constructed for
sale by the named insured) if possession has been relinquished to others,
and includes the ways immediately adjoining such premises on land;
"medical expense" means expenses for necessary medical, surgical, x-ray and
dental services, including prosthetic devices and necessary ambulance, hospital,
professional nursing and funeral services;
"retail store" means a store selling goods or products primarily at retail with
not more than 50% of the sales by mail order.
VI. ADDITIONAL CONDITIONS-LIMITATION OF COVERAGE TO STOREKEEPER'S
INSURANCE
No other insurance afforded by this policy shall apply to bodily injury or property
damage with respect to which insurance is afforded under Coverage S or T.
Medical Reports; Proof and Payment of Claim .', .
As soon as practicable the injured person or someone on his behalf shall give to
the company written proof of claim, under 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 constitute
admission of liability of any person or, except hereunder, of the company.
VII. POLICY TERRITORY t
This insurance applies I'ly to bodily injury or property damage which occurs
.witbjn the policy territory. .' ..
NAME AND ADDRESS OF INSURED
M. Alfred Gregory d/b/a
Marina Gift Souveniers
75 Causeway Boulevard
Clearwater, FL 33515
Burke-Lehman Insurance, Inc.
2348-B Sunset Point Road
Clearwater, FL 33575
COMPANIES AFFORDING COVERAGES
COMPANY
LETTER
A
B
C
o
E
Co.
COMPANY
LETTER
Excelsior Ins.
COMPANY
LETTER
COMPANY
LETTE R
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition
of any contrac.t or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the
terms, exclusions and conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits of Liability in Thousands (
OCC0~~~NCE AGGREGATE
A
GENERAL LIABILITY
~ COMPREHENSIVE FORM Being Is sued
00 PREMISES--OPERATIONS
o EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
IX] PRODUCTS/COMPLETED
OPERATIONS HAZARD
IKJ CONTRACTUAL INSURANCE
IX] BROAD FORM PROPERTY
DAMAGE
IX] INDEPENDENT CONTRACTORS
Ii] PERSONAL INJURY
$ 30:)
BODilY INJURY
3-14-84
3-14-85
eff.
thru
PROPERTY DAMAGE
$
BODll Y INJURY AND
PROPERTY DAMAGE
COMBINED
$ 300
PERSONAL INJURY
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON.OWNED
BODilY INJURY
(EACH PERSON)
BODilY INJURY
(EACH ACCIDENT)
$
PROPERTY DAMAGE
BODilY INJURY AND
PROPERTY DAMAGE
COMBINED
EXCESS LIABILITY
o UMBREllA FORM
o OTHER THAN UMBRELLA
FORM
BODll Y INJURY AND
PROPER'tY DAMAGE
COMBINED
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES
Cancellation: Should any of the above desc~~d policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
City Clerk
Clearwater City Hall
P. O. Box 474e
Clearwater, FL 33518
March 14
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