RENEWAL CERTIFCATE FOR CLEARWATER BEACH HILTON INN
<
~, -, ,';.,~ J
CITY Of CLEAKWATER
AUG 12 1986
HARBORM~STE.RS OffiCE.
(Ul/ \ .;,
~ :' 1
,t.! ..!
OBERDORFER
1-
Risk Management Since 1921
Telex 650-248-8860
JULY 28, 1986
City of Clearwater Beach
_ P.O. Box 4748
Clearwater Bch, FL 33518
POLICY : CI6789756\1
Gentlemen:
INSURED
CLEARWATER BEACH HILTON
Enclosed is a renewal certificate continuing the property
and general liability coverages for the captioned Insured
effective May 29, 1966 to May 29, 1967.
Please note, the certificate renews the policy subject to
the terms and conditions as expiring and notes any revi-
sions, deletions or new changes. Otherwise, it remains the
same. Therefore, your name is not indicated on this certi-
ficate because you were an addtional insured on the previous
policy and that has not changed.
In addition, I have enclosed a copy of the Insured's umbrel-
la liability renewal indicating the city's interest.
I trust you will find the enclosed to be in order. However
should you have any questions or require assistance, please
do not hesitate to call.
4
ESH:eh / v.5
rb
~.
Sincerely,
-.
. ,-
'_/.. -'--', - ----.'~
~ Elaine S. Hunt
~ Account Administration
~
,
../'
RECEIVED
/
~
V~
1(\;0
lb~
/
C\,r" \..
AUG 1 1986
CITX CLERK
I
< L'E'" ','- I '>'" \I~'- ,- '" .,\1
I ~ - ~;H:'n...: _ ' :)L,'-' -", l Co L '-' _j, ~ -.....,' I
r"hl,(~"::E'D"I a ,.....:-.1('5,','. .i:-:la -
,~L.I''.';E~ I :\':'... :,,~'~.::E C,:;f/,~/",~;Y
-"":Jr~~"___":,~:;:--~ ~ ~ €. ,', ,___nS'f)
AJrn'i':S:~a"'\-'~ C'; :.:.;.s-~rl';3-J~[:--::iC:1. ::Oenr:SYIl,-ania
0-
Coveragt> IS ~..HO"lded In the Curnpan..,. Ch-s,qnated by Number
Eacn IS a SIOCk. InSUldnce COrf10.-Hly rlereln calle-d the CUIl1Pi1n'r
CS:~
\
,), 11"~'~'(
'C:7'
Comprehensive Insurance Policy
Renewal Certificate
Name
Insured
Lane Clearwater Limited Partnership
DBA Clearwater Beach Hilton Inn (Spp CoT nnnR)
In Consideration of
the Required Premium
and Provisions
of This
Comprehensive Insurance Policy,
the Company
Does Insure
the Interest ot
90-6501
Oberdorfer Ins, Assoc.
Atlanta, GA.
Named
Insured's 715 South Gulfview Blvd.
Addre~ Clearwater Beach, Pinellas, Fl. 33515
The Named
Insured IS:O Individual C PartnershlP.x:: Corporation 0 Joint Venture 0 Other _
Period of Insurance
12:01 a.m. Standard Time at
Named Insured's Address
From
5/29/86
To
5/29/87
Deposit
Premium $ 167609. See Gen 1179
Audit Period: ~ Annual 0 Seml.Annual 0 Quarterly = Monthly
~nS~i:~.iI::~t:ttir:-P~meril7of thepremium~above'specitled 11. 15. agreed that -the policy'deSign-af~ir aooveis~ienewed from the'
1nCeJ)ti~~!~~iiO~~~bjlX:t':tQJdl.ll$_ie;:mraO(fcoodit'q!!&:~C:!.tl1 ~~ .fon.~:s;>lu-' ','.. _. ,. .
~~nn.~~!~~~~c~~~.and:aitacheiE t
- ------- - - -- -~--- - - -- - - - - - - ----- - - - - - - - - - ..,----- - - ------ - - - - - - --- - - - - -- - - - - - - - - - -- - - - --
Form Numoe' EffectIve This Date ICancels and Reolaces Same Form Number Effective
Gen 1179 CI 1103 ClOD 8 CI 2004 CI 2315 I Gen 1179 CI 1103 CI 0008 CI 2004 CI 2315
I
CI
/ ,
CF0406 CF04l5 CI
CI0008
LETED from this Polley:
Mich I rovision - rrent editions of forms will be substituted at each renewal date for the earlier editions, if reVised during the
prevIous poi ICY term. The policy is being renewed at rates in effect on the date of renewal.
In witness whereof, this Company has executed and attested these presents; but this Certificate shall not be valid unless countersigned
by the duly authorized Agent of this Company at the agency herein before mentioned,
Reliance Insurance Company
Planet Insurance Company
\
Secretary
PresIdent
U..~ WR~~~.~
Secretary President
3;~ ~racl'eU
AuthOrized RepresentatIve
l~~~ ~ ir-<;~
Countersigned
CI.0010 Ed4i82
INST1LLMENT OR T~KEN BILL ENDORSLt~ENT
Company Numbers If this enclorsement is issUed concurrentlv with the polley, the Altacnlng Clause need not be completed Endt. No,
1 = Reliance Insurance Company Issued by Co. No. Insurea Policy No.
2 = Planet Insurance Company Clearwater Beach Hilton CI 6789756
6 = United Pacific Insurance EflE:Ctive Date Policy Period I Addt'/ Premium I Return Premium I Premium sUOject
Company o to audit
8 = Reliance Insurance Co. of Unearned Premium Factor I ~lIterms and conditions of the policy remain unchanged l'countersigned
Illinois except as amended by this endorsement.
DATE DUE
PREMIUM
INSTAllMENT
CHARGE
STATE
SURCHARGES
TOTAL
o If this box is X'ed, the installments
(other than the first installment) are
to be equal amounts.
GEN.1179 Ed. 10/63
: P''':''I ~) I'~dfr,t 8r
L
l E-f'c: i. tot-e ~t=~s~ red _____t___ u______ ______=~~=]
COMPREHENSIVE INSURANCE POLICY
SECTION IA
PROPERTY
SCHEDULE OF LOCATIONS
-----
LocatIon 1 Location Location
715 s. Gulfview Blvd.
Clearwater Beach, Fl.
,
,
Coverage applies only where a Limit of Liability is shown.
Unless otherwise shown beneath the applicable limit of liability:
(1) Perils insured against for all locations shall be as provided in cr 1106 for coverages ABC E
as provided in for coverages
(2) Valuation clause applicable for all locations shall be Number -----I- for Buildings, Number ----I-. for
Personal Property.
Location Number, Building Number , -,
Occupancy Hotel and
Restaurant
Deductible 1 (applicable to coverage A&B See Endt. 2
per location, per occurrence) Section IA
Protective Safeguard Clause(s) Applicable
COVERAGE Co. I Automal~c I LIMITS OF LIABILITY
Increase In
Insurance Insurance
A. Building See
CF1210 2'70 15.506]00
B. Personal Property I
o Excludes property See
of others CF1210 I 2% Inc l.
C Excludes stock
o Reporting
Stock
o Reporting -
C. Additional Expenses
5 000
Contribution'
D. Loss of Rents
E. Gross Earnings See
[2{ Excludes ordinary CF 121 0
payroll
lJ Limited ordinary 3,108.062
payroll
Each
30
F. Loss of Earnings Days
Aggregate
CI.l103Ed,l/84
CI-1103A Ed, 1/84 (single)
POLICY NUMBER
-J----------Tc--------- ------1
i EF~ECT:VE DATI: , r-<AV.ED '''S0RED
I
COMPREHENSIVE INSURANCE POLICY
ENDORSEMENT NO. SECTION
Named insured to read:
Lane Clearwater Limited Partnership
DBA Clearwater Beach Hilton Inn
Lane Properties, Inc. as General
Lane Industries, Inc. which owns
,
partner of Lane Clearwater Limited Partnership;
Lane Hotels, Inc.
CI-OOOB Ed. 2/81
-"" --
J
I
POLICY NUMBER
EFFECTIVE DATE
NAMED INSURED
COMPREHENSIVE INSURANCE POLICY
SECTION I I
COMPREHENSIVE GENERAL LIABILITY
o Intermediate Fonn
IjQ Broad Form
Coverage applies only where a limit of Liability is shown.
\
o
Limits of Liability
Duaf Limits Each Occurrence Aggregate
G. Personal Injury Liability $ $
H. Property Damage Liability $ $
I. Fire and/or ExplO$ion Legal liability - Real Property $ xxxxx
J. Incidental Malpractice Liability $ $
K. Advertising Injury liability XXXXX $
Each Pllrn>n Each Accident
l. Premises Medic.! Payments $ $
XJ
Limits of Liability .
Single limits Each Occurance Aggregate
G. Personal Injury Liability
and $ 1,000,000 $ 1,000,000
H. Property Damage Liability
I. Fire and/or Explosion Legal Liability - Real Property $ 50,000 XXXXX
J. Incidental Malpractice Liability $ 1,000,000 $ 1,000,000.
K. Advertising Injury Liability XXXXX $ 10,000
ellch Perlon Each Accident
L Premises Medical Payments $ 1 000 $ 10,000
If Single Limits is applicable (designated by an IX! ) the following shall apply:
It is agreed that with respect to Section II-Comprehensive General Liability, the paragraph entitled LIMITS OF LIABILITY,
1. Coverage G and 2. Coverage H, is replaced by the fcllowing:
Regardless of the number of: (1) Insureds under this policy, (2) persons or organizations who sustain personal injury, bodily
injury or property damage, or (3) claims made or suits brought on account of personal injury, bodily injury, or property damage,
the Company's liability is limited as follows:
The limit of liability for personal injury liability and property damage liability stated in the Schedule above as applicable to "each
occurrence" is the total limit of the Company's liability for all damages including damages for care and loss of services as the
result of anyone occurrence which causes personal injury or property damage to one or more persons or organizations.
Subject to the limit of liability with respect to "each occurrence" the limit of liability for penonal injury liability and property
damage liability stated in the Schedule above as "aggregate" is the total limit of the Company's liability for all damages, if such
insurance applies, because of (1) personal injury arising out of the completed operations hazard or products hazard, (2) property
Damage arising out of the completed operations hazard or products hazard, (3) property damage arising out of premises or
operations rated on a remuneration basis or contractor's equipment rated on a receipts basis, including any liability for such
damage assumed by the Insured under any incidental or written contract in connection with such premises or operations, (4)
property damage arising out of operations performed for the Named Insured by independent contractors or general supervision
thereof by the Named Insured except (a) maintenance and repairs at premises owned by or rented to the Named Insured and (b)
structural alterations at such premises which do not involve changing the size of or moving buildings or other structures, and (5)
property damage arising out of liability assumed under a written contract or agreement. Such aggregate limit shall apply separately
to each division above for which insurance is provided and for each annual period of the policy.
CI-2004 Ed, 6/81
)
I
For the purpose of determining the limit of the Company's liability, all personal injury and property damage arISing out of
continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence.
,l
~
Subject to the above provision respecting "each occurrence", the total liability of the Company for all damages because of all
personal injury and property damage to which this coverage applies and described in any of the numbered subparagraphs below
shall not exceed the limit of personal injury and property damage stated above as "aggregate":
(a) all personal injury arising out of any offense in Groups A, Band C, defined in part (2) of th~,definition of personal injury;
(b) all property damage arising out of any premises or operations rated on a remuneration basis or contractor's equipment rated
on a receipts basis, including property damage for which liability is assumed under any contract relating to such premises or
operations, but excluding property damage included in subparagraph (c) below;
(c) -all property damage arising out of and occurring in the course of operations performed for the Named Insured by
independent contractors and general supervision thereof by the Named Insured including any such property damage for
which liability is assumed under any contract relating to such operations, but this subparagraph (c) does not include property
damage arising out of the maintenance or re~airs at premises owned by or rented to the Named Insured or structural
alterations at such premises which do not involve changing the size of or moving buildings or other structures;
(d) all property damage included within the products hazard and all property damage included within the completed operations
hazard.
Such aggregate limit shall apply separately to the property damage described in subparagraphs (b), (c) and (d) above, and under
subparagraphs (b) and (c). separately with respect to each project away from premises owned by or rented to the Named Insured.
Note: If this endorsement applies to CI 2006, Intermediate Form, (d) above does not apply and the prior paragraph is amended to
read:
Such aggregate limit shall apply separately to the property damage described in subparagraphs (b) and (c) above, and under
subparagraphs (b) and (cl. separately with respect to each project away from premises owned by or rented to the Named _ )
Insured. ,
,~)
\.
\ '
':'---
POLICY NO.
1
EFFECT/V:: DATE
NAMED INSURED
,-
r
!
1
COMPREHENSIVE INSURANCE POLICY
SECTION II
COMPREHENSIVE GENERAL LIABILITY
SCHEDULE
GENERAL LIABILITY HAZARDS
Description of Hazards
Code
No.
Premium Bases
Premises - Operations
Hotel - not apartment - with
swimming pool or bathing
beaches.
Rates \
B.1. P.D.
70112 209 vrs.
70122 cH,400,OOu vrs.
Ten Pak
99998
Restaurants - with sale of
alcoholic beverages that are
less than 75% of the total
annual receipts of the
restaurant - with dance floor
vrs.
vrs.
58260 d)81l,OOO vrs.
Building or premises office
vrs.
65121 c)1,400 vrs.
vrs.
PREMIUM BASIS:
Premises - Operations
(.1 Area (SQ. FtJ
CoJ ~,.ont~
Ie I Remuneration
ld) Receipts
lei Units
to AdmialOf'\$
Escalators (Number at Premisesl
NLtmCer inlured
Independent Contractors
Cost
Products
lal Sal..
Completed Operations
Cbl Receipts
CI-2315 Ed. 2/81
1.1 Per 100 Sa. Ft. of Area
(bJ Pet' L~. FOOl
tel Per S100 of Remuneration
Idl Per $HlO 01 ReceIPu
Ie. Per Unft
(f I Per 100 AdmiSSions
Pe-rUl1dlng'
""r SlClO of Cost
1.1 Per $1,000 01 Sales
Ib) Per 11,000 of Receipts
Advance Premiums
Bodily Injury Property Damage
Ine 1.
Ine1.
Ine 1.
Incl.
Inc 1.
Incl.
inc 1.
Inc 1.
Ine1.
Incl.
-~
1'------------ iEi=lcrivE DATE ------}-
, 'POLICY NUMBER . I NAMEO INSURED
. I "
COMPREHENSIVE INSURANCE POLICY
SECTION IA
SCHEDULE OF MORTGAGEE(S)
Location # Name I Address
\
,
\
-
!
-.
-
I
SCHEDULE OF LOSS PA YEE(S)
, Location # : Name i Address ! Designated Property
,
, ,
1 I Ameritech 149 W. Central TelepzlOne System
Credit Corporation Schaumburg, Ill. 60193
I I
I !
I
1 I Comtel Communications 170 Hontauk Hwy. Drawer E I Telephone System
I
I Corporation Speonk, New york 11972
I I -
I
1 Associate Business 11 James Street Telephone System
Telephone Systems Corp. Mt. Ephraim, N.J.
08059
AttN. Pete Karahalios
I
I I I I
CI.1117 Ed. 6/81
-
..
~I
CONTINGENT LIABILITY FROM OPERATION OF
BUILDING LAWS ENDORSEMENT
(For use with Property Damage Building Items Only)
1. In consideration of the additional premium for this coverage and subject to stipulations, limitations and conditions herein and in the policy to ....
this endorsement is attached, including enaorsements thereon, thIs Company under thiS policy and thiS endorsement shall, in the case of loss
building(s) covered by thiS endorsement by fire or other pelll insured against. be liable also for the loss occasIOned by the enforcement of any sta
municipal law or ordinance regulating the construction or repair of bUildings and in force at the time such loss occurs, which necessitates the demol
of any porllon of the Insured building(s) not damaged by the pelll(s) insured against. subject to the following Limits of Liability
2. limits of liability: This Company shall not be liable under this policy and this endorsement for:
A. Any cost of demolishing or clearing the site of undamaged portions of the building(s) unless such liability is otherwise specifically assume
endorsement hereon and an amount of insurance specified therefor. '
8, Any greater cost of repaIr, construction or reconstruction due to the enforcement of any itate or mUOlclpallaw or ordinance unless such liabili
otherwise specifically assumed by endorsement hereon and an amount of insurance speCified therefor.
C, More than the amount Insured under the policy to which this endorsement IS attached
Q, More than the actual cash value at the time of the loss of the building(s), or any part thereof, damaged by perils insured against or demolished dl
the enforcement of any state or municipal law or ordinance,
E. Any greater proportion of any loss than the amount insured under this policy on said building(s) bears to the total insurance on such buildinl
whether all such insurance contains this endorsement or not,
!~'-
..; II'
-........ ~
t
. '.
CF 04
@D:
,- .',,-
3. If this policy is divided Into two or more items, the foregOing shall apply separately to each item to which this endorsement applies.
This Endorsement must be attached to Change Endorsement when issued after ttle Policy is written.
CF 04 05 (Ed, 05 77l
or- _
{ :i
. 1
.,..
"-
~
~
~.
~
,~
j
1
.,
J
.1
, 'i
j
]
;,;i
"1
i
:1
. '1
.~i
'~
~1.
"
..
~
,.j
; J
~
.. ..
~ 1
fJ
i . ~
.-- '!
t ~:\,.
tf
t5
, &/i"
,_.~
't.~l
.1;.0-
rt:i
,;
~_. ,
"
,
~
, i:'
~t
,-
~
.;
,.
'Of
it
-~
~
~.
..
.-
.1
.
...
.
,
.,
~..; ...4L-
..,'':'
..
~
".i
;j
-i'~
'::1
:j
r'i
. f- ~
;i
_ tJi
f'>t
.... ,
rJ
t .-.
t~
~ j
r-i
,
.i
!
1
J
1
~
1
'A.
!' III ~ .
~ j,.l..:
... '
.
I
I
DEMOLITION COST ENDORSEMENT
(For use only wltn Contln,entllabillty from Operallon of
BUllOlnlllaws Enoorsement)
CF 04 06
lEd 05,7)
I COMPANY
POLICY NO,
AGENCY
1. In consideration of an additional premium of S Tnr 1 . the amount of Ir~urance uncer ;~IS policy IS Increased by 'not exceeding
$ 1.000.000 applicable only to the cost of :amollshlng anv uncamagec conlOn of !~e bUlldlng(s} co'..e'~c under this poliCY and this endorsement
including the cost Df clearing the site trereot. causec Dy IDSS from any cenllnsurea against underthrs poilcy c~d resulting from enforcement of any state
Dr municipal law Dr DrClnance regulating tne construction Dr repair of bUildings ana In force at tne time cf lOSS which necessitates such demDlltlon
2. This CDmpany shall nDt be liable u~der this endorsement fDr:
A, Any greater propDrtion of any less than :,e amount Insured "neer :his endorsement for demolitiDn and ciearing s,te bears to the total insurance
cDvenng expense Df demDlltlDn and cleann;: Site,
B, MDre than the amDunt speCIfied atov~
This EndDrsement must be attached to Chanlle Endorsement when issued after the PDlicy is written.
~
CF 0406 (Ed (577)
...........
..--.
(
'POC:lYNuMBE F'C---------------U FEl-:;~E.~--C---
NAM-EO-'-"SURIo----1
COMPREHENSIVE INSURANCE POLICY
ENDORSEMENT NO. SECTION IA
The following are added as additional Insureds
Ameritech Credit Corp.
Comtel Communications Corp.
Associate Business Telephone Systems Corp.
CI-0008 Ed. 2/81
.... - --........,
'.
- ....... - - -'
-- - .- -.... -.'.-- - - - ~,- ..,,-. ---
E(FlrIVEDATE ---.---- ~!\A-'_iE5-c"-S-URED---l
Clearwater B~ch Hilton Tnn
r
COMPREHENSIVE INSURANCE POLICY
ENDORSEMENT NO. 2 SECTION
IA
In consideration of the reduced rate at which this policy is written,
Loss Settlement Provisions for Coverages A and B is amended as follows:
,
The sum of $1,000 shall be deducted from the amount of each loss occurring
at the same time and at the same location for all perils except Windstorm,
the sum of 1,000,000 shall be deducted for the peril of Windstorm.
90-6501
Oberdorfer Ins.
Atlanta, GA
CI.OOO8 Ed. 2/81
-. ... ~
r-
(
, ~
EFFEl:.lVE D"IT
, NA-MEDTi~SUREDu--_u----I---
POLICYNUr~BER
COMPREHENSIVE INSURANCE POLICY
ENDORSEMENT NO. SECTION
SPECIAL THIRTY (30) DAYS NOTICE CLAUSE
It is hereby understood and agreed that the insurer will give the Investment
Administration, State Mutual Life Assurance Company of America, 440 Lincoln
Street, Worcester, Massachusetts 01605, at least thirty (300 days prior
written notice of cancellation or major modification, by any party.
CI-0008 Ed. 2/81
...--... _. - --- '-"--'-'- .- - ~...'
- .
~ ~~J I C_',' , "
.:.1)2~v~2c~i2_~)l,_
Renewal (If
1
1 RELlANtE INSURANCE COr,l,?ANY
>' ',ila:Jelphia, Penns,lvania
Reliance@
6 UNITED PACIFIC INSURANCE COMPANY
Federal Way, Washington
,i,
2 PLANET INSURANCE COMPANY
Home Office-Sun Prairie. Wisconsin
Administrative Offices-Philadelphia, Pennsylvania
8 RELIANCE INSURANCE COMPANY OF ILLINOIS
Home Office-Roiling Meadows, Illinois
Administrative Offices-Phlladel~hja, Pennsylvania
~ ~ Coverage 1$ ploVldotJ u, the Comoany ~ed by
'1 Number laclllS I StwllllHl....c. ~, her.1ll
~ the Company,
Dee ara loas "~_ .
It.. 1. MJllled Ins and and Address: INo., Street, Town, County, State, Zip)
',-; ~"Lane' Cls.ar\vater Limited Parb.1erslup
~" ~_ DBA Clearwater Beach Filton Inn -
715 South G.1lview Blvd.
Clea:ctJater, Pincllas, FL 33515
hem 2. POlicy From: 5/29/86 To: 5/29/87
" '; - Period:' 12:01 A.M. Standard TIme at the Address of the Named Insured as stated herein.
Agency Code, Name and Address
. ~O-6501
Cberdorfer Llsurance P-.gency
Atlanta, G\ 30328
'-,
'..
~ -1: , ,," .":.'
~~,.. ".
..'
'S
litem 3. Sc~edule of Underlying Insurances:
CARRIER
P.e1:iance Ins. Co .
COVERAGE
CJ Comprehensive Ceneralliabi lity
Li1 including Products--{;ompleled Operations
o excluding Produtls-Completed Operations
LIMITS
$ 1,000,000/1,000,000
$
81
PO
Reliance IrLS. Co .
1:1 Automobile liability
~ Covering Any Auto
o Other
o Employers' liability
$ 1,000,000/1,000,000
$
81
PO
$
H.
P.eliance LlS. Co ,
~
P G: I
$ 1,000,008/1,000,000
Item 4. Amount of ultimate net loss to be borne by the Named Insured in respect of Each Occurrence not covered by Underlying Insurances:
$ 10,000
Item 5. limits of liabi lity:
a. $ 5, 000 , 000
Each Occurrence
b. $ 5,000 , 000
Aggregate for Each Annual Period where applicable
~ -$32,24J
P~:I- $ 1,1~20
I\J.lto- ~~ 162
G~3 , ~25
Item 6. Premium:
S 33 , 825
It"- 7 M nlmum Prem m' $ 2000 f h An I P '00 t b'
~... i - iu . or e.ac nua en ,no su Ject to short rate a'lustment.
noorsements forming a part of this policy at issuance:
L'),73Q, 13740. GI2133. ('-en /~7-19. CeD. !~7c. rei 47
Cen 1179
,-
l;...t.r\uu", ~J\ "~. '..l""'''., II..
8~...dY-B~~ikii!/~/J. .
() thorized Repre~entative
ountersignetl
19_ at
By
:p!sP-6119 Ed. 9/80
Rev. 11-1-76
(;Yc&:f. 0/)1X01J~'lkd2/
C.:Jn'PF'Y t~Ui.::'3rS,
1 = Reliance Insurance Company
2:; Planet Insurance Company
6:; Un/Jed Pa;ific Insurance
Company
8:; Reliance/nsurance Co. of
illinoIs
t - - -- --
I \;~~,~e"~~~ ~~~':I' ~~~~~C"':~:~~~:icc v=" ,~c ),::2~~'C'; C:~.:~",(:j ~:~~~~~~d
T--'.-oa.--- _._-,-
Erd! No
POliCY No,
Unearned Premium Faclor
All terms and conditions of the policy remain unchanged
except as amended by this endorsement.
Return Premium
Premium subject
o Ie audil
Effective Dale
Policy Period
v
EXCLUSION OF REAL PROPERTY IN CARE, CUSTODY OR CONTROL
"
In consideration of the premium charged, it is understClod and agreed that
this policy shall not apply to real property rented to occupied or used by or
in the care, custody or control of the Insured.
'.
"
c.
l-3739 Ed. 12-75
h~,.';i~!f1~",~:;~~~~.~~~':~~.;f~~~;i~~ i}. ~}~.{.~;.~~;l:~t~:;'" . ';'-l~::~\';~~.;~:;f \rr;,,~ --:-c~-;:; ~~.~:i":? ~~~.,~!:~~~"'-~~~'~>X>..,~/o" .'
~:r1:~1~"" "i'~""""~~'''' *,,,...., . ,'-'" '...,.' ~ i./:.", "-1- ' ,1,.,..., '/ ~."" ~,,# ~..... ._ .;,." ~ t.,...... ,~,.".j #. '" -'~ '.... . - \'',:{ 1,' ,,~,;""., " . i'll-T'" T,
.-' .'.' 'C~' Z: . -::."-~-'<:--:'-:"";,.C;."" ~~< ,'...:.', Ji'.;' ': ".; :;~-...:...: ~,', "'"\4~: "~ ...';- :;,..'.i,;~!.>.,~,! :'C:": ',.:i.' ~~':.t.;:\.:!:~,;\..;;~~~"'~
. -;,,o;.;.~~.;-.;., -c=' ~,.;.:<:: -,;,,"".,,;,.:';;,:..," ~::," <:..:r':-', ., - . ,,'-- '- I '.,.;,~ ~..'l"_', '-, '.', ':..~, ',...;'.:< -- ..., '~", 'A' C~'~;c;"":"'" " '. ~-.. 'fi' . ~.,' .
~i~ ~~~.: X"'~iii:.:"~jt.~J' ......~.........- ~ .-~~ ':.t~,~~,.ZN..'4''' flt'-.t:.::.z.!-w- Y;.~t- :>..~rr~~ ~'r:,&~:J 1~. _';;."", "'"-":':-h~~~. F -_:..!~{._-t::~",~~~1I.~~:~-;~ -~. ~:",.,ot
"""-. '.' ~:J!{;i:i-c~';'''~'WIi;'';,vi'~~~ .~~.i}l.:"::'~"':itr.?..~~::'~"; .~..v~~ -~~~ ,..i~.t.:~.; ': .~.,'
.~~,_,..e,~1!'.,. -=~,.., ~" 'k'l;~"'~', ~. fl. ~ ..,~~""'.I..,,,,.........,..,?- o:::t~'),or., L""__Y-_it.~~..~
- <,,' .>.
'I C:':'I'-I~-~-.n-, "~~;~'~_"\::!.s
i 1 0 io;p!;,V1CE I~SUI5I)CC ro.Tlpany
2 ~.:- Pianet i.r.surnnce Compan~/
6 : Unlled Pacific Insurance Company
8 : Rel.ance Insurance Co. of IlImOIS
. 'I ".. "..'
J :~s"ed bj colic'
E Hective Date
Unearned Premium Factor
" L1f'L: ,_' ilL',: Ii'" !.',~
-, d'f' ~-:"J(\-~'~I'" ,--:. 'IF' ;''''''-1' ',,:: l~,,,..r)I'ele.
''..), ',,,rh.'" '; ,-.., .' '_!.-U' .,' v,"~ OJ
-----'-~----_. -
End:. No.
Polley No
-- .--------'---
Insured
Policy Pellod
Return PremIum
s
Alllerms anCl conCl.1I0ns 01 the policy
remain unet'lange<:! Heept as amende<:! by
Ihls endorsemenl.
EXCLUSION OF PERSONAL PROPERTY IN THE CARE, CUSTODY OR CONTROL
In consideration of the premium charged, it is understood and agreed that this policy shall
110t apply to personal property rented, to, used by or in the care, custody or control of
the Insured, or as to which the Insured is for any purpose exercising physical control.
L-3740 Ed. 12-75
Plemlum
o 5ub,eet
to audit
-
!~l 21 33
I (Fd ?85)
This 'endor'sem~nt forms a part of the policy tJwhlch atta:hed, effective ( the l:1ceplion dale oj the [,)ICY unless otherwise stated herein,
(The following information is required only when this endorsernrnt is issued subsequenllo preparation of policy.)
Endorsement effective
Policy No
Endorsement No,
I . ,Named Insured
. "'- .
Countersigned by
(Authorized Representative) .
i'~'
f '
i-~~-'
This endorsement modifies such Insurance as IS afforded by the provISions of the policy relallng to the follOWing:
, COMPREHENSIVE GENERAL LIABILITY INSURANCE
CONTRACTUAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
SMP LIABILITY INSURANCE
STOREKEEPERS INSURANCE
POLLUTION EXCLUSION
'II ',"'.
:... "', . ~.
~ 'j
~
,
~
c' "";
It is agreed that the exclusion relating to the discharge. dispersal. release or escape of smoke. vapors, soot, . ' .~
fumes. acias. alkalis. toxic chemicals. liquids or gases. waste material5 or other irritant5. contamlnarlts or pollu-, '
tantsis replaced by the following:
(i) to bodily injury or property damage ariSing out of the actual. alleged or threatened discharge. dispe'rsal.
release or escape of pollutants:
(a) at or from premises owned. rented or occupied by the named insured;
(b) at or from any site or location used by or for the named insured or others for the handling. storage.
disposal, processing or treatment of waste;
(c) which are at any time transported. handled. stored. treated. disposed of. or processed as waste by or:
for the named insured or any person or organization for whom the named insured may be iegally
responsible; or
(d) at or from any site or location on which the named insured or any contractors or subcontractors
working directly or indirectly on behalf of the named insured are performing operations:
(i) if the pollutants are brought on or to the site or location in connection with such operations; or ,
(ii) if the operations are to test for, monitor. .c1ean up. remove. contain. treat. d~toxify or neutralize,
.~ '''. the pollutants. ' .
.. (2) to any loss. cost or expense arising out of any governmental direction or request that the named insured
" ',.~ , test for. mor.itor. clean up. remove. contain. treat. detoxify or neutralize pollutants.
i Pollutants means any solid. liquid. gaseous or thermal irritant or contaminant. including smoke. vapor. soot. . '
fumes. acids. alkalis, chemicals and waste. Waste includes materials to be recycled. reconditioned or reclaimed.
'.
.:' . .~
,
. ,,_._.-_ '!I
.,
'. v
"
.,,,.
~; ""
'.. . .... . :.
GL 21 33 02 85
Copyright. Insurance ~ervices Office. Inc.. 1984
.....
..~~~_..-_"~ ~"%:','!",.. ":' J. -.... .
~
.
_ b,
. ~,~','
t~
-~
~
,
.'
,
y -.
~J
~~
~...
~<,>
r
.' .
. ~
k'.,
p'
! .
.......
..~~
.' . I~~
- . r.~
t
:.
~...
r
~,
. I
'-
; ;
~_...r~ t
~
f~
i
l~
l--~
t '
, .t.:,,;-
..' ~ 7'
,. p=
.-
t
.... ~'"
.
h"~
L~'
f"'~
f~
~
. .
L
b
. iT....
I
... i
~ .'
'-' ;
I
,
~.~-
. .
"..
..'
~,
I
Drsa.a: L~I€ S t.MiARi
I
, POLUJI'ICN EXCLl5I~ GL2l33
nu. policy ca'1taW an. endorsemmt not previously at your policy that
m::difiu tile pollut.ia1 ucluaia1. Please read 1:hi8 endorseIt=1t carefully.
It excl~ bodily inju:y or prcprty ~ ariairq out of the actual,
allecJod or threatened ~, dUpe.rsd, releue or ev"'~ of pollutants
as well u lc:u, c::aJt or upIlnM arUinq out of art[ govumental direction
or requD8t that Y'C'1 teDt fer, na'1i.tor, clean up, res:rcva, contain, treat,
dtltaxify or naautralize p:>>llutants. I
PollutMlta are defined in the endcrs~t.
, .
. .
j
".
I
I
Company Numoers
, . Relrance Insurance Comoany
2 .. Plane' Insurance Company
6 .. Un/led Pac",c Insurance Company
8 .' Rel,ance Insurance Co. of flllnO'S
Issueo by Co. No, lnsureo
" In IS enOolsement 'S .SSUfO tonCU'It"lly .,,'In lne POliCy me Anacnlno Clause neeo not Oe tama'ereO
EHeCI.\le Dale Policy Pelloct
Un~ameo Prlm'llum F aC10r
All 1prms Ind conOlltons 01 T'tlf' POlICy
r.m'ln unchangtd eo.cep, ~5. ~mend!d by
th', rnoorsempn,
LIQUOR LIABILITY
Return PremIUm
.p
O.
n.
s
It is agreed that this policy does not apply to personal injury or property damage
(or which .the insured or his indemnitee maybe held liable
.. .' '. \.
1) As '. a person or organization engaged in the business of
manufacturing, diStributing, selling or serving alcoholic
beverages, by reason of the selling, serving or glvingo[
. any alcoholic beverage (a) in violation of any' statute, ordi-
nance or regulation, (b) to a minor, (c) to a person under
the influence of alcohol, or (d) which causes or contributes
to the intoxication o{ any person; or
2) If not so engaged, as an owner or lessor of premises used
{or such purposes, by reason of the selling, serving or giving
. of any alcoholic beverage in violation of any statute, ordi-
nance or regulation. .
Unless such liability is covered by 'valid and collectible underlying insurance as.
described in the Schedule of Underlying Insurance, and then only for such hazards
for: which coverage' is afforded under said underlying insurance.
~
- -:---,,:-
.' ,,.
..:.-:~._..
- ~~~~~
-,....~..1....
..-...~.
-'""........C'.~.;._.
.... . .......-.. ,Olio
. - .a".::.. ~ -
...... ..100 '.--,.-.:'0 .
-~
.-.....'1.........
.... ..-
'1"
Use when Host Liquor Liability is not covered by the underlying liability policy".
and Reliance does 'not want the coverage on the Umbrella, even subject to the
, retention.
,'""'
GEN 47-19
. t, ;',"'r5
il
f"j'ssuvj-t,,. CQ
',','
'-
\" rl~' l,
,Ct:~t_' ,01_,:,1, ~J
[r.j: ""0
1 Rc/ld'H.C If':.,<..:f:;.nce Cunjpa,.,y
2....::: Pianet '"n~u.,ance Company
6 UntIed PacifIc Insurance Company
B : Reflance Insurance t;o, of illInOIS
1 Fflt.C;.c~
I
L;ate
J
.lled
__ --,_ u
Addd1vr,al Plemlum
o
PremIum
SouDlec1
10 audit
Attached 10 and lormmg .- 1rl of PolICY No
Covnlers'gned bV (Authorlled Repre'Mtntahve)
f\e1urn Premium
$
All terms and condlllons of the pOlicy remain unchanged excepl as amended by thiS endorsement Unearned Premium Faclor.
,
, ~.7':
;:-.. .
. '
..., ,.~
'.
/:.:.~ Additional Insureds
.~.~~-
City ot: Clean.-ater
P..O. Box 4743
Clearwater Ech. FL 33518
~~4"
Hilt.cn Hotel Corporation & Hilton Jrms,
-9880 Hilshire Blvd.
P.O. Box 5567
Beverly Hills, CA 90210
Inc.
.,
\.
v
0 THE PREMI:JM FOR THIS ENDORSEMENT IF ON INSTALLMENTS IS PAYABLE AS FOLLOWS:
AOOITIONAL RETURN REVISED ANNIVERSARY PREMIUM
AT DATE OF ENDORSEMENT S S (NOT APPL.ICABLEI
FIRST ANNIVERSARY S $ S
,.' .
SECOND ANNIVERSARY S S S
G~7 EO. 4/74 (Sets)
GEN..17A ED. 4/74 (5gJeJ
- ...:.:--...:. ...~~~~. ~~ :.-':-A."'-...., ..-..lOIIio?-.-""....~->--c'"'~--- ~ -..~.. - --.. .-4~ _ '"'-'"....,.> ~..._Jts.-. "'-'i>f.--'.
-r- '!-~:'--~"t. ..L......... .~~-~~~.1- _..-..,~ ;-;c.-~~"r~:.-\.lt_c:.'U'- .Hi-~I--f!-~If:JJ..: ...-!'~.....-.:~:..~.."!';,~l~~~,t~~~ "'ft-i;.1tl~.;r ,,;:;.:- .J
:,~, ~I ~jtsr~~~J:2~.11~J : i~~~ l{,:7 ':'; ',~:~ ~:~S::~~,-~~;,:_,;;:- ~~-~ ~ i.~t~-~?!~_::_:;:~ :j:~:~~J~:r~:;~(~~~i.;~~~~!;l~rf~~~~~~-: v
.~~.;:i..~~~~l.-;z.~:&~;f~.:t~~.r?;:.!('. ".~,:'r .-t,.:,:, ," ::.,>~~~ ~;t:~ r' ":,ii.'-~ . ^: ~ :".,::l: .>~ -' >.1 ";,;- ,~,; '~':: ....;:?: - ~-. :,U;?,;~~~ -:" ,ili~~);~"'r.;:;.~
:;~~i.f ~"f ;. ~~'::"-:~'!f-;r::~~.~.I'~ ;;-~;:.t"-;;.:!~'~ - "'_.~".? ~ .--.r. '-t: .i-:-::'::;'_~'''.... _ II.,.::.:: ..~.. <.~ ~. :'.~'; oJ': ! -!.~'..::;,(_~.::..~ 4>::''-''~ ~--~.f:j..)~t. -r:-~-~;.;~'~;~~ _ ..
~oM-~.~"$;:1/;"'l! ~~~~;\'~f..-\Y~\~\':::t:~~~:-!.t~~. ~~:;..: '~ '~}!r~I~-' ~~~~\:~.:.~: .~-~~!t ~'~';;,,"...5 '; 7~~'4',,-,,::, I.,",--;;:~: !,,~~..':~~j_~_~~t~~~~: !,~.:1\,{~ - .~.:;j.f:.\~~r~".f:fr~l~._:;.l ?::';~"i ~
/ .:.a..:.~.._~ : .....~ .'li:;.~"" ." __r-.~ .- t:..f ". -' '''~~'' ..'-....~_.._ _ .-. .,~.~ '_ ... r...~-....4 '.- -_......~ .! ...~~.~J.~J=---'l:' .. ...~ ..~.....t...
.:..-~~:... -~' i::-:; -;:'-Ii1i::' .."":'} -i: ~.c .' '~--:-'_-,~""'~d:.: ....h~. ~.:....;:.:. , ..-..,;. - ~'._-'-:- - ~ _>:i.....; <"Ii'. O::l..:'i_~'''''''-:''''''''~:'r''-L ..."'>~c~ ~';;f:' v'
~ '-,;;: ~;~{i~~~';E~': '~~;.~::-6~~~~':''''';;i;.~; :'.' ,<:->,:~:t-~~~~i. ~4;,~~'=i:~i~~:~~<;~:~'f'i~~~:;'~~~"t:f.:~~~H~~, _ .
~~,.~~_,;~~i!~~~:~~-!!'0~~~~)",j.2i--;;:'~~J~{'#4~~~;:;::~~;~~::-#J:{7~~;:~~~lt.:~~..
lt~s'u'l-r,~t:[-JT OH'I OIZr:r LdLL l:h!UOHSI':i/I~:~r
Company Numbers
1 = Reliance Insurance Compan.v
2 = Plane/Insurance Company
6 = Ufllted Pacific Insurance
"Company ,
8= Reliance Insurance Co. of
l/finols
If this endorsement is issued concurrently with the policy.l",e AlIaching Clause need not be completed
Issued by Co. No. Insured .
Endt. No.
Policy No.
"
Return Premium
Premium subject
o to audit
Effr:ctive Date
Policy Period
r
Uneam9d Premium Factor
All terms and conditions of the policy remain unchanged
except as amended by this endorsement.
.'~
DATEDUE PREMIUM INSTALLMENT STATE TOTAL ~
, CHARGE SURCHARGES
. . /
1 5/29/86 8454
.
2 6/29/86 2319
\
.
- ,
3 7/29/86 2819
>
4 8/29/86 2819
5 9/29/86 2819
10/29/36 2319
6
.
"
7, 11/29/86 2819
a 12/29/86 2819
-
9 01/29/87 2819
1002/29/87 2319
11
,
'.
12
, .
.'
.,.
. .'
, .
, .
o If this box is X'ed, the installments
(other than the first installment) are
to be equa.! amounts.
, ..
,.
GEN-1179 Ed. 10/83