BUSINESS OWNERS POLICY DECLARATIONS
..
Uuto-Owners _I
INSURANCE COMPANY
6101 ANACAPRI BLVD., LANSING, MI 48917-3999
AGENCY MUTUAL INS AGENCY AT CLEARWATER INC
12-0005-00
INSURED MARINA DENTAL & DENTURE CLINIC PA
ADORESS 25 CAUSEWAY BLVD I 20
CLEARWATER FL 34630-2099
:-
Page 1
I
54643 (01-90)
Issued 04-03-1997
BUSINESSOWNERS POLICY DECLARATIONS
Renewal E~~ective 06-03-1997
POLICY NUMBER
92-178-132-00
20-57-Fl-9206
Company Use
DB
12:01 a... 12:01 a.m.
to
06-03-1997
06-03-1998
In consideration of pay...,t of the PMtlliu. sho"" below, this policy is renewed. Plea_ .ttach this
Declarations and attach8ents to your policy. If you have any questions, pl.a_ consult with your &gent.
ENTITY: Co~poration
PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS
Special Coverage Form
Building limit - Automatic Increase 6%
BUSINESS LIABILITY PROTECTION
COVERAGES
Liability and Medical Expense
Medical Expense - Per Person
Personal Inju~y
Tenants Fi~e legal
Hired Auto & Non-Owned Auto Liability
FORMS THAT APPLY TO ALL LOCATlaNS:
BP0009 (01-87) 54679 (06-92)
54510
54709
COUNTERSIGNED BV:
LIMITS PREMIUM
$1,000,000 Included
5,000 Included
Included Included
50,000 Included
1, 000,000 $35.53
(09-82) BPOO02 (01-87) BPOO06 ( 01-87)
(04-94) 54656 ( 08-91) 54663 (09-91)
MUTUAL INS AGENCY AT CLEARWATER INC
Uuto-Owners
Page 2
54643 (01-90).
Issued 04-03-1997
BUSINESSOWNERS POLICY DECLARATIONS
I
INSURANCE COMPANY
6101 ANACAPRI BLVD., LANSING, MI 48917-3999
AGENCY MUTUAL INS AGENCY AT CLEARWATER INC
12-0005-00
INSURED MARINA DENTAL I DENTURE CLINIC PA
Renewal Effective 06-03-1997
POLICY NUI1BER
92-178-132-00
20-57-FL-9206
Company Use
DB
ADDRESS 25 CAUSEWAY BLVD I 20
CLEARWATER FL 34630-2099
12:01 a.m. 12:01 a.m.
to
06-03-1997
06-03-1998
In consideration of pa~t of the p....iu. shown b.low, this policy is ...newed. Pl.... attach this
Declarations and .ttac:t.ents to your policy. If you have any questions, pl.._ consult with your ~t.
LOCATION 001
LOCATION: 25 CAUSEWAY BLVD I 20 CLEARWATER FL 34630-2099
COVERAGES
DED
LIMITS
PREMIUM
$8.42
Add1 Insured-l1anage~s or lessors of Premises
Included
ADDITIONAL FORI1S FOR THIS LOCATION:
BP0303 (04-89) 54661 (08-91)
LOC 001 BLDG 0001
COVERAGES
54604 (07-88)
Il0175 (09-93)
Il0255 (07-94)
BPOI04 (01-87)
55081 (08-88)
BP0402 (01-87)
Business Personal Property - REPL. COST
Business Income and Extra Expense
Windstorm and Hail
DED
$250
LIMITS
$50,000
12 Months
Excluded
PREMIUM
$540.63
Included
ADDITIONAL FORI1S FOR THIS BUILDING:
54619 (05-88)
BP1203 (06-89)
SECURED INTERESTED PARTIES:
See Attached Schedule
RATING INFORI1ATION
Occupancy: Dental
Class Code: 65121
Prog~am: Office
Liability Rate Number: 00
Bu~glary Rate Group: 00
Office Tenant Occupied
Const: Fire Resistive, Non-Sp~inkle~ed
Protection Class: 03
Ter~itory: 019 Pinellas County
Inside Cii:y liNii:s
I TOTAL POLICY PREMIUM
TERM
$589.16
The Total Policy Premium shown above includes:
Flo~ida Surcharge of $.58
Emergency Trust Fund Su~cha~ge of $4.00
:Auto-Owners
Page 3
I
54643 (01-90)
Issued 04-03-1997
~
INSURANCE COMPANY
6101 ANACAPRI BLVD.. LANSING. MI 48917-3999
AGENCY MUTUAL INS AGENCY AT CLEARWATER INC
12-0005-00
INSURED MARINA DENTAL & DENTURE CLINIC PA
BUSINESSOWNERS POLICY DECLARATIONS
Renewel Effective 06-03-1997
POLICY NUMBER
92-178-132-00
20-57-FL-9206
Company Use
ADDRESS 25 CAUSEWAY BLVD I 20
CLEARWATER FL 34630-2099
DB . ._..... TER"
12:01 e... 12:01 a.m.
to
06-03-1997
06-03-1998
In consideration oi pay_nt of the Prelliu. shown below, this policy is ranewed. Please attllCh this
Declarations 8nd attacllllents to your policy. Ii you have any questions, plea.. consult with your agent.
SECURED INTERESTED PARTIES AND/OR ADDITIONAL INTERESTED PARTIES
Loc 001 Bldg 0001
ALOHA lEASING loan: 95072114
PO BOX 1039
SYRACUSE NV 13201-1039
Inte~est: loss Payable
Fo~m: BP1203 (06-89) PARAGRAPH A
SIP ID: NV000568
loc 001 Bldg 0001
TRANS LEASING INTERNATIONAL loan: 22-1287
3000 DUNDEE RD
NORTHBROOK IL 60062-2422
Interest: Loss Payable
Form: BP1203 (06-89) PARAGRAPH A
SIP ID: ILOI1053
,J~1-29-97 10:16A Mutual Ins Agency
..
1
.;
B13 442 9751
I
Policy Number
P.01
Agency Code 12-0005-00
92-178-132-00
BP 04 02 01 87
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR LESSORS
OF PREMISES
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE-
Designation of Premises (Part Leased to You):
25 CAUSEWAV BLVD STE 20-23
CLEARWATER FL
Name of P.rson or Organization (AddlUonallnsured);
CITV OF CLEARWATER
25 CAUSEWAV BLVD
CLEARWATER FL 34630
Additional Premium:
A. The rollowing is added to Paragraph C, WHO IS AN
INSURED in the Businessowners Liability Coverage
Form:
This insurance does not apply to:
1. Any "occurrence" that takes place atter you
cease to be a tenant In the premises described
in the Schedule.
2. Structural alterations. new conslruction or de.
molition operations performed by Or for the
person or organization designated in the Sche-
dule.
4. The person or organization shown in the Sche-
dule is also an insured. but only with respect to
liability arisinQ out of the ownership, mainte-
nance or use of that part of the premises leased
to you and shown in the Schedule.
B. The following exclusions are added:
-Inrormation required to complete this Schedule. if not shown on this endorsement. will be shown in the Declarations.
BP 04 02 01 87
Copyright. Insurance Services Drfice, loe.. 1984, 1985