THREE YEAR INSURANCE POLICY
, New .~.
MAY 30t7"Q
-!1Ay~:g, 1979
1 RELIANCE INSURANCt: COMPANY
Philadelphia, Pennsylvania
6 ~~~~~~vfa~Yn':~~ INS1~NCE COMPANY
2 PLANET INSURANCE COMPANY
Home Office - Madison Wisconsin
Administrative Offices - Philadelphia, Pennsylvania
8 RELIANCE INSURANCE COMPANY OF ILLINOIS
Home Office - Chicago, Illinois
Administrative Office - Philadelphia, Pennsylvania
-!"____n_ _____.,,______
RI:f1tNilIOf
['.D.... Coverage is provided In Ihe Company desIgnated by
1 Number. EJlCh Is a Stock In~u'ance Company. here,n
called lhe Company.
DECLARATIONS
Item 1, Named Insured and P.O. Address (No.. Slreet. Town, County, Slale)
Palm Pavilion of Clearwater, Inc. &
The Four Suns, Inc.
10 Bay Esplanade
Clearwater, FL 33515
Item 2. Policy Period:
Agency Code. Name and Address
The Veghte Agency 067314
P. O. Box 1560
Clearwater, FL 33517
From 4/1/79
Item 3. The Named Insured is:
o Individual
lIem 4. Designated Premises (ENTER BElOW)
No,1 2-8 Clearwater Street, Clearwater Beach, Florida
No,2 332 S. Gulf'v'iew Blvd., Clearwater Beach, Florida
NO.3 330 S. Gulfview Blvd., Clearwater Beach, Florida
o Additional buildings or premises as designated on Supplemental Declarations attached.
ItBm 5, 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 OF THE TERMS OF THIS POLICY INCLUDING FORMS AND ENDORSEMENTS MADE A PART HEREOF.
To 4/1/82
12:01 A.M. Standard Time at location ot designated premises,
o Partnership
~ Corporation
o Joint Venture
o Other:
Occupancy of Premises
SECTION I Building(s) Personal Property Personal Property DEDUCTIBLE
PROPERTY COVERAGE of the Insured of Others each occurrence ) II aggregate each occurrence
Coinsurance Percentage 80 % 80 % % $ 1,000 dis ppearing
Applicable
loc, No, Bldg, No, If no deductible stated above, the deductible shall be
Limit 1 1 40,000 30,000
of $ $ $
Liability 2 1 $ $ 20,000 $ $100 $1,000
3 1 $ $ 6,000 $ each occurrence aggregate each occurrence
Additional Cov. (Specify) Loss of Earnings, Reporting Form
SMP Form MP'200 Bodily Injury I Property Damage Premises Medic
SECTION \I Bodily Injury and Property Damage Liability Liability liability Payments
LIABILITY COVERAGE Premises Medical Payments
Combined Single Limit IF NO LIMIT SHOWN FOR
each occurrence k aggregate each person each accident MP-200 REFER TO COVERAGE
Umlt olUability PART OR ENDORSEMENT
$ See MP 01 $ $
Additional Cov. (Specify) Personal Injury
Audit Period: Non-Auditable Unless Indicated By IX] 0 Annual o Semi-Annual o Quarterly o Monthly o Other:
o SECTION III-CRIME COVERAGE } As stated in the endorsement, made part of this Policy, if indicated by 00
o SECTION IV-BOILER AND MACHINERY COVERAGE
Item &, Forms and Endorsements made part of this policy at time of issue: (INSERT NO ANO EDITION DATE)MP- 81( 7 -77), MP-177 (7 -77
a. General conditions, Form MP-4 (Ed. 7 -77 lUst all those lorms and endorsements which apply to both Section I and Section II including the General Conditions:
~~61~f?7~7~~ ~9~M~i:t~~~ ~o128~(i7r1} MP-:00A~7=TOG_i1C9tt~6gl77), MP-16(7-77),
b. Section I-list only those forms and endorsements applying to Section I: MP-8l~:&&~!7r, 7'kP-179, MP-l 3, MP-100, MP-100A, MP-119
c. Section II-LIst only those forms and endorsements applying to Section Illo1P-16, LlOl, L- 9288, MP - 201, G-109
d. Section 11I- List only those forms and endorsements applying to Section III
e. Section IV-list only those forms and endorsements applying to Section IV:
Item 7. Mortgagee: Bldg. #1 (NAME ANDADORESSl
Clearwater Beach Bank, 423 Mandalay Avenue, Clearwater, FL 33515
Item B.The Total Advance Premium is: $ 19,449. ,and is payable $ 6,483. at inception, and $ 6,483. at each anniversary.
o NOT APPLICABLE Unless indicated by an X in the box as .. NOT APPLICABLE" , the premium lor installments subsequent to the initial install-
ment shall be subject to adjustment on the basis 01 the rales in effect at each anniversary date.
Clearwater, FL /.",. '- ~
Countersignature Date 4/1/79 Agency at / J I /,
The V e f~th~ized Representative
IN CONSIDERATION OF THE PREMIUM. INSURANCE IS PROVIDED THE NAMED INSURED WITH RESPECT TO THE DESIGNA€fPD PREMfS~WN IN ITEM 4 ABOVE
AND WITH RESPECT TO THOSE COVERAGES AND KINDS OF PROPERTY FOR WHICH A SPECIFIC LIMIT IS SHOWN, SUBJECT TO ALL OF THE TERMS OF THIS POLICY
INCLUDING FORMS AND ENDORSEMENTS MADE A PART HEREOF.
THIS DECLARATIONS PAGE WITH POLICY JACKET. SPECIAL MULTI-PERIL FORM MP-4. AND FORMS
AND ENDORSEMENTS. IF ANY, ISSUED TO FORM A PART THEREOF. COMPLETES THE ABOVE NUMBERED POLICY
J:
'1-ooL(
tJOl.193 Ed Ifn
.'
.""
(u}
I
I
G 1'09
(Ed. 76&)
This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise slated herein.
(The following information is required only when this endorsemenl is issued subsequenlto preparation of policy.)
Endorsement effective 4/1/79 Policy No. FM 10009202 Endorsement No.
Named Insured 'll1e Four Suns, Inc.
Additional Premium $
inc.
Cou ntersigned by
(Authorized Representative)
This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
ADDITIONAL INSURED
(Premises Leased to the Named Insured)
It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated below, but only with respect
to liability arising out of the ownership, maintenance or use of that part of the premises designated below leased to the named insured, and subject to the
following additional exclusions:
The insurance does not apply:
1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises;
2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated below.
SCHEDULE
Name of Person or Orcanization
(Additional Insured)
Annual Premiums
Bodily Property
Injury Damace
Liability Liability
Designation of Premises
(Part Leased to Named Insured)
Location #2 & #3
City of Clearwater
inc.
inc.
G109 (Ed. ]-66)
I
I
GI09
(fd 7f,G)
'n'
(.t,,\}
lhim''',o m,"11 "m' . ,,,I 01 I h, '01'" '0 . hi,h .""h". ,II "Ii" " I h, i ""Ii" d.l. 011 h, ,oh" ""I'" 0 th" .i,o ".1 ,d h".i,
(Th' 10IlOW'" "I "m .Ii" " "." ,,,d "" .h," lhi, ,,,,,,um,,1 i, ,,,,,d '" bu ."", 10 '" '" .Il" ,I ,oli<,.)
["""um,"' .",di" 4/~/79 ,oil" Ho:iN ~OO09202 ',d",om,,'Ho
H.m,,,,,",,d Palm Pavilion of Clearwater, Inc, & 1he Pour suns, Inc,
Counlersigned by
(Authorized Representative)
Additional Premium $
inc.
T hi' "d"um ,,' m odili" ,",hi ,,".. '" " i, .11" d" b, th, ,."" ;'" 01'" ,oh', "I. Ii " 10 Ih' 10110' '"
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUF ACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
ADDITIONAL INSURED
(Premises leased to the Mamed Insured)
II i, .""d 1h.1 Ih' "',,"''' ,,," "d" ""',',, i' .m "d ,d 10 i ,01" d. " " ,,,",,d Ih. ,."" " ",,,',,Ii" d";' ,,' od b.lo'. b"' "I, ..I h ,,,,,,I
10 Il. bitit, "',i" 001 of \ h. o.,,,,h;'. m.; ,\." '" " "" 01 1"" ,.rt 0\ Ih. ,,,m ,,,' d" i,,, \.d b.'o, ,",ud \0 'h. "mod ,,,",,it. "d '" b i.d 10 1 h.
following additional exclusions:
lhe insurance does not apply:
1. to any occurrence which takes place alter the named insured ceases to be a tenant in said premises;
,. 10 ,Ii" 01"..1 ."",Ii 0". ". ",,'m ,Il" " d.mohli" 0'" .lio" ,.rt" m.d b, " " b.h.1I of Ih, ,.."', " ",,,; "Ii" d "i, ,,\,d b,lo'
SCHEDULE
Location #l
Agnes Janet Rouix, OrlandO, Florida inc.
Mame 01 Person or Organization
(Additional Insured)
~nnual Premiums
Bodily Property
Injury Damage
liability liability
Designation of Premises
(Part leased to Mamed Insured)
inc.
G109 (Ed. 7-66)
on'
. .
\ I
.
I
SECTION II
AMENDMENT OF LIMITS O.F ,lABILITY
-BODILY INJURY AND PROPERTY DAMAGE
Form'MP-201
(Ed 7-77)
LIABILITY
This endor~ement modifies such Insurance a:, I~ afforded by the provisions of the policy relating to the Special Multi.Perilliability Insurance Form Mp.700
1. The Section II-limit of liability stated in 11111 fJeclarations as applicable to liability Form Mp.200 is deleted and replaced with the follOWing:
Bodily Injury liability
SCHEDULE
S 300,000
s 300,000
s lOO,OOO
S lOO,OOO
each occurrence
aggregate
each occurrence
aggregate
Property Damage liabllrty
2. Provision III. limits 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 account of bodily injury or property damage. the Company's liability is limited as follows:
Bodily Injury liabilrty- The totallrabilrty 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 liabilrty stated in the above schedule as ap-
plicable to "each occurrence".
Subject to the above provisions respecting "each occurrence" the totatliability 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 above schedule 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 organ.
izations as the result of anyone occurrence shall not exceed the limit of property damage liability stated in the above schedule as applicable to "each oc.
currence".
Subject to the above provision respecting "each occurrence", the total Irability 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 liabilrty stated
in the above schedule as "aggregate".
(1) all property damage ariSing out of premises or operations rated on a remuneration basis or contractors equipment rated on a receipts basis, includ.
ing 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 gen.
eral 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.
This Endorsement must be attached to Change Endorsement MP-20 when issued after Policy is written.
Form Mp.201 (Ed. 7-77)
,
.
."
COVERAGE PART
IOMPREHENSIVE GENERAL LIABILITY INSURANCE I
L 101
([~, ).73
For attachment to Policy No. Dt 1009202 , to complete said policy.
ADDITIONAL DECLARATIONS
location of all premises owned by, rented to or controlled by the named insured ,'NT" ..SA..... .. OA'" LOCATION AS ADDU" .HOWN IH ITO" 10' U'U,,"",OONO,
Interest of named insured in such premises fCoHt.. .now,
1] Owner 0 Generallessee 00 Tenant 0 Other
Part occupied by named insured (ONT" "LOW,
lntirt
The following discloses all hazards insured hereundnr known to exist at the effective date of this policy, unless otherwise stated herein,
SCHEDULE
The insurance afforded is only with respect to such of the following Coverages as are mdlcated by specific premium charge or charges. The limit of the company's
liability against each such Coverage shall be as stated herein. subject to all the terms of this policy having reference thereto.
Coverages
each occurrence
$00000
$ 100 0,;0
Advance
Premiums
A-Bodily Injury liability
~Property Damage liability
Form numbers 01 endorsements attached at issue
$
$
ne.
nc,
Total Advance Premium
Code Premium Bases Rates Advance Premiums
Description of Hazards No. B.I, P.O. Bodily Injury Property Damage
Premises" Operations
SH~ Sch-.:dlle NP-.16
(a) Area (Sq. Ft.) (a) Per 100 Sq. Ft. of Area
(b) Frontage (b) Per linear Foot
(c) Remuneration (C) Per $100 of Remuneration I
(d) Receipts (d) Per $100 of Receipts
(e) Units (e) Per Unit
(I) Admissions (f) Per 100 Admissions
Escalators (Number at Premises) Number Insured Per landing 1
!
:
Independent Contractors Cost Per $100 of Cost I
Completed Operations (a) Receipts (a) Per $1,000 of Receipts
,
i
Products (b) Sales (b) Per $1,000 of Sales i
lTotal Advance B.I, and P,D. Premiums ~ S
General Liability Hazards
(Continued on next page)
When used I. · premium b.uI, J 4
1. ...dnll..te..... means the.". number of perlORI, other then employees of the RImed Iqu,", .dmittlld to the .vent I red or to ,venls conducted on the
premises whether on ~I~ '"ion tltket., complimentary tickets or passel;
2. ....,.. m.... lhe Iot.llOtt to the _ __ _ ...,oct .. --'Ions portormod IIf the _. ....... during tho policy period by ind.pendent
conITlClor. of 011 _h It1 If _ In _ion _ ..... lpecific projoel. incl...... the COlt of .1I1....r. InIteri.l. .nd .quipment furni.h.d. used or
dol....... "" UII in lhe nleution of ..... .n. ....!her lonished by lhe OWlIIr. ...trlCto< If .ubcontrlClor. including .11 I.... .IIOW'nc... bonu...
or commit. ions 1Udt. peid 1M' duei
3. -ro..",," m.en. the I'''' .mount of monoy chlrg.d by the _. "'1It' lor luch .perotion. by lhe _'II'ur.' or by oth... dUlinll1le polity perIOd
., Ire r.ted an . receipts besil other than receipts from 1,leClltinl. brudc:lstlna Dr motion picturn. .nd includes tillS, other than tun which the .....
"sm' collects 'I I ..par.t. Item Inti rem", directly to . lovernment.l division;
4. .....Olllflllo... m.... the .ntir. ..m....rotlon .lInod during the polley po,i.d by prGIlfielor1 .nd by .11 .mploy... 01 tho .....100.... other th.n
chaun.un "Jtlp! operato,s of mobll. lqulpmlnU and lircrlft ,;1otI 1M co-pilob, subject to IftJ overtime ..rnin,s or Umltallon 0' remuneration rule
.pplltlbll In oecord..... w~h tIl. menuols In UII by the CDmplOy;
5. ......" m....th. 1'011 _unt ol......y c...r.... by lhe _. .......If by othe,,'rodi.. under his n.m. fo< .11 pod. ond product. sold Dr dlstrobut.d
during tIl. policy porlOd .nd chll..d durilllth. policy ...rlOd lor i..t.llo1,on. ....icing or..peir. end includolllul, other tllen t...1 wIIith \Ile _II
_1ft. and tueh other. collect IS . ..par.te item and remtt directly to . IOYlrnmentl1 ',viston.
I. CmllACE lo-aaDILY IIlJUIY lIA1llm
COYUAlE a..-naPOn OAllAlIlIAJILm
Tho ....pony will IllY on ......K oflhe -.. .11 _ wIllcIo till ..... ...11
be.- Ioplly oblll.ted to IllY II d_1I ~...... of
A. ...IIy...., If
8. ....."'......
to wIIich till, InsunntI .,,11... ......, bJ .. _. ond the _ _II
..... tho rlghl .nd duly 10 d.l.nd .ny su~ ...lnst the ...... _hi.. _III
,",1CCOII1I1 of,uch"'lly II,"" 0< ,,"""....... _n K any of the .llIptions
of tIlo suit .re aroU1ldIoss. 1.1sI .r ".udul.nt, ond IRIJ ...'" oucII ......tlption
ond 1Ilt1....nt 01 eny cl.1m Dr ,ult IS ~ deom. llpedl.nl but the compony ....11
not be obllftot.d to IllY .ny cl.lm Dr ludgm.nt Dr ,. del.nd .ny 'u~ oltIr th.
=:: o~~~ttr:"'::tscompony'. IIoblllty hll be.n .rhllustll by poym.nt of
EJclall..
This Insuro... ..... not opp/y;
(0) to Iloblllty lSIumed by .... tu.... undor "'" _ or ......."'" nCl9l
en ilcldtorbl ..-, but thl, IIc""lon ..... IIDI ."Iy to . wormrty of
ftIne.. Dr qUl11ty of lhe _.d I_I ....- If . .."only IhIt WI'"
pot1orm.d by or OIl behllt 01 tho ..... ..... will be _ In . _lib
IRItmIrj
Ib) 10 ....11y II"" If """'" .... IIlsi.. "'" ellhe -.ship, IIIIlnt.lIIIlCI.
oporolion. US,, loIding 0< unloldinl 0'
UI ony _110 If .ircr.ft _ If DIlIraled by or rent'" 0< Iooaed tD
.ny Ins.... Dr
I2l ony .ther 11I_ or .Ircrall DIlIrot'" by "'" penon 10 tIIo CDIIISI 01
hi. omplorment by ony......;
but this IIclusion doe, not IJIP~ to the porh.. 01 .. _1IIb1lo on ....mis..
::';:~ 'Zij:i~~~~ ~o ~ co=~II:y Is....not -::.'... "'::':: :'.'nt':: ~
any ....rod;
Ie) to ndlly In/"" Dr ...,.", _II lIislnl out of 1Il th. ownershi,. lIIi..
tenance, operation, use, toading or unloadinl of any ..... ........ whlll
being used in Iny prNHI"led or Ofllnized flCina. speed or demolition
contosl Dr In eny Ilunlilll .ctivity Dr In ,rectite .r proporotion IIf "'" such
:~:~~do:o:C:i:te:W~~jthe operation or use of any snowmobile or trliler
Idl :~,~:~.:1~:ryOfo~'W.'~0~=::: ::i~~g':"~~I:~d':'~'o~::'::d t;
or rented or loaned to any Insured;
Ie) to hdllJ In).ry Dr _.'" ........ .rl.ing out 01 Ih. own.rshlp, ...int.nanc..
operation, use, kwlinl or unloading of
III .nJ w.lorcraft owned Of oper.l.d by If rent.d .r Ioan.d to .ny I....... Dr
(2) .ny other wot.rcllft opereted by .ny perlin In Ih. course of his ....
ploJIR.nt by ony ........;
but Ihis IIclusion does IUlt .pply to w.t.rcrolI willi. 1I!Iore on premise.
owned by. ronted to or controlled by th. .....IIs...;
lfl to bodllJ IIj1ry or .....'" ..... lIi.in, out of the dischlrp. dispe".I.
release or escape of smoke, Vlpol'1, soot, fumes, lCids, INtalls, toxic chemicals,
liquids or pses, waste materials or other initlftts, contninlnts or pollutlnts
into or upon lind, .... otmospller. Dr .ny w.ter course .r body 01 w.ler; but
Ihi. orclusion doel nol .pply if ,uch di.chorao, dlspolSll. r...... 0< _
Is sudden .nd occident.l;
III to bodily 10)"" 0< ,ro,'rIJ ....... duo to WII, wII.ther .r IIOl docll"",
civil war, insurrection, rebellion or revolution or to any ICt or conditMMl
Incid.nt 10 .ny of tho IorolDinl. with resp.et to
III II.Mily llsumod by tho "..rod under .n _11II __ or
(2) orpens.1 lor first .id under the Suppllmonllly POJlIlIIIls prD'fision;
Ih) 10 bodily I.jury If --" __ lor wIIic:ll lhe ....... or hi. Indomnit..
...y b. h.ld liabl.
III :1'1~~: :;1~~:~1l( =itl'1..:.~:''::'r'' 01 ......foetun...
(21 if not so IMpled, as In owner or lessor of premises used for such
purposes.
il such liability Is iInpos<d
lil by, or because of the violation 01, any statute. ordinance or rlgumtion
pertaining to the sale, lift, distribution or use af any Ik:oholic bewerlle,
Of
Iii) by reason of the selling. serving or liwi.. of any Ilcoholic beverage to I
minor or to a person under the influence of alc0hoi or which causes or
contributes to the intoxication of Iny person;
but part (jj) 01 Ihi. orclu.ion do.. lUll IJIPly with r.....ct 10 liability ot tho
IISlrld or his indemnitee .s In owner or lessor described in (21 above;
Ii) to any obligation for which the &uurell or I~ carrier IS his insurer may
be held liable under Iny wortlmen's compensatlDfl. unemployment compensa.-
tion or disability benefits law, or under Iny similar lawj
Ij) to bodily lojury to .ny .mploy.. 01 the Ia... .n.illl out of .nd in Ih.
course of hi. .mployment by Ih. IlIIro' If to .ny oblilotiOll of tho IlIIred
to indemnity another because of damale5 Irising out of suell injuryj but this
ucluslon does not apply to liability assumed by the laanll under an
I""'orbl coalrlCl;
lkl to prep.", dIlIIp t.
m pr.perIJ owned Dr occupl.d by Dr IInted 10 th. _.
(2) property used by the "'1It', Dr
131 property In the tire, custody 0< _1nI1 01 the ....... or II to wIIidI
the lasured is for MY purpose elerCiSi"l~IClI control;
but p.rts (2) .nd I3l 01 this IIclusion do IUlt Y with relpect to Iiobihly
under I written sidetraek IIrtem.nt Ind part ) of this elcluston does not
::I~.:~:' ':.~~ ~~...:::,~~ ~:;~~~::.:::
_'llIund;
CD to ,",p.", __ to """illS .Ii.naled by the _. 108_ oris... out
of such p..mises If "'" port Ih..lOl;
lml t. loss 01 us< 01 lIIl(ible ,...,.'" wIIid1 .... ..t ....n pIIysiCllly injured or
m~roJ~~~:~~~1 portorm.nc. by Dr on bolIolt of IIlo _.. ......
of Iny contrlCt or ..reement, or
I2l th. 1.llulI of tho _. I........ ...._ or won portormed by 0< DO
behllt of lhe _ ....... to ....t the Iovel of po-.c.. quality.
fitness Dr _lily ....nt... or ..........Oll by the _. .....(
but Ihis orelusion does lUll opply to loll 01 UII of othor '""lib I. ......rIJ
....Iling lrom the sudden ond occlclonlll pIlysluI inj.ry to or ....truclJon 01
.... _. ....... ......,. 0< WI'" porlonnId by or . _It of the
Df';#i&~n
"'_""0"
_.. ...... ofter such products Dr work h.v. b..n put to us. by IIlJ
person Of orllnizltion other thin In I".rld;
III to .....'" ...... tD lhe ...d III.rod', ,rod.cts arising out of such
product, or ..., port of ,uch products;
Iol 10 .....rIJ -.,. 10 WI'" p.rtonned by Dr on b.h.1t 01 tho ...d las.rod
Irisinl aut. of the wortl or any portion thereof, or out of mattlllls, parts or
equipment furnished In connection therewith;
lpl 10 dIm.g.. e1llm'" lor the wRhdr...I. Inspection. repoir. ropilc.mont. Dr
loll of use of Ih. _.d ....ro... ...._ Dr wo'" compl.ted by or for
the _.. ....ro. Dr of .ny property.' w111c:11 such products 0< WI'" lonn
. port. It such products. _h or properIJ .11 withdllwn lrom tho 11I","1 or
from use becluse of Iny known or luspected defect Dr deficiency tII.rein;
(q) 10 "'PO'" ...... Included within'
m tho orplalll klur' In connoelion wllh operotlons Id.ntlllod In thl.
policy by . cl.ssit".t1on cod. numb.. whic:ll Incl..... Ih. I~I "".
(2) the c.I..,.. hlZlfd in conn.ction wllh operotlon. IdentIfied In thi.
policy by . clllllfotlllon code numb.. which Includ.. Ih. I~I "c",
131 :::nt~~'r.~~ '~~"'by~:r.~.=~onln':~':=r w.:-~c~:~":
th.lymbol"u".
II. PUSOIIS IlISUtEa
E.Ich of the fonowinl Is In Inlm' under this Insurane. to the extent let forth
below,
(J) if the _HI 1"lred is desllRlted in the declarations as 8n individual, the
person so do.ilnated but only with IIspecl '0 Ih. conducI of . busine.. 01
wIIid1 be is th. sol. propri.tor. .nd tho 'pous. 01 Ih. nam.d '''Ufld w~h
r.....ct to llIe conduct 01 suc:ll . bu.iness;
"" H the _ ...... is ....i(l1lled In the doclllotions II . p.rt.."hip Dr
~o:..:~~:.r~ne:~pw1\'h j~:~v:~r~I:"II~~ll~.~d ,:; .ny ,.rtner
Id if the -' ...... Is cIosp'" In lhe decllrotions II olher ..... .n i..
diwidull, Plrtnership or joint venture, the organization so deli~nat.d end eny
uecutivt officer, director or stockholder thereot while Bcting Within the scope
of his duties as such;
Idl ..y penon Iother thin en .mpioya. of tho .....d IIS0rool) Dr orpnizotion
while Ittif\l as ftll estate manlIer for the 1lI.,d Insund; Ind
II) :i::I~~j'.:i~he.:e.~:"r~:rst~r~I~~C:r. .:~ ~:g;o~~h~crr~lrst~~~
1Iw,
Ii) In employee of the u.d lMurld while operatinglny such equipment In
the course 01 his employment. .nd
(it) In, other person while operating with the permission of the ullllld lnlund
Iny such equipment registered in the name of the named Inured and any
person or orlanization legally responsible for such operation, but only If
there is no other valid Ind collectible insurance available, either on a
primlry or Ixcess basis, to such person or organization;
provided that no person or orlanization shall be an Inlund under this par.
fl:~~::I~~sroc:n~'I'IIoW .mploy.. 0' .uch pe".n Injured in tho cou".
of his employment, or
(2) :r~~II-:::'i~::r::.o:~~t:~~:I~:irreofteadn;O'p~"rs~~ar::S~:i::d o~u:~~~
paregropllllll.
This insur.nc. doe. not .pply to ~odllJ Injory Dr prop.", 11I_. arl.ing oul ot
~~:,=:t~ :~ilha~sn~stt)~~:: 'k.n:::r: ~Ii~;i:: :h:.=::ri:,~~. partner
III. LIMITS Df lIA1ll1n
lI~r::s S::t~~ =i~:r.:{ m ~~:::::~~~::,~:i(li ~~i::~~rD~~~~~
brou...t on ICCDIHII 01 ~.'11y r.:T"" Dr ,..p.rty d.m.g., tho comp.ny'. liability Is
limited IS foUows:
U::~:r ~:~dto~~ ~r~~~c::. ~e~a:~~~n~o~jl~ i~~u:~~:i~e~n~~~~~
w"U;r~.~ol~rl~~~;:d~no~n~:hneed:;::~S":::li~~~:~ nt~t ,!:~:do~m~1 0,1
Subject to the Ibove provision respecting "each occunenn",' the total liability
~.'i:,:,':::1 ~=~nd~r ::.\~ ~)~~d:~cl~~:1 ~if~i:~'I:~~.;.~
_III ....11 not orc.... the lim~ of bo.ilJ InJ.ry li.bllily ,I.t.d in IIle sdI.dul.
II ....."Iot....
eo".... II-The toIIl liIlIility of tho compony lor .11 IIIm.g.. beClUS. 01 .11
III'fIrtJ ....... sustained by one or more persons or organizations 115 the result
of ..., one ..._ .hllII not or..... lhe limit of pre,.", d....I. liability slot.d
in IIlo sd1edul. II opplicabl.lo .._....m.....,
Subject to the ....... previ.i... respeclilll ".lth .ccamn..... lt1. tol.1 Iilbillty
of the company lor .11 _ges blClus. 01 .11 ,ro,.", d.IIII' 10 wIIich Ihi.
coverage epplies and described in IRY of the numbered subparagraphs below
sII.lInot ....... tllo limit of "...'" ....... Ilobility .t.t.d In tho .c:lledule II
"'lIIreg,t,",
(l) .11 IIWQft'tJ ...... arisi.. out 01 premises or operattons rated on I re-
muneration basis or contractor's equipment rated on I receipts basis,
including ,...,.rty daIup for which liability is assumed under any in-
=:';;', C:I~= i:':I~~i:J i~ ::~r::~~~es12~r b:r:~~tions, but excluding
(2) III ,roperty Uaal' Irisinl out at and oceuninl in the course of operattons
performed tor the ....d Nlslrelll by independent contracton and leneral
=~s~:r th.:~co~ ~~m~y ~=s:;::d~n~=I~~II::~'s,: :':.~
relahnr to such operations, but this subparagnph (2) does not include
".,.rty haap Irising out of maintenance or repairs at premises owned
by or rented to the IIIItll1 hlsmd or structural lite rations at such premises
which do not involve chanline the size of or moving buildings or other
strvcture~
131 .11 ...perIJ _I' included wilhin tho ,rod.ct. hlllnl .nd .11 _.rIJ
Uucl included within the c..plttall ...ratio.. IuIl1rd.
Such lureRate limit shall Ipply separ.tely to the ,ro"rty _.... described
in .ubpar.gr.phs 1lI, 121 end 131 ..., .nd und.r subpallgr.ph. 1lI .nd 121
separ.t.1y wilt1 r..peel 10 ..ch proJ,ct "'J from pr.ml... owned bJ Dr r.nl'd
to the ...1lII '.Slnd.
Cenrap.1 lid B-for lhe purpose of detennininllhe limit of the company's
Iilbihty, .11 Hdily i.jar} Ind 'Rplrty ....... arisinl out of continuous or re-
pelted llposure to siA)stlntially the .....e pner.1 conditions thaI! be considered
as Insin,: out of one ICClfmlCt.
IV. HUn TEIIITDRl
Thil ....rollC8 ","es only to ...11y IalorJ Dr ",,.,,, '-" wIIic:ll octu"
within till ..11cy t.rrItory
. (31. PROPERTY
REPORTING ENDORSEMENT-SPECIFIC RATE Form MP-1l9
COVERED-l gPersonal Property of the Insured L}Personal Property of Others (Ed.].77)
This policy IS amended in accord ce with the reporling provisions contained herein at 'he locatIOns shown below in' the Schedule with
re~pectto the coverage specified by an "X" in the box(es) ( ~) shown above.
The limit of liability stated for each locatIOn shall apply to all Personal Property of the IW.llled and Personal Property of Others combined,
,Except for Debris Removal, the Coinsurance Clause and the loss Clause which all: ,uperseded by this endorsement. all the proVISions otherWise
applicable to Section I of this policy apply.
I. SCHEDULE
loco Bide.
No. No.
at 1 1
at
at
at
at
at
at
at
at any other location acquired by the insured for similar occupancies or warehouse purposes if specifically listed and
reported in the next report of values following such acquisition as provided in the Value Reporting Clause. If the value
is not so reported, no insurance attaches.
L $
2. $
3. $
4. $
5. $
6. $
7. $
8. $
$
limit olll.bility lor all
Contributing Insurance
35,000
Rate
inc.
Street Add,.n, City & St.t.
2-8 Clearwater Street, Clearwater Beach, ~L
The minimum premium for all contributing insurance shall be $
II. MINIMUM PREMIUM
III. REPORTING PROVISIONS
A, Provisional Amount Clause: The amount of insurance provided for
hereunder is provisional and is the amount on which the advance
premium is based, it being the intent of this insurance to insure here-
under the total actual cash value of the property described herein
subject to the limits of Liability for all Contributing Insurance. Any
loss in excess of the limits stated in this policy shall be borne by the
insured. notwithstanding the requirement that premium is to be
adjusted on the basis of full values reported,
8, Value Reporting Clause: The insured shall report in writing to the
Company, not later than 30 days after the last day of each calendar
month, the exact location of all property covered and the total actual
cash value of such property at each location as of the last day of each
calendar month. At the time of any loss, if the insured has failed to
file with the Company reports of values as above required, this policy,
subject otherwise to all its terms and conditions, shall cover only at
the locations and for not more than the amounts included in the last
report of ~alues filed prior to the loss, and further, if such delinquent
report is the first report of values herein required to be filed, liability
shall be limited to 90% of the amount for which the Company would
otherwise be liable.
If the inception date of this policy is the last day of the calendar
month, then the first report of values due shall show the total actual
cash values as of that date.
C. Full Reporting Clause: liability under this pOlicy shall not in any case
exceed that proportion of any loss hereunder which the last value
reported prior to the loss, at the location where the loss occurs, bears
to the total actual cash value at that location on the date for which
such report was made. liability for loss hereunder occurring at any
location acquired since filing the last report (except as provided in
the Value Reporting Clause) shall be apportioned in a like manner.
except that the proportion used shall be the relation that the values
reported prior to the loss at all locations bear to the total actual cash
values at all locations on the date for which such report was made.
Form MP-1l9 (Ed.7,77)
D, Premium Adjustment Clause: The premium stated in this policy is an
advance premium only. The actual premium consideration for the
liability assumed hereunder shall be determined, at the expiration of
this policy, by application of the following:
1. An average of the total values reported at each localion shall be
made, and if the premium on such average values at the rale ape
plying at each location exceeds the advance premium. the insured
shall pay to the Company the additional premium for such excess;
and, if such premium is less than the advance premium, the Com.
pany shall refund to the insured any excess paid.
2. It is a further condition of this policy, anything 10 the contrary
notwithstanding, that the final adjusted premium as provided In
this clause shall in no event be less than this policy's proportion
of the minimum premium specified elsewhere in this endorsement
E. Debris Removal Clause (Limited Coverage): This insurance covers
expense incurred in the removal of debris of the property covered.
which may be occasioned by loss caused by any of the perils insured
against in this policy.
The total liability under this policy for both loss to property and debris
removal expense shall not exceed the Company's proportion of 100%
of the total actual cash value of the property covered at the location
where the loss occurs, subject to the limits of liability and ali other
provisions of this policy.
The Company shall not be liable for debris removal expense occa.
sioned directly or indirectly by enforcement of any ordinance or law
regulating the use, construction, repair or demolition of property.
Debris removal expense shall not be considered in the determination
of actual cash value in the application of any clause forming a part of
this poliCY.
.' <nl.
-- .. - .- .. .- --.-
LOCATION OF PREMISES SECTION I FORMS AND LIMIT OF LIABILITY
ENDORSEMENTS ,-
Loc. No, B1d2. No. APPLICABLE EACH 30 DAYS AGGREGATE
1 1 MP-100A 40,000
2 1 MP-1OOA 36,000
I
LOSS OF EARNINGS ENDORSEMENT
I
Form MP-143
(Ed ].77)
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 li~bility specified above for the
premises at which the damage or destruction occurs. For the purposes of this insurance, "perils insured against" shall mean the penis, 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 Dr 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 Dr finished) at the locations described herein or elsewhere,
such reduction sha II 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 a II 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, "Norma''': 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
!'~" GLASS COVERAGE ENDORSEMENT
\~~ I I
In consideration of the payment of premium and subject to all the terms of this endorsement:
1. PROPERTY COVERED
This endorsement covers damage to the glass described in the schedule and to the lettering and ornamentation separately described therein, by brca~~~e 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.
Form MP-179
(Ed 7.77)
2, SCH EDUlE
Description of Glass, Lettering and
Number Length Width Ornamentation; Position in Building, Specific
Loc, Bldg. of in in The glass is plain flat glass with all edges Limit, Premium
No, No, Plates Inches Inches set in frames, unless otherwise stated herein. if any
1 1 4 70 69 Plate Exterior inc.
1 1 1 70 72 II II inc.
1 1 1 70 18 II II inc.
1 1 2 32 77 Doors inc.
Total Premium $
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 enst 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 (lal. (lb) and (lc) above, is $75 with respect to loss due
to anyone occurrence at anyone location separately occupied or designed for separate occupancy.
The Company may pay for the loss in money or may repair or replace the property. Any property so paid for or replaced shall become the property of the Company
5, OTHER PROVISIONS APPLICABLE TO THIS ENDORSEMENT
The following conditions contained in the 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.
This Endorsement must be attached to Change Endorsement MP-20 when issued after the Policy is written.
Form MP-179 (Ed, 7-77)
. . ",. DISAPPEARING DEDUCTIBLE ENDORSEMENT Form Mp-177
. {:"J. II ' (Ed. 7.77)
In consideration of the premium charged, it is agreed that the following provisions apply to Section I insurance afforded under Buildlng(s) and Personal
Property 01 the Insured: ' .
L Disappearing Deductible Clause:
(a) The Company shall be liable only when the whole loss exceeds $ 1,000 .
(b) When the whole loss ~cet1bo 1,000 but is less than $ 10,000 , the Company shall be liable lor 11l % of the
amount in excess of $ , but. in the event there is any other insurance covering the property (or which would have covered the
property except lor the existence of this insurance) against the perils which caused the loss (whether collectible or not), then the Company shall
be liable for only its proportion of % of the amount of such excess. Such proportion shall be determined in the same manner as
the Company's proportion of the whole loss would be determined.
(c) When the whole loss is $ 10,000 or more, this deductible shall not apply.
2. The "whole loss" as used herein is defined as the amount which would be recoverable under this policy and any other insurance covering the property
(or which would have covered the property except for the existence of this insurance) against the perilS which caused the loss (whether collectible or
not) in anyone occurrence, disregarding this deductible clause and any other deductible provisions in this policy or in such other insurance poliCies.
3. If this pOlicy covers on two or more items of insurance, the provisions of this deductible clause shall apply separately to each item to which the deductible
clause applies.
4. The provisions of this endorsement shall supersede any other deductible provisions applicable to Section I Insurance afforded, except if this policy
insures against loss by earthquake, volcanic eruption, vandalism or malicious mischief, the provisions of this endorsement shall not apply to the amount
of such loss recoverable under this policy.
This Endorsement must be attached to Change Endorsement MP.20 when issued after the Policy is written.
Form MP-l77 (Ed. ]-11)
.'-
COVERAGE PART
I COMPREHENSIVE GENERAL LIABILITY IHSURANIE
for allachmentto Policy No...Fl'L1ClO9202.__. to complete said policy.
ADDITIONAL DECLARA TrONS
location of all premises lJwned by. rented to or controlled by the named insured lENT" ........, "..... LOC.TlO" AO .00.... ."OW"." "'M 10' O'CL'UTOON.,
, L 101
(Ed. 1.73)
Interest of named insured in such premises 'CH'C. "LOWI
fJ Owner 0 Generallessee IKJ Tenant 0 Other
Part occupied by named insured . 'NTE. enow,
l'ntire
The following discloses all hazards insured hereunder known to exist at the effective date of this policy, unless otherwise stated herein,
SCHEDULE
The insurance afforded is only with respect to such of the following Coverages as are Indicated by specifIC premium charge or charges. The limit of the company's
liability against each such Coverage shall be as stated herein. subject to all the terms of this policy having reference thereto.
Coverages
Limits
each occurrence
of Lia b i1ity
aggregate
$ 300 000
$ 100 000
Advance
Premiums
A-Bodily Injury Liability
B-Property Damage Liability
Form numbers of endorsements attached at issue
$ 00 000
$ 100 000
Code Rates Advance Premiums
Description of Hazards Premium Bases
No. B.I. P.O. Bodily Injury Property Damage
Premises - Operations
See Schetllle MP-16
(a) Area (Sq. ft.) (a) Per 100 Sq. ft. of Area
(b) frontage (b) Per linear foot
(c) Remuneration (c) Per $100 of Remuneration
(d) Receipts (d) Per $100 of Receipts
(e) Units (e) Per Unit
(f) Admissions (f) Per 100 Admissions
Escalators (Number at Premises) Number Insured Per Landing
Independent Contractors Cost Per $100 of Cost
Completed Operations (a) Rece ipts (.) Per $1.000 of Receipts
Products (b) Sales (b) Per $1,000 of Sales
TTotal Advance B.I, and P.O. Premiums ~ $
General Liability Hazards
Total Advance Premium
$ inC.
$ inc.
$
$
IContinued on next pagel
(3).
I
GENERAL SCHEDULE-SECTIONIII
SMP LIABILITY INSURANCE
Form MP.16
(rd,777)
Description of Hazards and Locations
--'-'--
The rating classifications herein, except as specifically Code Premium Bases Rates Advance Premium,
provided elsewhere, do not modify any of the provisions of No.
the policy. t *B.1. P.O. *B.1. P.O.
(a) Area (Sq. ft,) a) Per 100 Sq. Ft. of Area
(a) Premises-Operations (b) Frontage b) Per linear Foot '"For Form MP.200.
(c) Remuneration c) Per $100 of Remuneration Single limit, Use B.I.
(b) Escalators (d) Number Insured d) Per landing Column.
(c) Independent Contractors-let or Sublet Work (e) Cost e) Per $100 of Cost Include Premium for
(d) Completed Operations (I) Receipts (I) Per $1,000 of Receipts Premises Medical Payment
Insurance in B.1. Column.
(e) Products (g) Sales (g) Per $ 1.000 of Sales
Palm Pavilion of Clearwater, Inc.
2-8 Clearwater Street
Clearwater Beach, Florida
Bath Houses or Bathing Pavilions 7 )493 :> (f) 5,000 inc. inc. inc. inc.
Beach Chairs & Umbrellas 7 992 (f') 5,200 inc. inc. inc. inc.
rented to others
Stores, Retail 59991 (a) 2,100 inc. inc. inc. inc.
Stores, Refreshment Stands 5B132 (a) 800 inc. inc. inc. inc.
Golf Courses, Miniature 7 497 (a) 6,600 inc. inc. inc. inc.
PRODUCTS
Palm Pavilion of Clearwater, Inc.
Stores, Refreshment Stands 5:5131 (g) 250,Oae inc. inc. inc. inc.
Clothes or other wearing apparal 5:>991 (g) 200,00e inc. inc. inc. inc.
The Four Suns, Inc.
Stores, Refreshment Stands 53131 (g) 225,00e inc. inc. inc. inc.
The Four Suns, Inc.
332 Gulf\riew Blvd.
Clearwater Beach, Florida
Beach chairs & Umbrellas, 7~991 (f) 45,000 inc. inc. inc. inc.
rented to others
Stores, Refreshment stands 5B132 (r) 2,500 inc. inc. inc. inc.
Independent Contractors 1 [:>292 (e)lOO,OOO inc. inc. inc. inc.
tDescribe premium basis, if other than stated.
Form MP.16 (Ed. ]-17)
COVERAGE PART
.
..,
I
PERSONAL INJURY LIABILITY INSURANCE,
l 9288
(rd. 1.73)
~.
For atlachmentto Policy No.
1M 1009202
, to complete said policy.
Coverage
P-Personallnjury liability
SCHEOULE
00 000
limits of Liability
thousand dollars aggregate 0 % Insured's Participation
The insurance afforded is only with respect to personal injury arising out of an'offense included within such of the following groups of offenses as are indicated by
specific premium charge or charges,
Groups of Offenses
A. False Arrest, Detention or Imprisonment, or Malicious Prosecution
B. Libel, Slander, Defamation or Violation of Right of Privacy
C. Wrongful Entry or Eviction or Other Invasion of Right of Private Occupancy
Farm numbers of endorsements attached at issue
I. COVERAGE P-PERSONAL INJURY LIABILITY
The company will pay on behalf of the insured all sums which the insured shall
become legally obligated to pay as damages because of injury Iherein called
"personal injury") sustained by any person or organization and arising out of one
or more of the following offenses committed in the conduct of the named insured's
business:
Group A-false arrest, detention or imprisonment, or malicious prosecution;
Group B-the publication or utterance of a libel or slander or of other defam.
tory or disparaging material, or a publication or utterance in violation
of an individual's right of privacy; except pUblications or utterances
in the course of or related to advertising, broadcasting or telecasting
activities conducted by or on behalf of the named Insured;
Group C-wrongful entry or eviction, or other invasion of the right of private
occupancy;
if such offense is committed during the policy period within the United States of
America, its territories or possessions, or Canada, and the company shall have the
right and duty to defend any suit against the Insured seeking damages on account
of such personal injury 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 insurance does not apply:
lal to liability assumed by the insured under any contract or agreement;
lb) to personal injury arising out of the wilful violation of a penal statute or
ordinance committed by or with the knowledge or consent of any insured;
Ic) to personal injury sustained by any person as a result of an offense directly
or indirectly related to the employment of such person by the named Insured;
Id) to personal injury arising out of any publication or utterance described in
Group B, if the first injurious publication or utterance of the same or similar
material by or on behalf of the named Insured was made prior to the effective
date of this insurance;
.... ....r.
n~'UTHEiiTicO
................
Advance Pre m iums
$
$
$
$
Total Advance Premium $ inc.
Minimum Premium $
(e) to personal injury arising out of a publication or utterance described in Group B
concerning any organization or business enterprise, or its products or services.
made by or at the direction of any insured with knowledge of the falsity thereof.
II. PERSONS INSURED
Each of the following is an insured under this insurance to the extent set
forth below:
(a) if the named insured is designated in the declarations as an individual, the
person so designated and his spouse;
Ib) 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;
Ic) if the named insured is designated in the declarations as other than an indi-
vidual, partnership or joint venture, the organization so designated and any
executive officer, director or stockholder thereof while acting within the
scope of his duties as such,
This insurance does not apply to personal injury arising out of the conduct
of any partnership or joint venture of which the insured is a partner or member
and which is not designated in this policy as a named insured.
III. LIMITS OF LIABILITY; INSURED'S PARTICIPATION
Regardless of the number of Ul insureds under this policy. (2) persons or
organizations who sustain personal injury, or (3) claims made or suits brought
on account of personal injury, the total limit of the company's liability under
this coverage for all damages shall not exceed the limit of personal injury
liability stated in the schedule as "aggregate".
If a participation percentage is stated in the schedule for the insured, the
company shall not be liable for a greater proportion of any loss than the difference
between such percentage and one hundred percent and the balance of the loss
shall be borne by the insured; provided, the company may pay the insured's
portion of a loss to effect settlement of the loss, and, upon notification of the
action taken, the named insured shall promptly reimburse the company therefor.
IV, ADDITIONAL DEFINITION
When used in reference to this insurance:
"damages" means only those damages which are payable because of personal
injury arising out of an offense to which this insurance applies,