STANDARD WORKMENS COMPENSATION POLICY # C75 23 42
CON.!:. 'tov~: BMP 9 fX:S 221 . T
~.. ....... _n~ILlNG_FD_RM_S_nnl '~:-O. St. pete..\Sb....U.. rg Branch
__-.Z749c.~_. AGENT Jack Rans\. Insurance
, . ._~~PEQ.Il~__1 Clearwa te_<:Floricl,a
I. ADDRESS . .
Office
..___~_~_ .'!t_
RENEWS NO, C 75 23 42
REPLACED BY NO,
~
-/
Part Two. This Declarations pag~ with "Policy Provisions-Part One" (FORM Comp 1370b) completes the below numbered
Item DECLARATIONS POLICY NUMBER C Z 8 Il, ::) .~ 1
1.
..Name 0/ J-nJureJ . M. Alfred Gregory dba/
. Marina Gift Souvenirs
ADDRESS:
(Number & Street, Town, County & State)
71 Causeway Blvd.
Clearwater, Florida
33515
INDIVIDUAL XX
PARTNERSHIP 0
CORPORATION 0
UOTHER-
Locations-All usual workplaces of the insured at or from
which operations covered by this pol icy are conducted are lo-
cated at the above address unless otherwise stated herein: * *
2. Policy Period: MOM N~Mt6A~~:~~E61~~ ~~AW5 AHDflE~~S From:
To:
STANDARD WORKMEN'S COMPENSATION AND EMPLOYERS' LIABILITY POLICY
~ The Ohio Casualty Insurance CQm~flJlY
Store Risks-Retail NOC
8017
10,000.
1.80
Estimated
Annual
Premiums
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136 North Third Street, Hamilton, Ohio 45025
MAR
4.
3. Coverage A of this policy applies to the workmen's compensation law and any occupational disease law of each-D.Lthe follOWing states:
Florida - <.:ITY CLERK
CLASSIFICATIDN OF OPERATIONS
Entries In this Item, except as specifically provided elsewhere
In this policy, do not modify any of the other
provisions of this policy,
Code
No,
PREMIUM BASIS
Estimated Total
Annual Remuneration
RATES
Per $100 of
Remuneration
--------------_.,-~._--~-------------,-,--_.,- ------------ _._--_._~,-"-
These rates are tenative only. New
rates will be promulgated shortly by
the rating authoritr~~
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xYIV
!~ ;1\,1 S 0 ,\1 ,;~ GE i'I G 'f
~a.. - Real ElItate '..
J365
' P. o. 61( 3344
BOULEVARD CLfM.1 IV TER FL
.. . 335 S
Loss Constant
Expense Constant
Loss and Expense Constant
Minimum.. Prem.~!l!.L.ll.
If indicated, interim adjustments of premium shall be made: 0 Semi-Annually; 0 Quarterly;
Form numbers of Endorsements forming a part of this policy on its effective date:
3.
15.
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Total Estimated Annual Premium $
o Monthly:-OeposltPremlum $
5. limit of liability for coverage B-Employers' Liability:$1 00, 000.
**ABSENCE OF AN ENTRY MEANS "NO EXCEPTION".
Date Typed. 2-7-75/rr
11(
Countersigned by
~~
AlIthorized Representative
Comp, 1388.
RETUrn! TllI(~ LJ!-U ,\!?^ liON TO C(lMI'MI'( II (\iKJI II)
""j .'...,,--, ".'----.~.,". .....,.".,--... ,,,...._~..
,
- ij) The 0\111 Casualty Insuraret Company'
,.
136 North Third Street, Hamilton, Ohio 45025
Coverage A-Building(sl
D Coverage B-Personal Property
I Add'\. Coverage (Specify)
I VI.
PROPERTY I Ie...~ JIIat.ap
COVERAGE S Loss Deductible Clause No.1 is 1;0
I
o Add'\. Coverage (Specify)
N 2.
Address
(No., Street,
ToWn or City,
County, State,
Zip Code)
Policy Period: From:
Location of Premises: (Enter "Same" if same location as above)
No. 1.
NO.2.
NO.3,
Insurance is provided with respect to those premises described above and with respect to those coverages and kinds of property for~ich a specific limit of
liability is shown, subject to all of the terms of this policy including forms and endorsements made a part hereof: '0 " c=,.
Coinsurance LIMITS OF I~
Percentage
Applicable :<: I 0
% $. '? ~ <:'
% 0
"'.~ '
( . /:S'
......Cl i ~~'
.\0 ~
MEMORANDUM OF SPECIAL MULTI-PERIL POLICY
Part Two, This Declarations Page with "Policy Provisions-Part One" completes the below numbered policy
8' 3. RECEIVED RENEWAL OF NUMBER
POLICY NUMBER SMP 52 59
Named
Insured II. ~.~ ...u. MAR 6 1975
.1Ju1a tift. fljlftl'tld...
" eau...,. ......
O1eana..., fta.
CrfY CLE....J:tK
Individual
o Partnership
o Corporation
DJoint Venture
Item DECLARATIONS
1.
2.
3.
To:
NOON STANDARD TIME AT LOCA-
TION OF DESCRIBED PROPERTY
Dccupancy of Premises
-
tit. .... - ..un
4.
M applicable.
SECTION
COVERAGE
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II
LIABILITY
COVERAGE
COVERAGE
Coverage C Bodily Injury and Property Damage Liability
Coverage D-Premises Medical Payments '" )
Add'\. Coverage (Specify)
each occurrence
each person
aggregate
each accident
-\. "
5. Forms and endorsements made a part of this pol~t tifti'l!"Qf'Q; e",Fi.sert No. and Edition DGlte);'
.. (."1 - (\ ,.!~ :..
.~.::> ()-~. ,~~/ ,'," '~ i . "
IU l00(2-71)_~,~~~~)14M""')i~~>~1~")1JO(1511)
~2 {.,~c ,J~;" ( }:dLt,'twoJl.U: . Rsal b,tat"
:( ""0 . ......', ". ',;>":t PO
6. Mortgagee: 0 (>. \(J''''').~.. lJ./fJ CAUStWA:i'Il;- .. .3<.')( 3344
(Name and Address) .f:' ~ '? l> . O"lEVARD 1:1.1:.1 11 \V HER, :l. .1 -
7. The Total Provisional P~iur?('s $. , and is payable $ 21UL at inception, and $ at each anniversary.
...r-;J "S ~ro\ 7~
',. .,-
Agent: J:. a.*... .......\:
Address: C1euwa~_'.-;
,,",, Countersigne
Date Issued 2-21-"~' b Authorized Representative
In Consideration of the Provisions and Stipulations Therein Or Added Thereto and of the Premium Above Specified (or specified in endorsement attached thereto),
this Company, for the term of three years from inception date shown above (At Noon Standard Time) to expiration date shown above (At Noon Standard Time) at
location of property involved, to an amount not exceeding the limit of liability specified, has insured the insured named in the Declarations above and legal rep.
resentatives, to the extent of the actual cash value of the property at the time of loss, but not exceeding the amount which it would cost to repair or replace the
property with material of like kind and Quality within a reasonable time after such loss, without allowance for any increased cost of repair or reconstruction by
reason of any ordinance or law regulating construction or repair, and without compensation for loss resulting from interruption of business or manufacture, nor
in any event for more than the interest of the insured, against all DIRECT LOSS BY FIRE, LIGHTNING AND OTHER PERILS INSURED AGAINST IN THE POLICY IN-
CLUDING REMOVAL FROM PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THE POLICY, EXCEPT AS THEREINAFTER PROVIDED, to the property de-
scribed therein while located or contained as described in the policy, or pro rata for five days at each proper place to which any of the property shall necessarily
be removed for preservation from the perils insured against in the policy, but not elsewhere. ""'I
(t' -.I / ).-,/.' ~
( , r;;' .~./(/D'
INCLUDES STANDARD FIR INSURANCE POLICY FOR MISSOURI AND KANSAS ~ g)
Form Nc. M715 1-73 (52 35 01 to 53 35 00) r:;.r
Countersignature Date: ....
This CERTIFIES that policy numbered as above has been issued.
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Concealment, This entire policy shall be void if, whether
fraud. before or after a loss, the insured has wil.
fully concealed or misrepresented any ma-
terial fact Or circumstance concerning this insurance or the
subject thereof, or the interest of the insured therein, or in case
of any fraud or false swearing by the insured relating thereto.
Uninsurable This policy shall not cover accounts, bills,
and currency, deeds, evidences of debt, money or
excepted property. securities; nor, unless specifically named
hereon in writing, bUllion Or manuscripts.
Perils not This Company shall not be liable for loss by
included. fire or other perils insured against in this
policy caused, directly or indirectly, by: (al
enemy attack by armed forces, including action taken by mili-
tary, naval or air forces in resisting an actual or an immediately
impending enemy attack; (bl invasion; (cl insurrection; (dl
rebellion; (el revolution; (fl civil war; (gl usurped power; (h)
order of any civil authority except acts of destruction at the time
of and for the pu.rpose .of preventing the spread of fire, provided
that such fire diu not originate from any of the perils excluded
by this policy; (j)neg!ect of the insured to use all reasonable
means to save and preserve the property at and after a loss, or
when the property is endangered by fire in neighboring prem-
ises; (j) nor shall this Company be liable for loss by theft.
Other Insurance. OtherinS1Jrance may be prohibited or the
amount of in~urance may be limited by en-
dorsement attached hereto.
Conditions suspending or restricting insurance. Unless other-
wise provided in writing added hereto this Company shall not
be liable for loss occurring
(a) while the hazard is 'increased .by any meanswfthin the con-"
trol or knowledge of the insured; oi '
(b) while a described building, whether intended for occupancy
by owner or tenant, is vacant or unoccupied beyond a period of
sixty consecutive days; or
(c) as a result of explosion or riot, unless fire ensue, and in
that event for loss by fire only.
Other perils Any other peril to be insured against or sub-
or subjects. ject of insurance to be covered in this policy
shall be by endorsement in writing hereon or
added hereto.
Added provisions. The extent of the application of insurance
under this policy and of the contribution to
be made by this Company in case of loss, and any other pro.
vision or agreement not inconsistent with the provisions of this
policy, may be provided for in writing added hereto, but no pro-
vision may be waived except such as by the terms of this policy
is subject to change,
Waiver No permission affecting this insurance shall
provisions. exist, or waiver of any provision be valid,
unless granted herein or expressed in writing
added hereto. 'No provision, stipulation or forfeiture shall be
held to be waived by any requirement or proceeding on the part
of this Company relating to appraisal or to any examination
provided for herein. .
Cancellation This policy shall be cancelled at any time
of policy. at the request of the insured, in which case
this Company shall, upon demand and sur-
render of this policy, refund the excess of paid premium above
the customary short rates for the expired time. This pol-
icy may be cancelled at any time by this Company by giving
to the insured a five days' written notice of cancellation with
or without tender of the excess of paid premium above the pro
rata premium for the expired time, which excess, if not ten-
dered, shall be refunded on demand. Notice of cancellation shall
state that said excess premium Of not tendered) will be re-
funded on demand,
Mortgagee
interests and
obligations.
If loss hereunder is made payable, in whole
or in part, to a designated mortgagee not
named herein as the insured, such interest in.
this policy may be cancelled by giving to such
mortgagee a ten days'. written notice of can-
cellation.
If the insured fails to render proof of loss such mOltgagee, upon
notice, shall render proof of loss in the form herein specified
within sixty (60ldays ,thereafter and shall be subject to the -pro-
visions hereof relating to appraisal and time of payment aA<l of
bringing suit. If this Company shall claim that no liability ex-
isted as to the mortgagor or owner, it shall, to the extent of pay-
ment of loss to the mortgagee, be subrogated to all the mort-
gagee's rights of recovery, but without impairing mortgagee's
right to sue; Or it may payoff the mortgage debt and require
an assignment thereof and of the mortgage. Other provisions
Page 2
84 relating to the interests and obligations of such mortgagee may
85 be added hereto by agreement in writing.
86 Pro rata liability. This Company shall not be liable for a greater
87 proportion of any loss than the amount
88 hereby insured shall bear to the whole insurance covering the
89 property against the peril involved, whether collectible or not.
90 Requirements in The insured shall give immediate written
91 case loss occurs: notice to this Company of any loss, protect
92 the property from further damage, forthwith
93 separate the damaged and undamaged personal property, put
94 it in the best possible order, furnish a complete inventory of
95 the destroyed, damaged and undamaged property, showing in
96 detail quantities, costs, actual cash value and amount of loss
97 claimed; and within sixty days after the loss, unless such time
98 is, extended in writing by this Company, the insured shall render
99 to this Company a proof of loss, signed and sworn to by the
100 insured, stating the knowledge and belief of the insured as to
101 the following: the time and origin of the loss, the interest of the
102 insured and of all others in the property, the actu~1 cash value of
103 each item thereof and the amount of loss thereto, all encum-
104 branc~s: tj1ereon, all other contracts of insurance, whether valid
105 or not, covering any of said property, any changes in the title,
106 use, occupation, location, pos_session or exposures of said prop.
107 erty since the issuing of this: policy, by whom and for what
108 purpose any building herein described and the several parts
109 thereof were occupied at the time of loss and whether or not it
110 then stood on leased ground, and shall furnish a copy of all the
111 descriptions and schedules in all policies and, if reqUIred verified
112 plans and specifications of any building, fixtures or mc;chinery
113 de~troyed or damaged, The insured, as often as. may be reason-
114 ably required, shall exhibit to'any person designated by this
115 Company all that remains of any property herein described, and
116 submit to examinations under oath by any person named by this
117 Company, and subscribe the same; and, as often as may be
118 reasonably required, shall produce for examination all books of
119 account, bills, invoices and other vouchers, or certified copies
120 thereof if originals be lost, at such reasonable time and place as
121 may be designated by this Compa~y. or its representative, and
)22 shall permit extracts and copies the'1'eofto be made.
123 Appraisal. In case the insured and this Company shall
-124 .' fail to agree as' to the actual cash value or
125 the amount of loss, then, on the written demand of either, each
126 shall select a competent and disinterested appraiser and notify
127 the other of the appraiser selected within twenty days of such
128 demand. The appraisers shall first select a competent and dis-
129 interested umpire; and failing for fifteen days to agree upon
130 such umpire, then, on request of the insured or this Company,
131 such umpire shall be selected by a judge of a court of record rn
132 the state in which the property covered is located. The ap-
133 praisers shall then ,appraise the loss, stating separately actual
134 cash value and loss to each item; and, failing to agree, shall
135 submit their differences, only, to the umpire. An award in writ-
136 ing, so itemized, of any two when filed with this Company shall
137 determine the amount of actual cash value and loss. Each
138 appraiser shall be paid by the party selecting him and the ex-
139 ,. penses. of appraisal and umpire shall be paid by the parties
140 equally,
141 Company's
142 options.
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160-
161
162
163
164
165
It shall be optional with this Company to
take all, or any part, of the property at the
agreed or appraised value, and also to reo
pair, rebuild or replace the property destroyed or damaged with
other of like kind and Quality within a reasonable time, on giv-
ing notice of its intention so to do within thirty days after the
receipt of the proof of loss herein required,
Abandonment. There can be no abandonment to this Com-
pany of any property.
When loss The amount of loss for which this Company
payable. may be liable shall be payable sixty days
after proof of loss, as herein provided, is
received by this Company and ascertainment of the loss is made
either by agreement between the insured and this Company ex-
pressed in writing or by the filing with this Company of an
award as herein provided.
Suit. No suit or action on this policy for the recov-
ery of any claim shall be sustainable in any
court of law or equity unless all the requirements of this policy
sllall ~ave been complied with, and unless commenced within
twelve monthS' next after inception of the loss.
Subrogation. This Company may require from the insured
an assignment of all right of recovery against
any party for loss to the extent that payment therefor is made
by this Company.
......
,. MISSOURI EXCEPTION-Lines 60 through 6..... Standard Fire p'olicy are .amended as !ollows: ;,,a,)liCY .may be cancell.ed, not renewed, reduc.ed !n
amount or adversely modified at any time '~tJ' Company by giving to ~he insured a thirty days ~ n?tlce of cancell~tlon, .non.ren~wal~ reductIOn rn
amoulit or advwe modification with or without tender of the excess of paid premium above the pro-rata premium for the expired time, which excess, If not
tendered, shall be refunded on demand.".
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LOSS OF EARNINGS ENDORSEMENT
Form MLB-143
(Ed. 5-69)
LOCATION OF PREMISES
Lac. No.
Bldg. No.
SECTION I FORMS AND
ENDORSEMENTS
APPLICABLE
EACH 30 DAYS
LIMIT OF LIABILITY
AGGREGATE
:r.,
1
KLB 100
2'"
15,000
1. Subject to all the prOVISIOns and stipulations otherwise applicable to Section I of this policy, except the Coinsurance
Clause and the Loss Deductible Clauses, 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 exceed-
ing 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, commenc-
ing with the date of such damage or destruction and not limited by the date of expiration of this policy. Due con-
sideration shall be given to the continuation of normal charges and expenses, including payrolI expense, to the extent
necessary to resume operations of the insured with the same quality of service which existed immediately preced-
ing 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 ex-
pense 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 shalI 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
This Endorsement must be attached to Change Endorsement MLB-20 when issued after the Policy is written.
Form MLB-143 (Ed. 5-69)
Page 1 of 2
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 manufac-
ture 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.
6. Alterations and New Buildings: Permission granted to make alterations in or to construct additions to any building
described herein and to construct new buildings on the described premises. This endorsement is extended to cover, subject to
all its provisions and stipulations, loss 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 deter-
mined 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 Exclusions and Limitations:
a. The Company shall riot 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 business
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 de-
scribed, 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.
Form MLB-143 (Ed. 5-69)
Page 2 of 2
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In consideration of the payment of premium and subject to all the terms of this endorsement:
Form MLB-179
(Ed. 1-71)
GLASS COVERAGE 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
Loc. Bldg.
No. No.
Number
of
Plates
Description of Glass, Lettering and
Ornamentation; Position in Building.
The glass is plain flat glass with all edges
set in frames, unless otherwise stated herein.
Premium
Length
in
Inches
Width
in
Inches
Specific
Limit,
if any
SEE AftAOHID SClWXJLE
.sa1 c. of glass r lette De; if any and not ins
her under
Total Premium $
41
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
A. The following Provisions as found on Page 2 of the Policy are also applicable to this Endorsement: Cancellation of Policy; Requirements in
Case Loss Occurs; Suit.
B. The following Provisions applicable to Section I of the Policy are also applicable to this Endorsement: Nuclear Exclusion; Protective Safeguards;
Other Insurance.
C. The following Provisions applicable to Section I and II of the Policy are also applicable to this Endorsement: War Risk Exclusion; Liberalization
Clause; Inspection and Audit; Cancellation; Subrogation; Conformity with Statute; Policy Period, Territory; Time of Inception.
This Endorsement must be attached to Change Endorsement MLB.20 when issued after the Policy is written.
Form MLB-179 (Ed. 1-71)
"::
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VANDALISM OR MALICIOUS MISCHIEF ENDORSEMENT
)VERED
o Coverage A - Building(s)
IX Coverage B - Personal Property
to all the provisions and stipulations otherwise applicable to Section I of this policy of which this endorsement is m
provided for herein, the following perils are added to and made part of the "Perils Insured Against" section of the f(
is made a part with respect to the coverage specified by an "X" in the appropriate box above.
or Malicious Mischief: Loss by vandalism or malicious mischief shall mean only the wilful and malicious damage to Or
:overed. The Company shall not be liable, as respects these perils, for any loss:
ss (other than glass building blocks) constituting a part of a building;
rerage, theft, burglary or larceny, except tor wilful damage to the buildings covered hereunder caused by burglars;
llosion, rupture, or bursting of steam boilers, steam pipes, steam turbines, steam engines, Or rotating parts of mad
, operated or controlled by the insured;
j by or resulting from power, heating or cooling failure unless such failure results from physical damage to power,
nent situated on premises where the property covered is located;
described buildings had been vacant or unoccupied beyond a period of 30 consecutive days immediately preceding
such period commenced prior to the inception date of this endorsement.
A building in process of construction shall not be deemed vacant or unoccupied,
Ictible Clause No.2 does not apply to the coverage afforded by this endorsement.
This EndOrsement must be attached to Change Endorsement MLB-2D when issued after the Policy is written.
1 (Ed. 3-71)
Item
No.
Number
of
Plates
1
2
3
4-
5
6
7
8
9
length
in
Inches
1
78
78
60
78
78
78
78
Width
in
Inches
40
3
3
3
36
SCHEDULE OF GLASS
7
2
2
7
4-
2
1
'(8
;4
De p Ion of Glass, lettering ond Ornamentotion; Po I
in Building. The glass is plain flat glass with all edges set
in frames, unless otherwise stated herein.
J'ront 'Plain Plate Borth D1d.
l:'
;J
"
40
100%"8 Plaill Plates
P.rODts Plain Plates West .End.
II
J'roata tint.. plates South Bad.
"
"
ho.t Plain Plates West _ eD4
To be attached to and forming a part of Polity No
to
issued
by
THE OHIO CASUALTY INSURANCE CO.
Effective
Specific
limit,
if any
Premium',~
4.28
31.~
4.56
8.08
33.32
18.08
8.56
4.28
8..85
ye-~
Agent
Form G-7302
End. No
,