BUSINESS OWNERS POLICY INFORMATION
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BECEIVFD
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MAR 3 01993
CITY CLERK DEPT.
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AGENCY 12 - 0 0 5 POLICY 9 2 - 1 7 8 - 1 3 2 - 0 0
MUTUAL INS AGENCY AT C~EARWATER INt
POBOX 1779
CLEARWATER FL 34617
13173 (10-88)
tAuto-Owners InsUratlCe
(813) 446-6064
BOX 30660, LANSING, MICHIGAN 48909-8160 · 517/323-1200
AUTO-OWNERS INSURANCE COMPANY
AUTO-OWNERS LIFE INSURANCE COMPANY
HOME-OWNERS INSURANCE COMPANY
OWNERS INSURANCE COMPANY
PROPERTY-OWNERS INSURANCE COMPANY
MARINA DENTAL & DENTURE PA
25 CAUSEWAY BLVD STE 20
CLEARWATER FL 34630-2000
Thank you for selecting Auto-Owners as your Businessowners insurance company - we appreciate this opportunity to
be of service.
Please review the enclosed policy to make sure your coverages and limits are correct.
Originally named for those it served, Auto-Owners has become one of the nation's leading multiple-line insurance
organizations offering Life, Home, Car and Business protection to. over 2 million policyholders.
Feel free to contact your independent Auto-Owners agent for other insurance needs or answers to any questions you
may have.
Thank you again for placing your confidence in Auto-Owners.
@
Auto-Owners Insurance - The "No Problem" People
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Agency Code
12-005
Page 1
Policy Number
92-178-132-00
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AVAilABILITY OF RISK MANAGEMENT PLAN - FLORIDA
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55061 (6-66)
The Florida Tort Reform and Insurance Act of 1986 requires Insurance companies to make available to commercial
casualty and commercial property policyholders guidelines for risk management plans.
Risk management guidelines include the following:
A. Safety measures, including, as applicable, the following areas:
1. Accidental occurrences;
2. Fire hazards and fire prevention and detection;
3. liability for acts from the course of business;
4. Slip and fall hazards; and
5. Product injury,
B. Training to insureds in safety management techniques.
C. Safety management counseling services.
Risk Management Plan guidelines are available at your request. If you desire this service/please contact your agent
for assistance in completing the request.
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tAuto-Owners
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.Page2
54643 (01-90)
I Issued 06-11-92
BUSINE SOWNERS POLICY DECLARATIONS
INSURANCE COMPANY
Effective 06-03-92
INSURED MARIUA DENTAL & DENTURE PA
Company Use
92-178-132-00
20-57-Fl-9206
AGENCY MUTUAL IUS AGEUCY AT CLEARWATER INC
12-005
POLICY NUMBER
POLICY TERM
12101 n.m. 12101 a.m.
to
06-03-93
AOO~U 25 CAUSEWAY BLVD STE 20
CLEARWATER FL 34630-2000
06-03-92
SPECIAL FORM
PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS
DED
LIMITS
PREMIUM
Building Limit - Automatic Increase 6%
BUSINESS LIABILITY PROTECTION
Countersigned By:
(09-82)
LIMITS
$1,000,000
5,000
Included
50,000
1,000,000 $
BP0002 (01-87>
PREMIUM
FORMS THAT APPLY
BP0009 (01-87>
54510
Included
Included
Included
Included
35.53
BP0006
(01-87>
Liability and Medical Expense
Medical Expense - Per Person
Personal Injury
Tenants Fire Legal
Hired Auto & Non-Owned Auto Liability
#
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"tAuto-Uwners
.Page.3
54643 (OI~90)
l Issued 06-11-92
BU~IN~SSOWNERS POLICY DECLARATIONS
Effective 06-03-92
I
INSURANCE COMPANY
AGENCV MUTUAL INS AGENCY AT CLEARWATER INC
12-005
POLICY NUMBER
92-178-132-00
20-57-FL-9206
INSURED MARINA DENTAL & DENTURE PA
Company Use
ADDRESS 25 CAUSEWAY BLVD STE 20
CLEARWATER FL 34630-2000
POLICY TERM
12101 a.m. 12101 a.m.
to
06-03-93
06-03-92
LOCATION 001
25 CAUSEWAY BLVD STE 20 CLEARWATER FL 34630-2000
COVERAGES
DED
LIMITS
PREMIUM
8.42
Add1 Insured-Managers or Lessors of Premises
Included $
ADDITIONAL FORMS THIS LOCATION:
BP0303 (04-B9) BP0402 (01-B1)
LOC 001 BLDG 0001
COVERAGES
54604 (07-88)
n0255 (11-86)
550Bl (OB-BB)
DED
LIMITS
PREMIUM
183.35
Included
Business Personal Property - REPL. COST
Business Income and Extra Expense
SECURED INTERESTED PARTIES: None
$
250 $ 25,000 $
12 Months
RATING INFORMATION
Occupancy: Dental
Class Code: 65121
Program: Office
liability Rate Number: 00
Burglary Rate Group: 00
Office Tenant Occupied
Const: Fire Resistive, Non-Sprinklered
Protection Class: 03
Territory: 015 Pinellas County
Inside City limits
I TOTAL POLICY PREMIUM
TERM
$227.30
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~, Agency Code 12-005
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Page 4
Policy Number
92-178-132-00
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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 CAUSEWAY BLVD STE 20-23
CLEARWATER Fl
Name of Person or Organization (Additional Insured):
CITY OF CLEARWATER
25 CAUSEWAY BLVD
CLEARWATER FL 34630
Additional Premium:
A. The following is added to Paragraph C. WHO IS AN
INSURED in the Businessowners Liability Coverage
Form:
4. The person or organization shown in the Sche-
dule is also an insured, but only with respect to
liability arising 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:
This insurance does n6t apply to:
1. Any "occurrence" that takes place after you
cease to be a tenant in the premises described
in the Schedule.
2. Structural alterations, new construction or de-
molition operations performed by or for the
person or organization designated in the Sche-
dule. .
.lnformation 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 Office, Inc., 1984, 1985
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