BUSINESSOWNERS POLICY DECLARATIONS - INSURANCE POLICYAPR 06 2009 21!46 FR
auto. Owners Page 1
AGENCY COPY
INSURANCE COMPANY
6101 ANACAPRI BLVD., LANSING, MI 48917-3999
AGENCY MUTUAL INS AGENCY AT CLEARWATER INC
12-0005-00 MKT TERR 052 (727) 446-6064
msuneo BRUCE LITTLER INC
ADDRESS 25 CAUSEWAY BLVD
CLEARWATER FL 33767-2064
TO 4626957 P.02i03
54643 (01-90)
Issued 02-13-2009
BUSINESSOWNERS POLICY DECLARATIONS
Renewal Effective 04-01-2009
POLICY NUMBER 91-130-168-00
Company Use 20-57-FL-9104
Company POLICY TERM
Bill 12!01 a.m. 12:01 a.m.
04-01-2009 to 04-01-2010
Policy change: Effective Date of Chsngo MO DY_ Yk_
Cross out old information and write in the changes.
SOME OR ALL OF THE LOCATIONS ON THIS POLICY MAY
CONTAIN AN EXCLUSION FOR THE PERILS OF WINDSTORM
AND HAIL.
ENTITY: Corporation
PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS DED LIMITS PREMIUM
Special Coverage Form
Automatic Increase(s)
Business Personal Property Limit 4.32
TERRORISM CERTIFIED ACTS INCLUDED
BUSINESS LIABILITY PROTECTION LIMITS PREMIUM
COVERAGES
Liability and Medical Expense
Medical Expense - Per Person
Personal Injury
Tenants Fire Legal
TERRORISM - CERTIFIED ACTS
FORMS THAT APPLY TO ALL LOCATIONS: 54510 (09-82)
BP0009 (01-87) 54679 (06-92) 54709 (0494)
$1,000,000 Included
51000 Included
Excluded
50,000 Included
INCLUDED
BP0002 (01-87) BP0006 (01-87)
54656 (08-91)
APR 06 2009 21:4? FR
011
TO 462695'7 P.03/03
r"%k
Pape 2 54643 (01-90)
AUTO-OWNERS INS. CO. AGENCY COPY Issued 02-13-2009
AGENCY MUTUAL INS AGENCY AT CLEARWATER INC Company POLICY NUMBER 9.1-130-168-00
12-0005-00 MKT TERR 052 Bill Company use 20-57-FL-9104
INSURED BRUCE LITTLER INC Term 04-01-2009 to 04-01-2010
LOCATION 001
LOCATIONS 25 CAUSEWAY BLVD CLEARWATER FL 33767-2064 c?2vG•,
COVERAGES DED LIMITS PREMIUM
Addl Insured-Managers or Lessors of Promises Included 919.60
TERRORISM
CERTIFIED ACTS SEE FORM(S) 59350 31.48
ADDITIONAL FORMS FOR THIS 40CATZON: BP0104 (01-87) RP0303 (06-89) IL0175 (09-93)
IL0255 (07-94) 54238 (12-01) 54244 (01-02) 54604 (07-66) 54661 (06-91)
55081 (08-88) 59350 (01-08)
LOO 001 BLDG 0001
COVERAGES DED LIMITS PREMIUM
Business Personal Property - REPL. COST $2,500 $218,480 $3,099.27
Business Income And Extra Expense Excluded
Exterior Grads Floor Glass 250 See Form 17.82
Interior Glass 250 Sea Form 10.69
Windstorm And Hail EXCLUDED
ADDITIONAL FORMS FOR THIS SUILDING: 54703 C08-941 54602 (07-87)
SECURED INTERESTED PARTIES: None
RATING INFORMATION
Occupancy: Gift Shop Tenant Occupied
Class Codas 59994 Const; Fire Resistive, Nan-Sprinklered
Program: Mercantile Protection Class: 03
Liability Rate Number: 04 Territory: 022 Pinellas County
Burglary Rate Group: 02 Inside City Limits
LOCATION 002
LOCATION: 621 LAKEVIEW RD 8 12 CLEARWATER FL 33756-3364
COVERAGES
TERRORISM
CERTIFIED ACTS SEE FORM(S) 59350
ADDITIONAL FORMS FOR THIS LOCATION:
54238 (12-01) 54244 (0102)
59350 (01-08)
LOC 002 BLDG 0001
COVERAGES
Business Personal Property - REPL.
Business Income And Extra Expense
SECURED INTERESTED PARTIES: None
DED LIMITS PREMIUM
$1.00
BP0303 (06-69) IL0175 (09-93) IL0255 (07-94)
54604 (07-88) 54661 (08-91) 55081 (08-86)
DED LIMITS PREMIUM
COST $1,000 $1,040 $99.59
Excluded
** TOTAL PAGE.03 **
APR 06 2009 21:46 FR TO 4626957 P.01/03
Agency Code 12-0005-00
F icy Number 91-130-168-00
54709 (0-94)
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 4
CLEARWATER, FL 346302000
Name of Person or Organization (Additional Insured):
CITY 01' CLEARWATER
25 CAUSEWAY BLVD
CLEARWATER, FL 346
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 Schedule is also an insured, but only with respect to liability aris-
ing out of the ownership, maintenance 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 not apply to:
1. Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Sched-
ule.
2. Structural alterations, new construction or demolition operations performed by or for the person or organi-
zation designated in the Schedule.
The limits of insurance for the additional insured are those specified in the written contract or agreement between
the insured and the person or organization named above, not to exceed the limits provided in this policy. These
limits are inclusive of and not in addition to the limits of insurance shown in the Declarations,
Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara-
tions.
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