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VARIOUS CERTIFICATES OF INSURANCE AND CORRESPONDENCE West Coast Insurors, Inc. P. O. Box 10340 St. Petersburg, FL 33733 COMPANIES AFFORDING COVERAGES Head Start Child Development and Family Service 12351 - 134th Avenue North Largo, Florida 33540 COMPANY A LETTER COMPANY B LETTER Cm~PANY C LETTER COMPANY 0 LETTER COMPANY E LETTER Employers Insurance of Wausau NAME AND ADDRESS OF INSURED 24 1978 ~ . :l.tt ~l. This is to certify that policies of insurance listed below have been issued to the insured named above and are in force atthis time, TYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION DX,E GENERAL LIABILITY o COMPREHENSIVE FORM o PREMISES-OPERATIONS o EXPLOSION AND COLLAPSE H AZA RD o UNDERGROUND HAZARD o PRODUCTS/COMPLETED OPERATIONS HAZARD o CONTRACTUAL INSURA,NCE o BROAD FORM PROPERTY DAMAGE o INDEPENDENT CONTRACTORS o PERSONAL INJURY BODILY I "IJUfiY PROPERTY DAMAGE $ BODILY INJURY AND f'ROPERTY DAMAGE COMBINED PERSONAL INJURY AUTOMOBILE LIABILITY o COMPREHENSIVE FORM DOWNED o HIRED o NON-OWNED EXCESS LIABILITY BODILY INJURY (EACH PERSON) [JODIL Y INJURY (EACH OCCURRENCE) PROPERTY DAMAGE BODILY INJURY AND PROPERTY DAMAGE COMBINED A WORKERS' COMPENSATION and EMPLOYERS' LIABILITY OTHER 1419 00 051034 __1__ I I --+ i BODILY INJURY AND PHOPERTY DAMAGE COMBINED o UMBRELLA FOHM o OTHER THAN UMBHELLA FORM 3/1/ 79 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES All Operations S tate of Florida Cancellation: Should any of the above deSCribed policies be cancelled before the expiration date thereof. the issuing com- pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, NAME AND ADDRESS OFCEHTIFICATE HOLDEH City Clerk City of Clearwater P. O. Box 4748 Clearwater, Florida 33518 l DATE ISSUED 4/6/78 -----===----"" - II is importanllhallhe wrillen portions of all pOlicies covering Ihe same property read exactly alike. If lhey do no~ Ihey should be made uniform al once. INSURANCE IS PROVIDED AGAINST ONLY THOSE PERILS AND FOR ONLY THOSE COVERAGES INDICATED BELOW BY A PREMIUM CHARGE AND AGAINST OTHER_ PERILS AND FOR OTHER COVERAGES ONLY WHEN ENDORSED HEREON OR ADDED HERETO, $ 3,500 xxxxxxx $ 1. 032 $ .336 $ .011 $ $ $ $ $ $ $ $ $ $ $ 36.00 12.00 ine! FIRE AND LIGHTNING EXTENDED COVERAGE AMOUNT RATE PREPAID TERM PREMIUM DUE AT INCEPTION ANNUAL PAYMENT DUE UNDER DEF, PREM, PAY. PLAN PERI L(S) Insured Against and Cover- age(s) Provided (Insert Name of Each) VMM APR 21 1978 $ 144.00 TOTAL PREMIUM TOT AL(S) Ite-m Amount Fire or .Fire and Extended Cov- No. eroge, or Other Peril 1. ' $ 3,500 80% err -f ~ ~ On the fr... approved roof building occupied as a Pre-School situated at: 701 North Mia.ourl AYenue Clearwater, Pine11as, Florida I hereby certify that this is a true and mlact copy of Policy No,~L1:'L2i W ST COAST INWRO~;), ri"e. - - '1"'" -- ~ (; ~ Fi re District ,_ Subject to Form No(s). FGP-l; FAM-09; ISQ.J.P:iRM NUMBER(S) AND EDI TION DATE(S) BELOW -. c/__ - - att~~t,;c1 hereto. Mortgage Clause: Subject to the provisions of the mortgdge clduse dttdched hereto, loss, if dny, on building items, shdll be puYd13le to:-~ - NOTARY Pt~bU:, STATE Or-~R . .,., MY COMMf.:>Jt1:'Irt E'" !l'IR.,S' ,.. ~DA AT. lARGE _ -' ^N,~ _ """"eN I, 19111 Agency dt St. PeterslMarg, FL Jf:1~u IN CONSIDERATION OF THE PROVISIONS AND STIPULATIONS HEREIN OR ADDED HERETO AND OF the premium dbove specified, this Compdny, for the term of yedrs specified above from inception ddte shown dbove At Noon (Stdnddrd Time) to expiration date shown dbove At Noon (Stdnddrd Time) dt locdtion of property involved, to dn dmount not exceeding the dmount(s) dbove specified, does insure the insured ndmed above dnd legdl representdtives, to the extent of the dctudl cdsh vdlue of the property dt the time of loss, but not exceeding the dmount which it would cost to repdir or repldce the property with mdteridl of like kind dnd qUdlity within d redsondble time dfter such loss, without dllowdnce for dny incredsed cost of repdir or reconstruction by redson of dny ordindnce or IdW reguldting construction or repdir, dnd without compensdtion for loss resulting from interruption of business or mdnufdcture, nor in dny event for more thdn the interest of the insured, dgdinst dll DIRECT LOSS BY FIRE, LIGHTNING AND BY REMOVAL FROM PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THIS POLICY, EXCEPT AS HEREINAFTER PROVIDED, to the property described herein while locdted or contdined dS described in this policy, or pro rdtd for five ddYs dt edch proper pldce to which dny of the property shdll nec, essdrily be removed for preservdtion from the perils insured dgdinst in this policy, but not elsewhere. Assignment of this policy shdll not be vdlid except with the written consent of this Ccmpdny. This policy is mdde dnd dccepted subject to the foregoing provisions dnd stipuldtions dnd those hereindfter stdted, which Me hereby mdde d pdrt of this policy, ::::'::::::::',: :::'::::,':::::::""'0"' oed "'<<m,," "~ .dd,d hMo, " pm.,d,d '0 ,hi, poli,y ~ e-e- ~1Vf)T. INSERT NAME(S) OF MORTGAGEE(S) AND MAILING ADDRESS{ES) Countersigndture Ddte 1-25-78 vy Agent It. ~~ ~ ~.~ : .~~~ Q.:I EO ~ ~ ~ =~ -- :: ~ - > ~ ~ . 2: '0, --::: E -~~~]~~ >..~>--Ec: o __ :; .~ ~ ~ ~~~~~ ~ o .......c:: -c c ~ ~.~ .~ -g ~ ~~:~~ c: -5 ~..&l :~ Q.:I iHlH -fE~og g:t;Ec:=.-c E""'C >-. ;; ~ 0 Q.:I.:: a::. E Q) 3: ~r-,~ox~ 3: '.0 > I:;;; Q.:I I-- ~j~j{ -~ ~--~ '~ ~ -~. -: ~=o,-,=> 1--...0 ~ c~ ~ ~ Q.:I ~ 3:.= ..... ~;~~~2 ~ ;;;...:::: E ~!~ :-~! o :; -c- _== E c: .... 3: ; ~.= ...c:: ~~ ~ ~ ~ c -e ~-: 8 ~ ~ ~ggo~~ f~ ~i} ~ - Q) 0 c: Q.:I ~ ~= .= : .~ ~ ~ ~ ...c I- 0 ~ ~ ~~ ~ ; -C E E ~'E ~"(;, ~ ~ >-""C ~ ..,., ~~!~i~ ~..=~ 0'0 .:: '" .. ~- ,...'" ..:::l zS: :;~ :E:E - ....'''' ....B:;z cCvo ....>e- "'........ ~ c '" ~ c:; z i o >- ~ The extent of the doot iCdt,on of insurance under this policy and 'of the contribution to be made by this Compdny in case of loss, and dny other pro- vision or dgreement 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 forfziture shall be held to be waived by any requirement or proceeding on the part of this Company relating to appraisdl or to dni eXdmination provided fJr huein. Cancellation This policy shall be cancelled dt any time of policy. at the request of the insured, in which case this Company shall, upon demdnd and sur- render of this policy, refund the excess of paid premium above the customdlY 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 cdncellatlon 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 re'funded on demand, Notice of cancellation shall state that said excess premium (if not tenderedl 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 b! giving to such mortgagee a ten days' written notice of can- cellation, If the insured fails to render proof of loss such mortgagee, upon notice, shall render proof of loss in the form herein specified within sixty (60) days thereafter and shall be subject to the pro- visions hereof relating to appraisal and time of payment and of bringing suit, If this Company shall claim thdt 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 impallle,g mortgagee's right to sue; or it may payoff the mortgage debt and require an assignment thereof and of the mortgage Other provisions ... I. 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 bedl to the whole insurance covellng 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 sepdlate the damaged and undamaged personal property, put 94 it in the best possible order, furnish a complete inventorv of 95 the destroyed, damaged and undamaged property, showing in 96 detdil 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 anc origin of the loss, the interest of the 102 insured ,and of all others in the property, the actual cash value of 103 each item thereof and the amount of loss thereto, all en cum- 104 brances thereon, all other contracts of insurance, whether valid 105 or not, covering any of said property, any changes in the title, 106 use, OCCupation, location, possession or exposures of So,d prop- 107 er~, since the IS5'"lng of this policy, 0/ whom and for what 108 purpose ani bUlioing herein described and the several parts 109 thereof, were occupied at the time of 100ss a;;d''v'/heth€r or not it 110 then stood on leased ground, and shall rurnl5na c0;>Y -of all the 111 descriptions and schechdes in aJ:i f1Kiii~s and, it r~([;_~dr)/eiified 112 plans and specifications of ~n\,-, blii Iding, fil<tL!res 01 machinery 113 demo ,ed or da,-11dged, The ie,sured,os -"TteR as' may be r~son- 114 dO" reClJired, shail exhibit -m:- ~n'i' pers()n~desi;Jnated by this 115 C'-;:Jdn, dll that rema,ins oE: am:: pro-pertr~i';erei~ -described; and 116 seo"",t to examinations under oath by ilnY pc.rs(".n named. !:iy this 117 Co~pcn., andsub-s'Ccibe-tl'ii' sarll~i .~fiCL.. asoften as may be 118 re'lsolcbl, required, shatl pre.du.~ fQr examination all 'books of 119 acco_nt. bills, invoices and'other.<;c.Ucner.s, or certified copies 120 th~re:Jf ,f 013inals be lost, dtsuch re4~~~bl~ time and place as 121 ma, be designated, by this Company"or itsr~presentative, and 122 shdll permit extractsandcopies thereof tcibemade, 123 Appraisal. In case the insured and this Company shall 124 fail to agree as to the actual cash value or 125 the a'11ount 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 in 132 the state in which the property covered is located. The ap- 133 praisers shall then appraise the loss, stating separately actual 13.<ush~'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 When loss 151 payable. 152 153 154 155 156 157 158 159 160 161 162 163 164 any party for loss 165 by this Company, 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 re- 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, Tile amount of loss for which this Company may be liable shall be payable sixty days after proof of loss, as herein provided, is received by this Company and ascertainment 01 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 shall have 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 to the extent that payment therefor is made I . .., -- 1 Concealment, This entire policy shall be void if, whether 2 fraud. before or after a loss, the insured has wil- 3 fully concealed or misrepresented any ma- 4 terial fact or circumstance concerning this insurance or the 5 subject thereof, or the interest of the insured therein, or in case 6 of any fraud or false swearing by the insured relating thereto. 7 Uninsurable This policy shall not cover accounts, bills, 8 and currency, deeds, evidences of debt, money or 9 excepted property. securities; nor, unless specifically named 10 hereon in writing, bullion or manuscripts, 11 Perils not This Company shall not be liable for loss by 12 included. fire or other perils insured against in this 13 policy caused, directly or indirectly, by: (a) 14 enemy attack by armed forces, including action taken by mili- 15 tdlY, naval or air forces in resisting an actual or an im'11ediately 16 imf)ending enemy attack; (b) invasion; (c) insurrection; (d) 17 rebellion; (e) revolution; (f) civil war; (g) usurped power; (h) 18 order of any civil authority except acts of destruction at the time 19 of and for the purpose of preventing the spread of fire, provided 20 that such fire did not originate from an! of the perils excluded 21 by thiS poliCY; I i) negler of the insured to use all re'lsondble 22 means to save and preserve the property dt and cfter c 1:)55, C' 23 when the property is endangered by fire in nGi3hb~,'n3 ore,,- 24 Ises; (ji nor shall this Company be liable for loss by theft 25 Othcar Insurance. Other insurance may be prohibited or the 26 amount of insurance ma'/ be limited by en- 27 dorsement attached hereto, 28 Conditions suspending or rcastricting insurancca. Unless other- 29 wise provided in writing added hercato this Company shall not 30 be liable For loss occurring 31 (0) while the hazard is increased bv a1\ ,,'~jns within the c)n- 32 trol or knowledge of the insured;' or 33 ib) while a described building, whether 'n~'2"ded for occupancy 34 by owner or tenant, is vacant or unoccupied e>e/.::>nd a period of 35 sixty consecutive days; or 36 (c', as a result of explosion or riot, unl,:s; I,e ensue, and in 37 that event for loss by fire only, 38 Other perils Any other peril to be :rs.,r~d against or sub- 39 or subjects, ject of insurance to be coyered in this policy 40 shall be by endorsement in writing hereon or 41 added hereto, 42 Added provisions. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 ~ 60 ~,' ~ 61 ~ ~ ~ ~ 62 >- c ~ >-.~ 63 .g ~ ~ . ~ e t 64 ii ~ ~ ~ ~ ~ 65 ~ ~. ~ ~ g, ~ ~o 66 ~.", ~ ~-5 ~.; 67 ~.g~~;; ~~ g,68 ~ ~ ~= r2:; ;; -5 69 ~ ! ~ ~ :; ~ ~ 70 ~ij{~~~ ;~ :~~;~!~~ ;~ -:::~~~E~76 ~~~~~i~ ;~ ~: ~ E : ~ c 80 ~ ~ a ~;= ~ ~ 81 z-:~ ;c~ ~ 82 ~ ~ ~~ C ~:i ~ 83 o~~]~!:c ~~::>o5 ~Q);=;=:ai:~ ~~ ~ ~ ~ ~ ~ _0.." >-........ ~:~ !~~ ~e~ zzz ( I I ":.~ <m 150-105 (Ed. 1-77) EFFECTIVE TIME ENDORSEMENT The time of inception and the time of expiration of this policy and of any schedule or endorsement attached shall be 12:01 a,m. standard time, To the extent that coverage in this policy replaces coverage in other policies terminating noon standard time on the inceptIOn date of this policy, coverage under this policy shall not become effective until such other coverage has terminated, 150-105 (Ed, 1-77) ( I I FLORIDA AMENDATORY ENDORSEMENT Form FAM-09 (Ed. 6-76) $ I. The following provision is added when the Coinsurance Clause applies. Coinsurance Contract: The rate charged in this policy is based upon use of a coinsurance clause attached hereto with the consent of the Insured, II. The Deductible Clause in the form made a part of this policy is replaced by the following: A, No deductible is applicable to the perils of fire, lightning or removal. B. When this policy is extended to include the Extended Coverage or Vandalism or Malicious Mischief perils, the fOllowing deductibles shall apply: The sum of $100 shall be deducted from the amount of loss to property in anyone occurrence resulting from the perils of Windstorm or Hail. The sum of $50 shall be deducted from the amount of loss to property in anyone occurrence resulting from the perils of Smoke, Explosion, Riot, Riot Attending a Strike or Civii Commotion, Aircraft or Vehicles, or Vandalism or Malicious Mischief. This deductible shall apply separately to each building (including personal property therein), separately to personal property in each building if no coverage is provided on the containing building and separately to personal property in the open (including within vehicles). The aggregate amount of this deductible in anyone occurrence shall not exceed $1,000. This deductible shall not apply to insurance covering Business Interruption, Tuition Fees, Extra Expense, Rent or Rental Value or leasehold Interest. III. The following clause is applicable to all properties located in the Counties of Broward, Dade, Martin and Palm Beach when this policy is extended to include the Extended Coverage peril of Windstorm: Windstorm Exterior Paint and Waterproofing Clause: It is hereby stipulated that coverage under this policy does not include damage caused in any manner by windstorm to paint or waterproofing material, applied to the exterior of the buildings or structures covered hereunder. The value of paint or water- proofing material shall not be considered in the determination of the amount of deductible and the actual cash value when applying the Coinsurance Clause, when loss, is caused by windstorm, IV. The following clause applies only when credit in rate is allowed: Fire Protection Clause: In consideration of the rate at which this policy is written, it is a condition of this policy that the named Insured shall: (1) Exercise due diligence in maintaining in complete working order all equipment and services (so far as they are within the control of the named Insured) installed for the detection, prevention and extinguishment of fire at or in the property covered by this policy; (2) give immediate notice of any impairment in or suspension of such protective services (within the knowledge of the named Insured) to this Company; and, (3) make no change in any sprinkler system, its water or chemical supplies, or any watchman service unless immediate notification is given to this Company_ Failure to comply with the above provisions shall suspend this insurance as respects the location where the breach occurs for the duration of the breach. Form FAM-09 (Ed,6-76) ., I I ,.~\ . ,. . , L' .~~ '0, GENERAL PROPERTY FORM Form FGP-1 (EeL 6-75) Insurance applies only to item(s) specifically described in this policy for which an amount of insurance is shown and, unless otherwise provided, all provisions and stipulations of this form and policy shall apply separately to each such item. SECTION I-PROPERTY COVERED When the insurance under this policy covers "Building(s)", "Personal Property of the Insured", or "Personal Property of Others" such insurance shall cover in accordance with the following description(s) of coverage, COVERAGE A-BUlLDING(S): Building(s) or structure(s) shall include at- This coverage shall also include Tenant's Improvements and Betterments, tached additions and extensions; fixtures, machinery and equipment con- when not otherwise specifically covered, Tenant's Improvements and Bet- stituting a permanent part of and pertaining to the service of the building; terments means the named Insured's use interest in fixtures, alterations, yard fixtures; personal property of the named Insured used for the mainte- installations or additions comprising a part of the buildings occupied but nance or service of the described building(s), including fire extinguishing not owned by the named Insured and made or acquired at the expense of the apparatus, outdoor furniture, floor coverings and appliances for refrigerat- named Insured exclusive of rent paid by the named Insured, but which are ing, ventilating, cooking, dishwashing and laundering (but not including not legally subject to removal by the named Insured, other personal property in apartments or rooms furnished by the named COVERAGE C-PERSONAL PROPERTY OF OTHERS.. This I'nsurance shall Insured as landlord); all while at the described locations, cover for the account of the owner(s) (other than the named Insured) COVERAGE B-PERSONAL PROPERTY OF THE INSURED: Personal property personal property belonging to others in the care. custody or control of the of the Insured means only business personal property. owned by the named named Insured, while (1) in or on the described buildings, or (2) in the open Insured usual to the occupancy of the named Insured, including bullion, (including within vehicles) on or within 100 feet of the described premises, manuscripts, furniture, fixtures, equipment and supplies, not otherwise covered under this policy, and shall also include the named Insured's Loss shall be adjusted with the named Insured for the account of the interest in personal property owned by others to the extent of the value of owner(s) of the property, except the right to adjust such loss with the labor, materials and charges furnished, performed or incurred by the owner(s) is reserved to this Company and the receipt(s) of the owner(s) in named Insured; all while (1) in or on the described buildings, or (2) in the satisfaction thereof shall be in full satisfaction of any claim by the named open, (including within vehicles) on or within 100 feet of the described Insured for which payment(s) has been made, This coverage shall not premises, otherwise benefit the named Insured nor any carrier or other bailee, DEBRIS REMOVAL: 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 amount of Insurance applying under this policy to the property covered, This Company shall not be liable for a greater proportion of such debris removal expense than the amount of insurance under this policy bears to the whole amount of insurance covering the property against the peril causing the loss, whether or not other insurance covers such expense, SECTION II-PROPERTY NOT COVERED A. THIS POLICY DOES NOT COVER: 1. Animals and pets; 2, Aircraft; watercraft, including motors. equipment and accessories (except rowboats and canoes while out of water and on the described premises); 3, Growing crops and lawns; 4, Personal property while waterborne; 5, Property which is more specifically covered in whole or in part by this or any other contract of insurance, except for the amount of loss which is in excess of the amount due from such more specific insurance; 6, Personal property in which parties other than the named Insured also have an insurable interest, when the named Insured's interest in said property is otherwise covered by insurance, B. THIS POLICY DOES NOT COVER THE FOLLOWING PROPERTY UNLESS SPECIFICALLY DESCRIBED ON THE FIRST PAGE OF THIS POLICY OR BY ENDORSEMENT: 1. Vehicles designed for use on public thoroughfares; 2, Outdoor signs. whether or not attached to a building or structure; 3, Outdoor trees, shrubs and plants, except as provided in Section III-Extensions of Coverage; 4, Outdoor swimming pools; fences; piers, wharves and docks; beach or diving platforms or appurtenances; retaining walls not constitut- ing a part of buildings; walks, roadways and other paved surfaces C. THIS POLICY DOES NOT COVER THE FOLLOWING PROPERTY WHEN SEC- TION IV-COINSURANCE CLAUSE APPLIES, UNLESS ADDED BY ENDORSE- MENT: 1. Cost of excavations, grading or filling; 2, Foundations of buildings. machinery, boilers or engines which foundations are below the undersurface of the lowest basement floor, or where there is no basement, below the surface of the ground; 3, Pilings, piers. pipes, flues and drains which are underground; 4, Pilings which are below the low water mark, THE ABOVE EXCLUSIONS SHALL NOT APPLY TO THE FOLLOWING PROPERTY WHEN HELD FOR SALE OR SOLD BUT NOT DELIVERED: 1. Animals and pets; 2, Watercraft, including motors, equipment and accessories, while not afloat; 3, Outdoor trees, shrubs and plants, SECTION III-EXTENSIONS OF COVERAGE (THIS SECTION IS APPLICABLE ONLY WHEN 80% OR HIGHER COINSURANCE CLAUSE APPLIES) When the named Insured elects to apply the following Extensions of Coverage: A, The liability of this Company for loss in anyone occurrence, including loss under these Extensions. shall not exceed the amount of insurance applicable to the coverage(s) being extended, except as provided under Extension No 1. B, This company shall not be liable for a greater proportion of any loss than would have been the case if all fire insurance policies covering the described property had contained an identical Extension of Coverage and the same election were made under all such policies C. When there is other insurance, whether collectible or not, this Company shall not be liable for more than its pro rata share of the amounts set forth in these Extensions of Coverage, 1. PERSONAL PROPERTY OF OTHERS: The named Insured may apply at each location up to 2%, but not exceeding $2,000, of the amount of insurance for Coverage B-Personal Property of the Insured at such loca- tion, as an additional amount of insurance, to cover for the account of the Form FGP-1 (~, 6-75) owner(s) (other than the named Insured), direct loss by a peril Insured against to personal property similar to that covered by this policy. belong- ing to others in the care, custody or control of the named Insured, while (1) in or on the described buildings, or (2) in the open (including within vehicles) on or within 100 feet of the described premises, Page 1 of 4 loss shall be adjusted with the named Insured for the account of the owner(s) of the property, except that the right to adjust such loss with the owner(s) is reserved to this Company and the receipt(s) of the owner(s) in satisfaction thereof shall be in full satisfaction of any claim by the named Insured for which payment(s) has been.made.This Extensionof Coverag~_ sh-alrffiltotfierwlseoenelirflle-named Insured nor any carrier or other bailee, 2. OFF-PREMISES: The named Insured may apply up to 2%, but not exceeding $5,000, of the sum of the amount(s) of insurance for Coverage A-Buildlng(s) and Coverage B-Personal Property of the Insured at a described location, to cover direct loss by a periljnsured against to such property, other than merchandise or stock (raw, in process, or finished). owned by the named Insured, while such property is temporarily removed for purposes of cleaning, repairing, reconstruction or restoration. This Extension of Coverage shall: (a) not apply to property in transit nor to property on any premises owned, leased, operated or controlled by the named Insured; (b) not apply except as excess over the amount due from any other insurance covering the property, whether collectible or not; (c) not directly or indirectly benefit any carrier or other bailee, 3. NEWLY ACQUIRED PROPERTY: A, The named Insured may apply up to 10%, but not exceeding $25,000, of the amount of insurance for Coverage A-Building(s) to cover direct loss by a peril insured against to the following described property: (1) New buildings and new structures being constructed on the described premises and intended for similar occupancy, This coverage shall cease 30 days from the date construction begins or on the date the values of new construction are reported to this Company, or on the expiration date of the policy, whichever occurs first. --. . - (2) Buildings acquired by the named Insured at any location, elsewhere than at the described premises, within the fifty states of the United States of America and the District of Columbia and used by him for similar occupancies or warehouse purposes, This coverage shall cease 30 days from the date of such acquisition or on the date values of the buildings are reported to this Company, or on the expiration date of the policy, whichever occurs first. B, The named Insured may apply up to 10%, but not exceeding $10,000, of the amount of insurance for Coverage B-Personal Prop- erty of the Insured to cover direct loss in anyone occurrence by a peril insured against to such property at any location (except fairs and exhibitions) acquired by the named Insured, elsewhere than at the described premises, within the fifty states of the United States of America_and_theDistrict-of Columbia, This coverage shall cease 30 days from the date of such acquisition or on the date values at such locations are reported to this Company, or on the expiration date of the policy, whichever occurs ,first. Additional premium shall be due and payable for values so reported from the date construction begins or the property is acquired. 4. PERSONAL EFFECTS: The named Insured may apply up to 5%, but not exceeding $500, of the amount of insurance for Coverage B-Personal Property of the Insured to cover direct loss by a peril insured against to personal effects while located on the described premises, belonging to the named Insured, officers, partners or employees thereof, and limited to $100 on personal effects owned by anyone individual. This Extension of Coverage does not apply if the loss is covered by any other insurance, whether collectible or not, or which would have been covered by such other insurance in the absence of this policy, At the option of this Company, loss under this Extension of Coverage may be adjusted with and payable to the named Insured. 5. VALUABLE PAPERS AND RECORDS: The named Insured may apply up to 5%, but not exceeding $500, of the amount of insurance for Coverage B- Personal Property of the Insured at a described location to cover direct loss by a peril insured against under this policy to valuable papers and records, This Extension of Coverage covers only the cost of research and other expense necessarily incurred by the named Insured to reproduce, replace, or restore such valuable papers and records consisting of books of account, manuscripts, abstracts, drawings, card index systems, film, tape, disc, drum, cell and other magnetic recording or storage media for electronic data processing, and other records, allJhe property of the named Insured at such location(s), . 6, OUTDOOR TREES, SHRUBS AND PLANTS: The named Insured may apply up to 5%, but not exceeding $1,000, of the sum of the amount(s) of insurance for Coverage A-Building(s) and Coverage B-Personal Property of the Insured to cover outdoor trees, shrubs and plants at the location(s) described in this policy against direct loss in anyone occurrence by the perils of fire, lightning, explosion, riot, civil commotion or aircraft, but only to the extent such perils are insured against. This Company shall not be liable for more than $250 on anyone tree, shrub or plant, including debris removal expense. SECTION IV-COINSURANCE CLAUSE (THIS CLAUSE VOIO UNLESS A PERCENTAGE IS SPECIFIED IN THE APPROPRIATE SPACE ON THE FIRST PAGE OF THIS POLICY OR BY ENDORSEMEND This Company shall not be liable for a greater proportion of any loss to the property covered than the amount of insurance under this policy for such property bears to the amount produced by multiplying the actual cash value of such property at the time of the loss by the coinsurance percentage applicable (specified on the first page of this policy, or by endorsement). In the event that the aggregate claim for any loss is both less than $10,000 and less than 5% of the total amount of insurance applicable to the property involved at the time such loss occurs, no special inventory or appraisement of the undamaged property shall be required, providing that nothing herein shall be construed to waive the application of the first paragraph of this clause. The value of property covered under Extensions of Coverage, and the cost of the removal of debris, shall not be considered in the determination of actual cash value when applying the Coinsurance Clause, SECTION V-DEDUCTIBLE CLAUSE The sum of $100 shall be deducted from the amount of loss to property in anyone occurrence resulting from any of the perils insured against. This deductible shall apply separately to each building (including personal property therein), separately to personal property in each building if no coverage is provided on the containing building and separately to personal property in the open (including within vehicles). The aggregate amount of this deductible in anyone occurrence shall not exceed $1,000, This deductible shall not apply to insurance covering Business Interrup- tion, Tuition Fees( Extra Expense, Additional liVing Expense, Rent or Rental Value or leaseho d Interest. SECTION VI-PERILS INSURED AGAINST This policy insures against all direct loss caused by: 1. FIRE OR LIGHTNING, 2. REMOVAL, meaning loss by removal of the property covered hereunder from premises endangered by the perils insured against, and the amount of insurance applies pro rata for 5 days at each proper place to which such property shall necessarily be removed for preservation from the perils insured against. This policy is extended to insure against direct loss by Windstorm, Hail, Smoke, Explosion, Riot, Riot Attending A Strike, Civil Commotion, Aircraft And Vehicles as hereinafter provided, only when premium for EX- TENDED COVERAGE is shown on the first page of this policy or by endorsement. 3, WINDSTORM OR HAIL, excluding loss caused directly or indirectly by frost or cold weather, or ice (other than hail), snow or sleet, whether driven by wind or not. A, This Company shall not be liable for loss to the interior of the building(s) or the property covered therein caused: Form FGP-1 (El!., 6-75) I (1) by rain, snow, sand or dust, whether driven by wind or not, unless the building(s) covered or containing the property cov- ered shall first sustain an actual damage to roof or walls by the direct action of wind or hail and then shall be liable for loss to the interior of the building(s) or the property covered therein as may be caused by rain, snow, sand or dust entering the build- ing(s) through openings in the roof or walls made by direct action of wind or hail; or (2) by water from sprinkler equipment or from other piping, unless such equipment or piping be damaged as a direct result of wind or hail. B. This Company shall not be liable for Windstorm or Hail damage to the following property: (1) Windmills, wind pumps or their towers; (2) Crop silos or their contents; (3) Metal smokestacks; or Page 2 of 4 I (4) When outsid~ of b'uildings, I (a) Grain, hay, straw or other crops, (b) Trees, shrubs or plants, (c) Awnings of fabric or slat construction, canopies of fabric or slat construction, including their supports, (d) Radio or television antennas, including tneir lead-in wiring, masts or towers, 4. SMOKE, meaning sudden and accidental damage from smoke, other than smoke from agricultural smudging or industrial operations. 5. EXPLOSION. including direct loss resulting from the explosion of accu- mulated gases or unconsumed fuel within the firebox (or combustion chamber) of any fired vessel or within the flues or passages which conduct the gases of combustion therefrom, A, This Company shall not be liable for loss by explosion of steam boilers, steam pipes, steam turbines or steam engines, if owned by, leased by or operated under the control of the Insured. 8. The following are not explosions within the intent or meaning of these provisions: (1) Shock waves caused by aircraft, generally known as "sonic boom", (2) Electric arcing, (3) Rupture or bursting of rotating or moving parts of machinery caused by centrifugal force or mechanical breakdown, (4) Water hammer, (5) Rupture or bursting of water pipes, (6) Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water, _ (7) Rupture, bursting or operation of pressure relief devices. 6. RIOT, RIOT mENDING A STRIKE OR CIVIL COMMOTION. including direct loss by acts of striking employees of the owner or tenant(s) of the described building(s) while occupied by said striking employees and shall also include direct loss from pillage and looting occurring during and at the immediate place of a riot. riot attending a strike or civil commotion. This Company shall not be liable for loss resulting from damage to or destruc- tion of property due to change in temperature or humidity or interruption of operations whether or not such loss is covered by this policy as to other perils. 7. AIRCRAFT OR VEHICLES, meaning only direct loss resulting from actual physical contact of an aircraft or a vehicle with the property covered or with the building(s) containinlthe property co:red, exc~Pt that loss by aircraft includes direct loss by 0 jects falling therefrom. This Company shall not be liable for loss: (1) by any vehicle owned or operated by an Insured or by any tenant of the described premises; (2) by any vehicle to fences, driveways, walks, or when outside of buildings, to trees, shrubs or plants; (3) to any aircraft or vehicle including its contents other than stocks of aircraft or vehicles in process of manufacture or for sale. The word "vehicles", means vehicles running on land or tracks but not aircraft. The word "aircraft", shall include self-propelled missiles and spacecraft. This policy is extended to insure against direct loss by Vandalism or Malicious Mischief as hereinafter pro- vided, only when premium for VANDALISM AND MALI- CIOUS MISCHIEF is shown on the first page of this policy or by endorsement. 8. VANDALISM OR MALICIOUS MISCHIEF, meaning only the willful and mal icious damage to or destruction of the property covered, This Company shall not be liable for loss- A, to glass (other than glass building blocks) constituting part of a building, structure or an outside sign; 8. by pilferage, theft, burglary or larceny, except that this Company shall be liable for willful damage to the building(s) covered caused by burglars; C. by explosion of steam boilers, steam pipes, steam turbines or steam engines, if owned by, leased by, or operated under the control of the named Insured; or by rupture or bursting of rotating or moving parts of machinery caused by centrifugal force or mechanical break- down; D. from depreciation, delay, deterioration or loss of market; nor for any loss resulting from change in temperature or humidity; E. if the described building(s) had been vacant or unoccupied beyond a period of 30 consecutive days immediately preceding the loss, whether or not such period commenced prior to the inception date of insurance against these perils; but a building in process of construc- tion shall not be deemed vacant or unoccupied, nor shall the unoccu- pancy provision be applicable to private dwelling property. (The words "vacant" and "unoccupied" are defined in Section IX, paragraph 8.) SECTION VII-EXCLUSIONS 1. ELECTRICAL APPARATUS: This Company shall not be liable for any loss resulting from any electrical injury or disturbance to electrical appliances, devices, fixtures or wiring caused by electrical currents artificially gener- ated unless fire as insured against ensues, and then this Company shall be liable for only its proportion of loss caused by the ensuing fire, 2. NUCLEAR CLAUSE (Not applicable in New York): The word "fire" in this policy or endorsements attached hereto is not intended to and does not embrace nuclear reaction or nuclear radiation or radioactive contamina- tion, all whether controlled or uncontrolled, and loss by nuclear reaction or nuclear radiation or radioactive contamination is not intended to be and is not insured against by this policy or said endorsements, whether such loss be direct or indirect. proximate or remote, or be in whole or in part caused by, contributed to, or aggravated by "fire" or any other perils insured against by this policy or said endorsements; however, subject to the foregoing and all provisions of this policy, direct loss by "fire" resulting from nuclear reaction or nuclear radiation or radioactive contamination is insured against by this policy, 3. NUCLEAR CLAUSE (Applicable in New York): This policy does not cover loss or damage caused by nuclear reaction or nuclear radiation or radioac- tive contamination, all whether directly or indirectly resulting from an insured peril under this policy. 4. NUCLEAR EXCLUSION (Not applicable in New York): (This clause ap- plies to all perils insured against hereunder except the perils of fire and lightning, which are otherwise provided for in the Nuclear clause above): Loss by nuclear reaction or nuclear radiation or radioactive contamination, all whether controlled or uncontrolled, or due to any act or condition incident to any of the foregoing, is not insured against by this policy, whether such loss be direct or indirect, proximate or remote, or be in whole or in part caused by, contributed to, or aggravated by any of the perils insured against by this policy; and nuclear reaction or nuclear radiation or radioactive contamination, all whether controlled or uncontrolled, is not "explosion" or "smoke", 5. ORDINANCE OR LAW: This Company shall not be liable for loss, includ- ing debris removal expense, occasioned directly or indirectly byenforce- ment of any ordinance or law regulating the use, construction, repair or demolition of property, unless such liability is otherwise specifically as- sumed by endorsement. Form FGP-1 (E!!, 6-75) 6. POWER FAILURE: This Company shall not be liable for loss caused directly or indirectly by the interruption of power or other utility service furnished to the described premises if the interruption takes place away from the described premises, If a peril insured against ensues on the described premises, this Company shall be liable for only its proportion of loss caused by the ensuing peril. 7, WAR RISK (This clause applies to all perils insured against hereunder except the perils of fire, lightning and removal which are otherwise pro- vided for in this policy): This Company shall not be liable for loss caused directly or indirectly by: A, hostile or warlike action in time of peace or war, including action in hindering, combating or defending against an actual, impending or expected attack, (1) by any government or sovereign power (de jure or de facto), or by any authority maintaining or using military, naval or air forces; or (2) by military, naval or air forces; or (3) by an agent of any such government. power, authority or forces, it being understood that any discharge, explosion or use of any weapon of war employing nuclear fission or fusion shall be conclUSively presumed to be such a hostile or warlike action by such a government. power, authority or forces; 8, insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating or defending against such an occurrence, 8. WATER EXCLUSION: This Company shall not be liable for loss caused by, resulting from, contributed to or aggravated by any of the following: A, flood, surface water, waves, tidal water or tidal wave, overflow of streams or other bodies of water, or spray from any of the foregoing, all whether driven by wind or not; 8, water which backs up through sewers or drains; C. water below the surface of the ground including that which exerts pressure on or flows, seeps or leaks through sidewalks, driveways, foundations, walls, basement or other floors, or through doors, windows, or any other opening in such sidewalks, driveways, founda- tions, walls or floors; unless fire or explosion as insured against ensues, and then this Company shall be liable for only its proportion of loss caused by the ensuing fire or explosion, Page 3 of 4 SECTION VIII-VALUATION The following bases are established for valuation of property: 1. All property at actual cash value, except as provided below or by endorsement. "2. The vaTlJeo(allsfClckaCtualiysoldbutllofdelilleredshall be the price at which it was sold, less all discounts and unincurred expenses, 3, Tenant's Improvements and Betterments: A. If repaired or replaced at the expense of the named Insured within a reasonable time after loss, the actual cash value of the damaged or destroyed improvements and betterments, B, If not repaired or replaced within a reasonable time after loss, that proportion of the original cost at time of installation of the damaged or destroyed property which the unexpired term of the lease or rental agreement, whether written or oral, in effect at the time of loss bears to the periods from the dates such improvements or betterments were made to the expiration date of the lease, C, If repaired or replaced at the expense of others for the use of the named Insured, there shall be no liability hereunder. 4. Valuable Papers and Records: A, Books of account, manuscripts, abstracts, drawings, card index systems and other records (except film, tape, disc, drum, cell and other magnetic recording or storage media for electronic data pro- cessing) for not exceeding the cost of blank books, cards or other blank material plus the cost of labor incurred by the named Insured for transcribing or copying such records, B. Film, tape, disc, drum, cell and other magnetic recording or storage media for electronic data processing for not exceeding the cost of such media in unexposed or blank form. SECTION IX-OTHER PROVISIONS 1. APPORTIONMENT: This Company shall not be liable for agreater pro- portion of any loss less the amount of the deductible, if any, from any peri I or perils included in this policy than (A) the amount of insurance under the policy bears to the whole amount of fire insurance covering the property, or which would have covered the property except for the existence of this insurance, whether collectible or not, and whether or not such other fire insurance covers against the additional peril or perils insured against hereunder, nor (B) for a greater proportion of any loss less the amount of the deductible, if any, than the amount hereby insured bears to all insurance, whether collectible or not, covering in any manner such loss, or which would have covered such loss except for the existence of this insurance; except if any type of insurance other than fire extended to cover additional perils or windstorm insurance applies to any loss to which this insurance also applies, or would have applied to any such loss except for the existence of this insurance, the limit of liability of each type of insurance for such loss, hereby designated as "joint loss", shall first be determined as if it were the only insurance, and this type of insurance shall be liable for no greater proportion of joint loss than the limit of its liability for such loss bears to the sum of all such limits. The liability of this Company (under this policy) for such joint loss shall be limited to its proportionate part of the aggregate limit of this and all other insurance of the same type. The words "joint loss", as used in the foregoing, mean that portion of the loss in excess of the highest deductible, if any, to which this policy and other types of insurance above referred to both apply, 2. CONTROL OF PROPERTY: This insurance shall not be prejudiced by any act or neglect of any person (other than the named Insured), when such act or neglect is not within the control of the named Insured, 3, DIVISIBLE CONTRACT CLAUSE: If this policy covers two or more build- ings or the contents of two or more buildings, the breach of any condition or warranty of the policy in anyone or more of the buildings covered or containing the property covered shall not prejudice the right to recover for loss occurring in any building covered or containing the property covered, where at the time of loss a breach of condition or warranty does not exist. 4. INSPECTION OF PROPERTY AND OPERATIONS: This Company and any person or organization making inspections on the Company's behalf shall be permitted but not obligated to inspect the named Insured's property and operations at any time, Neither the right of this Company and any person or organization to make such inspections nor the making thereof nor any report thereon shall constitute an undertaking, on behalf of or for the benefit of the named Insured or others, to determine or warrant that such property or operations are safe or healthful, or are in compliance with any law, rule or regulation. 5. LIBERALIZATION: If during the period that insurance is in force under this policy, or within 45 days prior to the inception date thereof, on behalf of this Company there be adopted or fi led with and approved or accepted by the Insurance supervisory authorities, all In conformity with law, any changes in the form attached to this policy by which this form of insurance could be extended or broadened without increased premium charge by endorsement or substitution of form, then such extended or broadened insurance shall inure to the benefit of the named Insured hereunder as though such endorsement or substitution of form had been made, 6. LOSS CLAUSE: Any loss hereunder shall not reduce the amount of this policy, 7. MORTGAGE CLAUSE (Not applicable in Minnesota): (Applies only to building items and is effective only when policy is made payable to a named mortgagee or trustee,) Loss or damage, if any, under this policy, shall be payable to the mortga- gee (or trustee), named on the first page of this policy, as interest may appear, under all present or future mortgages upon the property herein described in which the aforesaid may have an interest as mortgagee (or trustee) in order of precedence of said mortgages, and this insurance, as to the interest of the mortgagee (or trustee) only therein, shall not be invali- dated by any act or neglect of the mortgagor or owner of the within described property, nor by any foreclosure or other proceedings or notice of , sale relating to the property, nor by any change in the title or ownership of the property, nor by the occupation of the premises for purposes more hazardous than are permitted by this policy; provided, that In case the mortgagor or owner shall neglect to pay any premium due under this policy, the mortgagee (or trustee) shall, on demand pay the same. Form FGP-1 (~, 6-75,,), . I Provided, also, that the mortgagee (or trustee) shall notify this Company of any change of ownership or occupany or increase of hazard which shall come to the knowledge of said mortgagee (or trustee) and, unless permitted by this policy, it shall be noted thereon and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof; otherwise this policy shall be null and void, This Company reserves the right to cancel this policy at any time as provided by its terms, but in such case this policy shall continue in force for the benefit only of the mortgagee (or trustee) for 10 days after notice to the mortgagee (or trustee) of such cancellation and shall then cease, and this Company shall have the right, on like notice, to cancel this agreement. Whenever this Company shall pay the mortgagee (or trustee) any sum for loss under this policy and shall claim that, as to the-mortgagor or owner, no liability therefor existed, this Company shall, to the extent of such payment, be thereupon legally subrogated to all the rights of the party to whom such payment shall be made, under all securities held as collateral to the mortgage debt,or may, at its option, pay to the mortgagee (or trustee) the whole principal due or to grow due on the mortgage with interest, and shall thereupon receive a full assignment and transfer of the mortgage and of all such other securities; but no subrogation shall impair the right of the mortgagee (or trustee) to recover the full amount of said mortgagee's (or trustee's) claim, 8. PERMITS AND USE: Except as otherwise provided, permission is granted: A, to make additions, alterations and repairs, This policy insofar as it covers building(s) or structure(s), is extended to cover additions, alterations and repairs, when not otherwise covered by insurance, including temporary structures constructed on site, materials, equip- ment and supplies therefor on or within 100 feet of the described premises; and this policy, insofar as it covers contents, is extended to cover in such additions, This provision does not waive or modify any of the conditions of the Automatic Sprinkler Clause, if any, attached to this policy; B. for such unoccupancy as is usual or incidental to the described occupancy; but vacancy is limited to the 60 day period permitted by the policy conditions ("Vacant" or "Vacancy" means containing no contents pertaining to operations or activities customary to occu- pancy of the building. "Unoccupied" or "Unoccupancy" means con- taining contents pertaining to occupancy of the building while opera- tions or other customary activities are suspended); C, in the event of loss hereunder, to make reasonable repairs, temporary or permanent, provided such repairs are confined solely to the protection of the property from further damage, and provided further that the named Insured shall keep an accurate record of such repair expenditures, The cost of any such repairs directly attributable to damage by any peril insured hereunder shall be included in determining the amount of loss hereunder. Nothing herein contained is intended to modify the policy requirements applicable in case loss occurs, and in particular the requirement that, in case loss occurs, the named Insured shall protect the property from further damage, 9. PROTECTIVE SAFEGUARDS: It is ,a condition of this insurance that the insured shall maintain so far as is within his control such protective safeguards as are set forth by endorsement hereto, Failure to maintain such protective safeguards shall suspend this insur- ance, only as respects the location or situation affected, for the time of such discontinuance, 10. PROVISIONS APPLICABLE ONLY WHEN THIS POLICY COVERS BUSINESS INTERRUPTION, TUITION FEES, EXTRA EXPENSE, ADDITIONAL LIVING EX- PENSE, RENT OR RENTAL VALUE, LEASEHOLD INTEREST OR OTHER CONSE- QUENTIAL LOSS: The term "direct", as applied to loss, means loss, as limited and conditioned in this policy, resulting from direct loss to described propertr from the peri I(s) insured against. If the business of the owner or tenant(s of the described building(s) is interrupted by a strike at the described location, this Company shall not be liable for any loss due to interference by any person(s) with rebuilding, repairing or replacing the property damaged or destroyed or with the resumption or continuation of business, 11. SUBROGATION: This insurance shall not be invalidated should the named Insured waive in writing prior to a loss any or all right of recovery against any party for loss occurring to the property described, I Page 4 of 4 ~ ...... ~ I I ~ ..tt~ J\~~ GENERAL ENDORSEMENT (Note to Agents-Please fill out all applicable blanks to avoid subsequent correction because of insufficient information) No. 284.4 (9-73) 2 ,effectl'veon 11/3/77 tt h t df t fP I N 52 37 91 ,a ac es 0 an orms par 0 0 icy 0, comDan~ I\I!W1E 'OF; I URANCE COMPANY .l:'J.O~hTr Agency WEST COAST INSURORS, INC. This Endorsement No, of the Ae tna Ins urance issued at its St. Pe te rsb urg. CITY OR TOWN Name of Insured Head Start Child Development Term of Policy-From ll/3/77 to 11/3/80 Location of Property ..1Ollilu:th Missouri NO, STREET ITEM OLD AMOUNT 3,500. & Family Service Form No FGP-l. FAM-09 .ISO-l05 ' LIST EDITION DATE Avenl~~ r.1earwater. Florida I,. olf"l'oWN COUNTY STATE NEW AMOUNT (if Changed) ZIP CODE- DESCRIPTION Pre-School fr~rnp building )-L $ $ $ $ $ $ Rate Card No. Dwellings: (Complete for Dwelling only). Construction Distance from hydrant-not more than feet. Check box if owner occupied: o Reporting. o Amount and Property Covered Protection Class Zone Roof No, of Families Check box if policy is:- 0 Blanket;- CHANGE IN AMOUNT, RATE, OR PREMIUM (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) CASH DPP ONLY EXCHANGE DPP ONLY NEW NEW % OF OLD RATE NEW + ADDITIONAL TOTAL AMOUNT COINS. RATE (if OLD PREMIUM - RETURN ADD'l (+) OR ITEM PERil (if changed) APPlI- changed) PREMIUM PAYMENTS RETURN (-) CABLE Net Net PAYMENTS D payments FOR REMAIN- remaining DER OF TERM FIRE E. C, (check box if V&MM included) 0 TOTALS X X t t + + TOTALS - - Column 10 is the sum of the increase or decrease in future payments multiplied tNo premium payments shall be less than the minimum by the number of payments remaining, plus (or minus) the cash exchange. premium applicable, Subject to provisions and stipulations herein and in the policy to which this endorsement is attached, the coverage of this poliCY is amended as follows: o 1. Removal Permit as provided on the reverse side, New Location o 2, Form(s) No,(s) -LIST EDITION DATE are attached, Form(s) No.(s) are voided. o 3. Description of property corrected to read: o 4, Percentage of co-insurance clause applicable to Item(s) No,(s) o 5, Valuation Clause amended as follows-(South Carolina only)- Item , $ ; Item , $ ; Item o 6, Policy assigned to o 7. Mortgagee or loss payee interest of ~ 8. Loss payable to C; ty nf r.lp.<In.J.<If"PTJ \l~E A~OA~SPI'H'polR Avenue, first mortgagee, and to NAME AND ADDRESS second mortgagee, subject to provisions of mortgagee clause printed on the reverse side, is amended to ,$ and Company consents, is eliminated, Clearwater, Florid~ o 9, t Accepted by INSURED t Accepted by t Signatures required when endorsement reduces or restricts policy, MORTGAGEE OR PAYEE No. 284-4 (9-73) No. 284-4 (9-73) Agent %. As provided in Paragraph 1- Removal Permit-Permission granted during the period of ten (10) days from the date of this permit, to remove the contents described on the reverse side to the location indicated. During such removal this policy shall attach in each of the described locations in such proportions as the value of the property covered in each location bears to the aggregate value in both locations, After the expiration of said ten (10) days (or prior thereto, if the removal shall have been completed), this policy shall attach in the new location only, As provided in Paragraph 8- Mortgagee Clause (This entire clause is void unless name of mortgagee is inserted on reverse side in space provided)-Loss, if any on the item(s) subject to this clause is specified on reverse side, shall be payable to the mortgagee (or trustee) as provided herein, as interest may appear, and this insurance, as to the interest of the mortgagee (or trustee) only therein, shall not be invalidated by any act or neglect of the mortgagor or owner of the within described property, nor by any foreclosure or other proceedings or notice of sale relating to the property, nor by any change in the title or ownership of the property, nor by the occupation of the premises for purposes more hazardous than are permitted by this policy: Provided, That in case the mortgagor or owner shall neglect to pay any premium due under this policy, the mortgagee (or trustee) shall, on demand, pay the same, Provided also, That the mortgagee (or trustee) shall notify this Company of any change of ownership or occupancy or increase of hazard, which shall come to the knowledge of said mortgagee (or trustee) and, unless permitted by this pOlicy, it shall be noted thereon, and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof; otherwise, this policy shall be null and void. This Company reserves the right to cancel this policy at any time as provided by its terms, but. in such case this policy shall continue in force for the benefit only of the mortgagee (or trustee) for ten days after notice to the mortgagee (or trustee) of such cancellation, and shall then cease, and this Company shall have the right, on like notice, to cancel this agreement. Whenever this Company shall pay the mortgagee (or trustee) any sum for loss under this policy and shall claim that, as to the mortgagor or owners, no liability therefor existed, this Company shall, to the extent of such payment, be thereupon legally subrogated to all the rights of the party to whom such payment shall be made, under all securities held as collateral to the mortgage debt, or may at its option pay to the mortgagee (or trustee) the whole principal due or to grow due on the mortgage withinterest, and shall thereupon receive a full assignment and transfer of the mortgage and of all such other securities; but no subrogation shall impair the right ofthe mortgagee (or trustee) to recover the full amount of his, her or their claim, (284-4) !if. -.. """'-- I I .. ~~j I ciTY OF CLEARWATER Interdep.rtment Correspondence Sheet TO: Sue Lamkin, City Clerk's Office FROM: Joseph R. McFate, Community Development Coordinator COPIES: SUBJECT: Head Start Program - North Missouri Avenue \\ECEiVt.::J DATE: March 6, 1978 M~.R "6 1918 erli CL'f.Ri."- I am enclosing the replacement Certificate of Insurance showing liability insurance covering the Head Start Program at the 701 North Missouri Avenue location, as required by their lease agreement. The lease agreement has been signed by Head Start and forwarded to the City Attorney for approval and execution by the City, you should be receiving a signed original soon. Pfivsn Enclosure I ! "Ri)['O'lT\ DMMGE $100 I $ ~---------+---+---- I ROcl11 {IN kill { AN[: I I PROPUHY DAMAGE I $ $ I C()MB'~ELl ~ ' I ! PEQSONAl INJUf'f{ I $ West Coast Insurors, Inc. 4535 Central Avenue St. Petersburg, Florida 33713 COMPANIES AFFORDING COVERAGES COMPANY A LETTER National COMPANY B LETTER C'J~,~Pl\N'y C , ETTER COMPANY D L ETTE R COMPANY E LETTER Indemnity Com any NAME AND ADDRESS OF INSURED .:. tf ;,;,... Head Start Child Development & Family Service 12351 - 134th AVenue North Largo, Florida 33540 MAR 6 i91'8 CITY ,C: .Ef'..:..~ This is to certify that policies of insurance listed below have been issued to the insured named above ilnd are in force at this time, TYPE OF INSURANCE POLICY NUMBER Limits of Liability in Thousands (000) EACH I OCCURRENCE ['OLlCY EXPIRATION DATE -+----- GENERAL LIABILITY $300 t,.()ri I L Y 1~.J L; f~Y A [J COMPREHENSIVE FOm,: ~ PREMISf5---0PEli"TIO';S o EXPLOSION fIND COLLAPSE HAZAFm o UNDERGROUND HAZARD o PRODUCTS/COMPLETED _ OPERATIONS HAZARD o CONTRACTUAL INSURANCE o lJROAD FORM PROPERTY DAMAGE o INDEPENDENT CONTRACTORS o PERSONAL INJURY 11/7/78 GLA 123048 AUTOMOBILE LIABILITY o COMPREHENSIVE FORM DOWNED o HIRED o NON-OWNED I!ODIL Y INJURY (EACH PERSON) BODILY INJURY lEACH OCCURRENCE) PflOPERTY DAMAGE BODILY INJURY AND PROPERTY DAMAGE COMBINED $ I ------1- i EXCESS LIABILITY o UMBRELLA FORM o OTHER THAN UMBRELLA FOflM WORKERS' COMPENSATION and EMPLOYERS' LIABILITY OTHER _nl :;::~::,:::::: -----STATUTORV - $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES Schools: 12351- 134th Avenue North, Largo, Florida 13400 Adams Circle, Largo, Florida 1344 - 22nd Street South, St. Petersburg, Florida 701 North Missouri Avenue, C1cazwater, Florida Cancellation: Should~ or ~t~~Y@~~r~:>'~9-~~c~;be~~M~~rel\:iIt@:Q~futlOn date thereof, the issuing com- pany will endeavor to mail _ days written notice to the below r1amed certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company_ NAME AND ADDRESS OF CERTIFICATE HOLDER 2/27/78 DATE ISSUED: Office of Community Relations City of Clearwater P. O. Box 4748 Clearwater, FL 33518 f) U 1011e (1/691 NATIONAL INDEMNITY COMPANY 30211ARNEY ST. OMAHA, NEBR. 681'1 NOTICE OF CANCELLATION OF________ POLICY POLICY NO. KIND OF POLICY ISSUEO THROUGH AGENCY OR OFFICE AT: IS CANCELLED TO TAKE EFFECT AT: GLA II 19 50 St. Petersburg, Florida tct\'l~~l ~1\ ~U\. '2.?~ c\.r~~\ (,\~ 12:01 A. M. August 4, 1977 HOUR - STANDARD TIME - DATE THIS NOTICE MAilED TO: r Head. Start Child Development & Family Service 12351 - l34th Avenue North Largo, Florida 33540 AMOUNT OF POLICY $ PREMIUM $ EXPIRATION RETURN PREMIUM $ PREMIUM DUE $ L ~ -Veu ~re ~e-:~~y----nct:f.~2d--- that.-,-in accordance -with -the te!"rn~ and c0ndjtic,ns.__ of". the _,,_300V~ mentjon~d .___policy. Vottr jnSHr:~r.ca -will - c~a~ at and from the hour and date mentioned above, COmpany Request. '\ \ If the premium has been paid, premium adjustment will be made as soon as practicable after cancellation becomes effective. Excess premium paid, if any, will be refunded on demand. If the premium has not been paid, a bill for the premium earned to the time of cancellation will be forwarded in due course. ~ INDEMNITY. COMPANY _c~~I"~ ~ /" 1" ~ f'//~ AUTHORIZEO REPRESENTATIVE I ~ cc: City Clerk, City of Clearwater P.O. Box 4748 Clearwater, Florida 33518 I NATIONAL INDEMNITY COMPANY I ' 3024 Harney Street . Omaha, Nebraska 68131 CERTIFICATE OF INSURANCE This certificate of insurance neither affirmatively or negatively amends, extends or alters the coverage afforded by the Policy or Policies numbered in this certificate. NOVEMBER 7 19 76 This is to certify that the folluwing described policies have been issued and are in full force and effect. NAME OF INSURED HEAD START CHILD DEVELOPHENT & FAMILY !;ERVICE P. O. ADDRESS 12351 - 134th AVENUE NORTH, LARGO, FLORIDA 33540 'L ,.,,1_~J r ~0' o'f:r i~'!i"" ,,~.. ...... LOCATION COVERED LARGO, FLORIDA 3AN "t::. {f '",;;:~~'~~t': .' ' '-~: ' . . '.:" DESCRIPTION OF WORK SCHOOLS. POLICY NO. KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES Workmen's Compensation and Employer's Liability Legal Property Damage. . . . For each item show "Not Covered" if no coverage afforded. Each Occurrence $ 300,000.00 Aggregate - Products - Completed Operations Each Occurrence Aggregate - Operations Aggregate - Products- Completed Operations $ $ N/A $ 100~~20.00 $ 11-7-76 to 11-7-77 General Liability: OL&T GLA 111950 Bodily Injury . . . . . . N/A Automobile Liability: Boclily Injury . . . . . . . Property Damage . , . ., Each Person Each Occurrence Each Occurrence $ $ $ Covers: Excess Liability: 0 Automobile Name of Primary Insurer: Primary Limits: Excess Limits: o General Liability In the event of any material change in or cancellation of said policies, NATIONAL INDEMNITY COMPANY intends to notify the party to whom this Certificate is addressed of such change or cancellation, but undertakes no responsibility by reason of any failure so to do. This Certificate issued to: CITY CLERK CITY OF CLEARWATER P.O. BOX 4748 CLEARWATER, FLORIDA 33518 By Title C. NOTE TO AGENT -- Mail Copy to Home Office immediately. U-100e (1/73) .....,.._'~-' :-1 , , November 8, 117. Se.d Start Child Develia.ent i Faa11y Service 12aSl-la"'th Av.nue !IoriL ,. Larlo, Florida 335_0 gentlemen: It has come to our .t~efttion that your policy '721-7"38812 with Fo~.t llUIUI'anoe Coapany tor .eneral liability in- surance expires on Noveaber 7. 1976. Plea.e arrange to have & renewal certificate reach this office no la~er than Novemb.r 7 in order that, the teras of your lea.. with the City are tully caapIi" with. V.ry truly yous. R. Q. Wbi teb..ct t CHC City Clerk .1 co: Hr. Tony Ihoeaaker. A..t. City ".....1' .. ...... ~ CITY OF CLfRWATER INTER-OFFICE COMMUNlcA liON C' h DATE/~r 3 , ,.4 TO /V-R ~~~ / (;7 ~/ ~~ FROM/~~()er4 SUBJECT 4JJ ~~-r , 'S S--/~~ a~r~Mo/ Z2v-~-n ~~ ~l' ~ ~cdJ>~.'~~/~ ~ L~F~ ~ 4--- ~ ti-. ~ &7 ,5;-//~? a/. /5 N ~ , c;~~;JJ~~ ~ >/~~ h,r Y/ a j/"r-/P [] PLEASE REPLY ON REVERSE SIDE ~ .....,) .-- '-~:~8 TO: FROM: COPIES: SUBJECT: DATE: 1 M. J. Paroby, Asst. City Mgr. R. G. vfuitehead, City Clerk Leaee - Head Start Program August 5, 1976 C I T 1 0 F C LEA R WA T E R fnterd .rtment Corre.pondence Sheet Attached is copy of above named Lease. This property is located at 701 N. Missouri Ave. RGW:k ,,--J /i { ~ ',.I' / ./ ,~, ;J '.. (' ; ,f f'. ~ ",..,/ , \1 ,~Jt.. f., , ." i, ) /'\.... J t" 1} 1 'J t , "1",.1 I ) \., t~._ 1 clly OF CLEARWATER Interdepartment Correspondence Sheet Mr. R. G. Whiteheadl City Clerk M. J. ParobYI Asst. City Mgr. lfl ()t TO: FROM: COPIES: SUBJECT: DATE: Mr. G. B. Weimer Expiration of Lease - Head-Start Program August 51 1976 In reference to your memo of August 41 1976, regarding expi rati on of a Head-Start Pre-School Program, pI ease send me a complete copy of the I ease agreement and any other informati on pertaining to the lessees such as lessee principalsl addresses and what Ci ty office or department handled this originally. I have no knowledge of this lease, the program or the property that is leased. ~-":-' .$...._- ,W,".. TO: FROM: COPIES: SUBJECT: DATE: J clTl OF CLEARWATER . Interd .rtment Corre.pondence Sheet Mr. M~ke Paroby, Assistant City Manager City Clerk Expiration of Lease, Head Start Pre-School Program August 4, 1976 Attached is copy of paragraph 7 of the lease outlining renewal option, which is self-explanatory. The original 5-year term expires September 12, 1976. r... --~---=;;~~l ;~ 'SEP <::,,(3 t076 '~ J:O/ ~ ~ ~ , ~ ~ ~ ~ A ~ a ~ fI1 ~, ~ ~ e ~ !. ~ ~ I'l ~ ~ I'l ~ JP ii; 4", ~ ~ ~ ~ g i;,., i t I r: : ~ P. 0, BOX 12769 / ST. PETERSBURG, FLORIDA 33733 '~ I ~~~ fwm<:4 ~ BYml-d__JJ~_~:t-: nm_n ~. I i ;&f~" r <jf ~_s.~~~~~~~~~~ ~~~~~........~~....~~~~~~_ ~S.~l ~ . ;cr:f~{ CL~, nil iI to mnm that the following described policy or policies has or have been issued by DANA ROEHRIG AND ASSOCIATES, authorized representative of the company or companies, and is or are in force on that date mentioned below. )~ ><i.t "::< ?,-} :-'P; :f, ~-~ ~ ~ ~ ~'~ Insured ___;1~~9__~t~!_t__ghiJ_~_f~y~_lq~~~1l~_~_1~~~i~Y_~_~~~fE~________________________________________ ~~ ..; ;> "~ '<if .____________!~~~}__!~~_lh~~~_e__~~E~1:____~_~~~9~__~~_~~!~~___~~?_~~_____________________________________ '.~ ,~ 'f~ ~ ~ ~ :~ Policy of Insurance beginning aL_ll;..Ol_~...-----on the__1-___day of__1loy~ber_________________, 19_15_, d d. Ir t 1Z" C 1 a ,11. th 7 d f :~ove,nber 19 70 Standard an en ln~ a _______~_____~__________on e_______ ay 0 ________________________________, ____, Time at place of issue, described as follows: ~t~ ;;~ 't.t ~ iI! a ~ ,~ ~ ,;,I ~ Jl ~ ';fJ 4~ ,~ 'i"~ " ,. NAME OF INSURANCE CO. TYPE OF INSURANCE LIMIT POLICY NUMBER General Liability :S.L P.D. 30;),000 100,000 721-7433812 This Certificate is issued at the request of Name ___C~-CleJ1~~-~~-of-i:Le~~ter-----------------------------_______________________________ Address P. O. Box 4748 Clealvater, Florida 33518 ------------------------------------------------------------------------------------------------ ~C'J ~) ~~i ! ,If Special Conditions: :.~~ \ ,~~ ,i ',,;:' : Notice is hereby given that DANA ROEHRIG AND ASSOCIATES, are not the insurer hereunder and shall not be held liable for any loss or damage. However, as the authorized representative of the above mentioned company or com- panies, DANA ROEHRIG AND ASSOCIATES, will endeaver to give written notice to the above named certificate holder in the event the policy or policies should be cancelled, assigned or changed in such a manner as to affect this certificate, but 'accepts no liability for failure to do so. ,!Ii: ',1-:': ... :~It .\ ;, ,,'. ' ," :1.", Dated at St. Petersburg, Florida ;,,:<-' ro . 1~ 7' . .. .. ~'~)~~~7~1.O.~~. . .'. . . . .. . . . . . . ., . . .19. .? ~ 1 (...~ 'I" I/'"\---' ;Q'; "" ~ ~Ir. ',,;It, I ~: : ~.......... -"C>E~:R,XG- &tAssociate~ I He, ,'~"" ::1" '" ,/ r :.)I~ , ,1~ i Name of Insured DESCRIPTIVE SCHEDULE hi d D & Famil servle CERTIFICATE OF INSURANCE Location Covered 12351 134th Avenue North Lario, Florida 701 North Missouri Avenue Clearwater, Florida Pre-School REC(JVED Address of Insured Operations Covered ~ t p, \J 1976 THIS IS TO CERTIFY TO CERTIFICATE HOLDER: Mailing Address IStreet And Number, City, State, Zip Cade) City Clerk City of Clearwater P.O. Box 4748 "" CITY CLE~ COVERAGE is provided in Company initialed below: IX] A=AETNA INSURANCE COMPANY D U=AETNA FIRE UNDERWRITERS INSURANCE CO, D C=CENTURY INDEMNITY COMPANY Clearwater, Florida 33518 Effective 9-17-76 that on the above date the following described insurance policies, issued by this Company, are ill full force and effect, subject to all the terms, conditions, limitations and exclusions, thereof. Co Name of Coverage " Policy Number Effective Date Expiration Date limits of liability Workmen's Compensation .Public liability-Bodily Injury (Not Auto) $ Statutory ,000 each occurrence Products-Completed Operations- Bodily Iniury .Public liability-Property Damage (Not Auto) (Explosion, Collapse, Underground Hazards Not Covered Unless Otherwise Stated Herein) Products-Completed Operations. Property Damoge Specitlc Contractual-Bodily tnjury (Other Than Incidental Contracts As Detlned In The Policy) Specific Contractual-Property Damage (Other Than Incidental Contracts As Defined In The Policy) $ ,000 each occurrence $ ,000 aggregate Fire EC & V&MM 573072 11-3-74 11-3- 77 3,500. Automobile-Bodily Injury $ $ $ ,000 each person ,000 each occurrence ,000 each occurrence Automobile-Property Damage Burglary Plate Glass .Includes coverage for the following incidental written agreements: (1) lease of premises, (2) easement agreement, except in connection with construction or demolition operations on or adjacent to a railroad, (3) undertaking to indemnify a municipality required by municipal ordinance, except in connection with work for the municipality, (4) sidetrack agree- ment, or (5) elevator maintenance agreement. Should any of the above described policies be cancelled bdore the normal expiration date thereof, the Company will endeavor to give written notice to the above Named Certificate-holder, but failure to give such notice shall im- pose no obligation or liability of any kind upon the Company. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICIES INDICATED ON THIS CERTIFICATE UNDER POLICY NUMBER. WEST COAST INSURORS, INC. 9-17-76 sp By A uthorized Agent (I nclude One D~te Copy for each Policy listed hereon) Form 600.840 3/73 'SEP 8 1976 INSERT ~~:~~Y , EMPLOYERS INSURANC49F WAUSAtJ . - - - - - - - - - - ~ - - - - - - T - - - - -,th;.i; ~ed ~ ~e;;";y) - - ~i~Ei)oF INSURANCE r NAMED INSURED AND ADDQ".c '{ C:'E.R:~ "I The company hereby stotes that it has issued to the in- sured named herein a policy or policies of insurance providing the types of insurance and limits of liability set forth herein. This certificate of insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policies scheduled here- in. It is furnished as a matter of information only, confers no rights upon the holder and is issued with the under- standing that the rights and liabilities of the parties will be governed by the original policy or policies as they may be lawfully amended by endorsement from time to time. Head Start Child Development And Family Service 12351 County Rd. 22 Largo, Fla. 33540 L .J TYPE OF INSURANCE POLICY EFFECTIVE EXPl.... nON LIMITS OF LIABILITY (Indicale by "X" In Baxl NUMBER DATE DATE BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY $ each $ each o Camprohen,lv. Automobile Liability person occurrence 0 $ each occurrence o Camprohen,ive Generalliabillly o Manufacturers' and each each Conlraelo'" liability $ occurrence $ occurrence o Owners', landlords' and T enanl" liability o Contraelual liability $ aggregate $ aggregale 0 0 $ each occurrence UMBREllA LIABILITY $ aggregate. products-completed operations sub~ct to ..If-in.ured retained limit and underlying insurance d..cribed in t e policy, Coyerage afforded in accordance with the Workmen's Compensation law of the States specified in subdivision (01 below arid the Occupational Disease law, if any, of such States, WORKMEN'S 14170005103l 3-1-76 3-1- 77 unless otherwise stated in subdivision (b) below. COMPENSATION (01 (bl EMPLOYERS' UABIUTY COVE....GE B-EMPLOYEES SUBJECT TO COMPENSAnON LAW IUnlell otherwl.e .tated, the pallcy $ .lUmber, effedive and expiration dates COVERAGE B-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW ore the same oj thOle shown for work- .....s compensation insurance) INJURY BY ACCIDENT INJURY BY DISEASE each each $ employe. S employe. each $ aggregate $ accident leach ,tate) MEDICAL $ .ach. employee lEMA RKS All Locations All Operations This certiflcate is issued at the request of the person or organization named below and the company will mail to such person or organization, at the address shown, notice of cancellation and, where possible, notice of any material change in any of the described policies. r I City Clerk Date City of Clearwater 9-6-76 pk p 0 Box 4748 By ~~~~~dNC7 L Clearwater, Fla. 33518 .J - Autharl.e~p'e..ntalife '1Au I PRINTED IN U.S.A, lIAB. 1618T H 752