INSURANCE BINDER (3)
DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY (INCLUDING LOCATION)
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Per Attached Proposal....,...... -""'-
. ;'8CDUCER
COf.APArN
Royal Insurance
EFFECTIVE
BINDER NO,
4119
Veghte Insurance
P.O. Box 17305
Clearwater, FL 34622
DATE
04/01/88
TH'S BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED
COMPANY PER EXPIRING POLICY NO,:
CODE
SUB-CODE
INSURED
Palm Pavilion of Clearwater,
The Four Suns; Inc. & Howard
10 Bay Esplanade
Cl earwater Be,ach, FL 34630
Inc.
Hamilton
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DEDUCTIBLE COINSURANCE ~
PO S
MEO, PAY $
PIP $ 10,
UM $ 20,
ACY
STATED AMOUNT 5
OTHER
UCH, AGGAEOA'tE SELF.I~SUREO
OCCURRENCE RETEN"'ON
2,000, 2,000, 10,
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AMOUNT
TYPE OF INSURANCE
PROPERTY
COVERAGES/FORMS
CAUSES OF LOSS
BASIC D BROAD ~SPECIAL
Per Attached Proposal
1000.00
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CVJ"5MAOE ~OCC\JAAENCE Per Attached Proposal
OWNER'S & CONTRACTORS
PROTECTIVE
GENERA~ AGGREGATE
PROOUCTS-tQMP/OPS AGGREGATE
PERSONAL & ADVERTISING INJURY
EACH OCCURRENCE
FIRE OAMAGE (ANY ONE FIRE)
MEDICAL EXPE NSE (ANY ONE PERSON)
CSl S 500
BI'PERSlACCIO $
RETRO DATE FOR CLAIMS MADE:
ALL VEHICLES SCHEDULED VEHICLES
Per Attached Proposal
ALL VEHICLES
X SCHEDULED VEHICLES
Per Attached Proposal
Per Attached Proposal
RETRO DATE FOR CLAIMS MADE:
lEACH AC~;OENTI
/OISEASE"?0UCY LIMIT}
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WORKEP'S COMPEtlSATION
AND
EMPLOYERS' LIABILITY
Per Attached Proposal
lOISE~SHACH EMPLOYEE!
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SPECIAL CONDITIONSIRESTRICTIONS/OTHER COVI;;RAGES
TIME
12"01 AM
NOON
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s 1,000,
s 1,000,
$ 500,
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$
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Glass - Per Attached Proposal
Boiler & Machinery - Per Attached Proposal
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ADDITIONAL INSURED
City of Clearwater
P.O. Box 4748
Clean1ater, Fl. 34618-4748
ATTN: Donald J. Petersen
Risk Manager
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A
PROGRAM
OF
INSURANCE PROTECTION
FOR
PALM PAVILION OF CLEARWATER, INC.
THE FOUR SUNS, INC. &
HOWARD HAMILTON
PREPARED BY:
JACK VEGHTE
VEGHTE INSURANCE
2575 ULMERTON ROAD
CLEARWATER, FL 34622
(813) 572-0055
W.H~CH 25, 1'388
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PALM PAVILION OF CLEARWATER, INC. ETRL
I. DIRECT PROPERTY COVERAGE
A. LIST OF LOCATIONS
1- 2-8 CLEARWATER ST. , CLEARWATER BEACH, CL.
(SNACK BAR, BATH HOUSE)
.=. 332 S. GULFVIEW BLVD. , CLEARWATER BEACH, FL.
1_ .
(GIFT SHOP, SNACK BAR)
.. 33() S. GULFVIEW BLVD. , CLEARWATER BEACH, FL.
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(BATH HOUSE)
4. R-10 BAY ESPLANADE, CLEARWATER BEACH, FL.
(STORAGE SHED)
5. 385 MANDALAY AVE. , CLEARWATER BEACH, FL.
(MERCANTILE & APARTMENTS)
B. LIMIT OF LIABILITY
1. LOCATION #1 REAL PROPERTY - $175,000
PERSONAL PROPERTY - $ 50,000
STOCK- REPORTING - $ 50, O~)O
2. LOCATION #2 REAL PROPERTY - $137,500
PERSONAL PROPERTY - $ 25,000
STOCK- REPORTING - $ 45,000
~ LOCATION #3 REAL PROPERTY $ 50,000
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PERSONAL PROPERTY - $ 10, 000 "
4. LOCATION #4 REAL PROPERTY - $ 20,000
PERSONAL PROPERTY - $ 20,000
5. LOCATION #5 REAL PROPERTY $300,000
C. FEATURES
1. COINSURANCE PERCENTAGE - 90% ON REAL & PERSONAL PPTY
-100% ON STOCK- REPORTING
2. REPLACEMENT COST REAL PROPERTY
3. REPLACEMENT COST PERSONAL PROPERTY
4. VALUES REPORTING FORM- STOCK OF LOCATION #1 & #2
D. CAUSES OF LOSS
1. ALL RISK ON BUILDING- EXCLUDING WINDSTORM, HAIL, FLOOD
EARTHQUAKE, AND NORMAL POLICY EXCLUSIONS
2. ALL RISK ON CONTENTS- EXCLUDING WINDSTORM, HAIL, FLOOD
EARTHQUAKE, AND NORMAL POLICY EXCLUSIONS
E. DEDUCT I 8LL~S
1. $1000 RLL LOSSES
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PALM PAVILION OF CLEARWATER INC ,ETAL
II. BUSINESS INTERRUPTION
A. TYPE OF POLICY
1. BUSINESS INCOME
B. LIMITS OF LIABILITY
1. LOCATION #5 $ 42,000
C. FEATURES
1. COINSURANCE PERCENTAGE 60 ~
D. PERILS
1. ALL RtSK - EXCLUDING FLOOD EARTHQUAKE, AND NORMAL
POLICY EXCLUSIONS
E. DEDUCTIBLE
1. NONE
F. INCLUDES ORDINARY PAYROLL
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PALM PAVILION OF CLEARWATER INC, ETAL
I I 1. COMMERCIAL GENERAL LIABILITY
A. TYPE OF POLICY
1. OCCURRENCE POLICY
B. LIABILITY COVERAGE AMOUNTS
1 .
GENERAL AGGREGATE
PRODUCTS COMPLETED OPERATIONS AGGREGATE
PERSONAL & ADVERTISING INJURY
BOSILY INJURY & PROPERTY DAMAGE
(OCCURRENCE/CLAIM)
FIRE DAMAGE LIMIT (PER FIRE)
MEDICAL EXPENSE LIMIT (PER PERSON)
2.
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4.
5.
E..
C. SCOPE OF COVERAGE
1. PREMI~ES/OPERATIONS
2. INDEPENDENT CONTRACTORS
3. PERSONAL & ADVERTISING INJURY
4. PRODUCTS/COMPLETED OPERATIONS
5. FIRE LEGAL LIABILITY - REAL PROPERTY
E.. HOST LIQUOR LIABILITY
7. INCIDENTAL MEDICAL MALPRACTICE
8. WATERCRAFT NON-OWNERSHIP (UNDER 2E. FEET)
9. CONTRACTUAL LIABILITY
10. EMPLOYEES AS ADDITIONAL INSUREDS
11. BROAD FORM PROPERTY DAMAGE
12. PREMISES MEDICAL PAYMENTS
$1,000,000
$1,000,000
$ 5(10,000
$ 500,000
$ 50,(100
$ 5,(1)0
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(Cot-.lT I NUED)
PALM PAVILION OF CLEARWATER INC, ETAL
I I I. CorflMERC I (:jL GENERAL- L I AB I L I TY
D. PREMIUM BASIS
1. PALM PAVILLION:
BEACH RENTRLS - RECEIPTS
CLOTHING - RECEIPTS
FOOD - RECEIPTS
$ 25,000
$ 440,000
$ 3i~5, 000
2. SOUTH BEACH:
BEACH RENTALS - RECEIPTS
CLOTHING - RECEIPTS
FOOD - RECEIPTS
$ '35,000
$ 430,000
$ 370,000
3. MANDALAY AVE. :
MERCANTILE - AREA
APARTMENTS - EACH
4,0(1)
2
E. SUBJECT TO AUDIT- ANNUAL
F. ADDITIONAL INSURED - LESSOR: CITY OF CLEARWATER
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PALM PAVILION OF CLEARWATER INC, ETAL
IV. AUTOMOBILE
A. LIABILITY COVERAGE AMOUNTS
1.
BODILY INJURY AND PROPERTY
PERSONAL INJURY PROTECTION
COMPREHENSIVE DEDUCTIBLE
COLLISION DEDUCTIBLE
UNINSURED MOTORISTS
DAMAGE $500,000
$ 10,000
- PER SCHEDULE BELOW
- PER SCHEDULE BELOW
$20,000
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4.
5.
B. COVERAGE
1. OWNED AUTOMOBILES
2. NON-OWNED AUTOMOBILE
3. HIRED CAR
c. PREMIUM BASIS
.
1- LIST OF OWNED VEHICLES $500 $500 $500
COMP SP COLL
OED. OED. OED.
(1) 1'374 DODGE PICKUP
( 2) HOMEMADE FLATBED
Q) 1'382 CHEVY CAVAL I ER DQ-() tJ -I X X
(4 ) 1'386 FORD F250 4X4 X X
(5) 1'386 FORD TRACTOR X X
(6 ) 1'386 GMC CONV. VAN X X
(7) HOMEMADE FLATBED
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PALM PAVILION OF CLEARWATER INC, ETAL
V. UMBRELLA LIABILITY
A. LIABILITY COVERAGE AMOUNTS
1. $2,000,000
B. SCOPE OF COVERAGE
1. PREMISES AND OPERATIONS
2. PRODUCTS AND COMPLETED OPERATIONS
3. VEHICLES
C. SELF INSURED RETENTION - $10,00(1
D. EXCLUDED FROM COVERAGE
1. UNINSURED MOTORISTS
2. AIRCRAFT
3. ~'OLLUTION
4. ERISA
5. ASBESTOS
6. LIQUOR LIABILITY
UMBRELLA COVERAGE PICKS-UP WHERE YOUR BASIC LIABILITY POLICY
LEAVES OFF, PROVIDING AN UMBRELLA PROTECTION FOR VIRTUALLY ALL
BUSINESS LIABILITY EXPOSURES UP TO LIMIT OF LIABILITY PURCHASED.
IN ADDITION IT COVERS IN EXCESS OF SELF-RETENTION YOUR LIABILITY
FOR HAZARDS WHICH MAY NOT BE COVERED BY YOUR BASIC INSURANCE.
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PALM PAVILION OF CLEARWATER INC, ETAL
VI. GLASS
A. LIMIT OF LIABILITY
1. REPLACEMENT COST
B. CAUSES OF LOSS
1. BREAKAGE OF GLASS
2. CHEMICALS APPLIED TO GLASS ACCIDENTLY OR MALICIOUSLY
C. PREMIUM BASIS
f. 2-8 CLEARWATER 8T. , CLEARWATER BEACH, FL.
A. 3- 72X72 PLAIN PLATE
B. 1- 32X76 PLAIN PALTE
C ,.-, 66X47 PLAIN PLATE
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D. 1- 32X76 PLAIN PLATE
E. 4- 55X72 PLAIN PLATE
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PALM PAVILION OF CLEARWATER INC, ETAL
VII. LIQUOR LIABILITY
A. TYPE OF POLICY
1. CLAIMS MADE
B. LIMIT OF LIABILITY
1. $1,000,000
C. DEDUCTIBLE
1. $ 2,500 ALL LOSS
D. RETROACTIVE DATE - 4/1/86
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E. SALES - $75,000.
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PALM PAVILION OF CLEARWATER INC, ETAL
VIII. WORKERS' COMPENSATION
A. SCOPE OF COVERAGE
1. UNLIMITED MEDICAL
2. WEEKLY COMPENSATION AS DETERMINED BY STATUTE ($330 MAX)
3. $500,000/$500,000/$500,000 EMPLOYER'S LIABILITY
4. DEATH BENEFIT AS DETERMINED BY STATUTE ($100,000 MAX)
B. STOCK PREMIUM DISCOUNT
C. DIVIDEND
3. EXPERIENCE DICTATES ~ OF DIVIDEND
D. EXPERIENCE MODIFICATION
1. .80~ 1988 MOD
E. PROPRIETOR/PARTNERS/CORPORATE OFFICERS ARE EXCLUDED
HOWARD HAMILTON, JEAN HAMILTON, KENNETH HAMILTON,
WADE HAMILTON, HOYT HAMILTON
F. PREMIUM BASIS - PAYROLL
1. STORE - $110,000
2. RESTAURANT - $205,000
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PALM PAVILION OF CLEARWATER INC, ETAL
IX. FLOOD
A. LIMIT OF LIABILITY
1. LOCATION #1 BUILDING - $ 70,600 (7/20/87-88)
CONTENTS - $ 5'+, 800
,-. LOCATION #,-. BUILDING $137,500 (7/20/87-88)
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CONTENTS - $ 35,500
7 LOCATION #3 BUILDING -- $ 60,500 ('+109/87-88 )
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CONTENTS - $ 5,500
4. LOCATION #5 BUILDING - $121,000 (11/8/87-88)
8. DEDUCTI8LES
1. $500.00
.
C. BILLED BY AND PAID DIRECTLY TO OMAHA INDEMNITY
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PALM PAVILION OF CLEARWATER INC, ETAL
x. WINDSTORM - (4/5/87 - 4/5/88)
A. LIMITS OF LIABILITY
1. LOCATION #1 BUILDING - $164,000
CONTENTS - $ 55,(>(>(1
2. LOCATION #2 BUILDING - $128,000
CONTENTS - $ ItO,OOO
7 LOCATION #3 BUILDING - $ 52,000
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CONTNETS - $ 10,000
4-. LOCATION #4 BUILDING - $ 1'3,000
CONTENTS - $ 20,000
5. LOCATION #5 BUILDING - $237,090
B. DEDUCTIBLES
1. $500.
c. BILLED BY AND PAID DIRECTLY TO THE FLORIDA WINDSTORM
UNDERWRITING ASSOCIATION
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PALM PAVILION OF CLEARWATER INC, ETAL
XI. BOILER & MACHINERY
A. LOCATION
1. 332 S. GULFVIEW BLVD., CLEARWATER BEACH, FL.
B. LIMIT OF LIABILITY
1. 1, 000, 000
C. OBJECTS COVERED
1. AIR CONDITIONING UNIT - 48rOOO BTU'S