POLICYHOLDER INFORMATION
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OLD DOMINION INSURANCE CO.
P.O. DRAWER 56770
JACKSONVILLE, FL 32241-6770
INSURED
COMMON POLICY
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DJCLARATIDNS
POLICY NUMBER:
ACCOUNT NUMBER:
ENTITY:
POLICY EFF:
RENEWAL OF:
NUMBER:
BPG15254
CACG15254
CORPORATION
04/24/00
PICKLES PLUS TOO INC
320 CLEVELAND ST
CLEARWATER, FL 33758
I.
090168003
AGENT:MITCHELL AGENCY INC.
AGENT PHONE : 813 595 2529
POLICYHOLDER INFORMATION
NA~ED INSURED: PICKLES PLUS TOO INC
MAILING ADDRESS: 320 CLEVELAND ST
CLEARWATER, FL 33758
POLICY TERM: 12 ,
INCEPTION: 04/24/00 12:01 A. .
EXPIRATION: 04/24/01 OF THE NAMED INSURED STATED
NAMED INSUREDS BUSINESS: MINI-RESTAURANT
"-
IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO THE TERMS OF THIS
POLICY I WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS
COVERAGE.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM
IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
SPECIAL COMMERCIAL PACKAGE POLICY
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL CRIME COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
I"'fr:- ~ ~ ~,-lJ.5-,
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MAR' Ii 1 "'-,"J
u L.~""
MITc.1iELL AGENCY, IN .
TOTAL
t
2,175
PREMIUM SHOWN IS PAYABLE:
t
2,175
AT INCEPTION.
FL EMPAT FUND:
FL FIRE MARSHALL:
.
.
4.00
2.07
TOTAL PREMIUM AND CHARGES . 2,181.07
FORM NUMBERS OF COVERAGES AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART
ARE SHOWN ON THE ATTACHED SCHEDULE
64-7985 0/88)
02/25/00
RENEWAL
BY --tLiPhJ1JI
DJ
COUNTERSIGNED
,JLD DOMINION INSURANCE C~I'
P.O" DRAWER 56770
JACKSONVILLE, FL 32241-6770
IN'IURED
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320 CLEVELA D ST
CLEARWATER, FL
SPECIAL COMMERCIAL PACKAGE POLICY
INC
POLICY NUMBER: BPG15254
ACCOUNT NUMBER: CACG15254
ENTITY: CORPORATION
POLICY EFF: 04/24/00
RENEWAL OF:
NUMBER: 090168003
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33758
AGENT:MITCHELL AGENCY INC.
AGENT PHONE : 813 595 2529
POLICYHOLDER INFORMATION
NAMED INSURED: PICKLES PLUS TOO INC
MAILING ADDRESS: 320 CLEVELAND ST
CLEARWATER, FL 33758
POLICY TERM: 12
INCEPTION: 04/24/00 12:01 A.M. STANDARD TIME AT THE ADDRESS
EXPIRATION: 04/24/01 OF THE. NAMED INSURED S~ATED ABOVE.
NAMED INSUREDS BUSINESS: MINI-RESTAURANT
IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS
POLICY.
DESCRIBED PREMISES: SEE ATTACHED SCHEDULE.
PROPERTY COVERAGE: SEE ATTACHED SCHEDULE.
LIABILITY COVERAGE
LIABILITY & MEDICAL EXPENSES
PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT
GENERAL AGGREGATE
FIRE LEGAL LIABILITY
OF INSURANCE
500,000 EACH OCCURRENCE
1,000,000
1,000,000
50,000 ANY ONE FIRE
OR EXPLOSION
MEDICAL EXPENSE LIMIT . 5,000 PER PERSON
Business Liability and Medical Expense: Except for Fire Legal Liability,
each paid claim for the above coverages reduces the amount of insurance
we provide during the applicable annual period.
LIMITS
.
.
.
.
OPTIONAL COVERAGES: SEE ATTACHED SCHEDULE.
MORTGAGEE: SEE ATTACHED SCHEDULE IF APPLICABLE. ,
FORMS AND ENDORSEMENTS APPLYING TO THIS POLICY: SEE ATTACHED SCHEDULE.
THESE DECLARATIONS AND SCHEDULES TOGETHER WITH THE COVERAGE FORMS, L.IMIT-
ATIONS, COMMON POLICY CONDITIONS AND ENDORSEMENTS, IF ANY, FORM THE
COMPLETE ABOVE NUMBERED POLICY.
TOTAL ANNUAL PREMIUM: . 2,175
;
COUNTERSIGNED
64-5255 (5/96)
BY
02/25/00
RENEWAL
DJ
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PICKLES PLUS TOO INC
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POLICY NUMBER
ACCOUNT NUMBER
ENTITY
POLICY EFF
NUMBER:
AGENT: MITCHELL AGENCY INC.
SPECIAL CPP FORM SCHEDULE
BPG15254
CACG15254
CORPORATION
04/24/00
090168003
Forms and Endorsements apPlYing to this COverage Part and made a part of this
pOlicy at time of issue:
Form
CG2011
CG2407
CM0001
CM0028
CMO 116
CP0030
CP0321
CP0417
CP0440
CR0018
CR0206
CR1000
ODl-6
CG0033
CG0001
CG0220
CP0010
CP0090
CP0125
CP1030
IL0021
IL0l75
IL0255
IL0935
OD3-40
OD4-19
Edition
0196
0196
0695
0695
0489
0695
0695
0695
0695
1090
0695
0695
1081
0196
0196
0792
0695
0788
0695
0695
1194
0993
0794
0498
0788
0186
Description
ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES
PRODUCTS/COMPLETED OPERATIONS HAZARD REDEFINED
COMMERCIAL INLAND MARINE CONDITIONS
SIGNS COVERAGE FORM
FLORIDA CHANGES - LOSS PAYMENT
BUSINESS INCOME COVERAGE FORM (AND EXTRA EXPENSE)
WINDSTORM OR HAIL PERCENTAGE DEDUCTIBLE
OFF-PREMISES POWER FAILURE - DIRECT DAMAGE
SPOILAGE COVERAGE ENDORSEMENT
FORM Q - ROBBERY & SAFE BURGLARY COV-MONEY & SECURITIES
FLORIDA CHANGES
CRIME - GENERAL PROVISIONS
MANUSCRIPT ENDORSEMENT
LIQUOR LIABILITY COVERAGE FORM
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
FLORIDA CHANGES - CANCELLATION & NON-RENEWAL
BUILDING & PERSONAL PROPERTY COVERAGE FORM
COMMERCIAL PROPERTY CONDITIONS
FlORIDA CHANGES
CAUSES OF LOSS - SPECIAL FORM
BROAD FORM NUCLEAR EXCLUSION ENDORSEMENT
FLORIDA CHANGES - LEGAL ACTION AGAINST US
FLORIDA CHANGES - CANCELLATION & NONRENEWAL
EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES
PUNITIVE DAMAGES EXCLUSION
ABSOLUTE POLLUTION EXCLUSION
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OLD DOMINION INSURANCE CO.
PICKLES PLUS TOO INC
POLICY NUMBER: BPG15254
ACCOUNT NUMBER: CACG15254
ENTITY: CORPORATION
POLICY EFF: 04/24/00
NUMBER: 090168003
AGENT:MITCHELL AGENCY INC.
LOCATION COVERAGE SCHEDULE
DESCRIPTION OF PREMISES - ADDRESSES
Prems. Bldg.
No. No.. Address
1 1 320 CLEVELAND ST
CLEARWATER, FL 33758
DESCRIPTION OF PREMISES - OCCUPANCY AND CONSTRUCTION
Prems. Bldg.
No. No. Occupancy Construction Protectil
1 1 FAST FOOD RESTAURANT MASONRY NON-COMBUSTIBLE 3
COVERAGES PROVIDED
Prems. Bldg.
No. No. Coverage
1 1 CONTENTS - SPECIAL
Limit of
Insurance
50,000
Ded
1,000
OPTIONAL COVERAGES
Prems. Bldg.
No. No.
1 1
1 1
1 1
1 1
1 1
1 1
1 1
Coverage
SIGN - $250 DED
FOOD SPOILAGE - $250 DED
OFF PREMISES POWER FAILURE
ROBBERY/SAFE BURG-MONEY/SEC~INSID-$250 DED
ROBBERY/SAFE BURG-MONEY/SEC-OUT-$250 DED
ROBBERY/SAFE BURG-MONEY/SEC-SAFE-$250 DED
BUSINESS INCOME (25%'EACH 30 DAYS)
Limits
2,500
5,000
10,000
2,000
2,000
2,000
50,000
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EWAL DJ