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DECLARATIONSStateFarm STATE FARM FIRE AND CASUALTY COMPANY 2.702 Ireland COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Bloomingfon,Gm� Road 61709-0001 F -18- 3784 -FB02 F Z 1136 3123 Add! Insured - Section II Only CITY OF CLEARWATER PO BOX 4748 CLEARWATER FL 33758 -4748 Office Policy DECLARATIONS AMENDED JUN 24 2013 Policy Number 94 -LR- 3824 -2 Policy Period Effective Date Expiration Date 12 Months APR 4 2013 APR 4 2014 The polipy period begins and ends at 12:01 am standard time at the premisesTocalon. Named Insured HESSPORT LLC C/0 HESS, PATRICK 134 S MORTON ST KENDALLVILLE IN 46755 -1635 Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee /Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Limited Liability Company Reason for Declarations: Your policy is amended JUN 24 2013 ADDITIONAL INSURED ADDED FORM CMP -4786 ADDED Endorsement Premium Increase $ 44.00 Discounts Applied: Renewal Year Years in Business Claim Record Prepared AUG 262013 CMP -4000 009645 290 Al N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 6 530 -686 a.2 05 -31 -2011 (o113231c) DECLARATIONS (CONTINUED) Office Policy for CITY OF CLEARWATER Policy Number 94 -LR- 3824 -2 SECTION I - PROPERTY SCHEDULE Location , Number Location of Described Premises Limit of Insurance* Coverage A - Buildings Limit of Insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 134 S MORTON ST KENDALLVILLE IN 46755 -1635 No Coverage $ 27,500 25% * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES1 Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 231.4 SECTION I - DEDUCTIBLES Basic Deductible Special Deductibles: Money and Securities Equipment Breakdown $1,000 $250 Employee Dishonesty $250 $1,000 Other deductibles may apply - refer to policy. Prepared AUG 26 2013 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009645 Continued on Next Page Page 2 of 6 StateFarm 0 DECLARATIONS (CONTINUED) Office Policy for CITY OF CLEARWATER Policy Number 94 -LR- 3824 -2 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises LIMIT OF INSURANCE $50,000 $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared AUG 26 2013 CMP -4000 009646 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Continued on Reverse Side of Page Page 3 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF CLEARWATER Policy Number 94 -LR- 3824 -2 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION 1- EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. LIMIT OF COVERAGE INSURANCE Dependent Property - Loss Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained -12 Months Prepared AUG 26 2013 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009646 Continued on Next Page Page 4 of 6 StateFarm 00 DECLARATIONS (CONTINUED) Office Policy for CITY OF CLEARWATER Policy Number 94 -LR- 3824 -2 SECTION 11- LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You LIMIT OF INSURANCE $1,000,000 $5,000 $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products /Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP -4100 Businessowners Coverage Form CMP -4786 *Addl Insd Owners Lessee Sched CMP -4214 Amendatory Endorsement FE- 6999.1 Terrorism Insurance Coy Notice CMP -4714 Excl Data Processing and Prog CMP -4713 Excl Testing Consulting E &O CMP -4839 Loss Payable CMP -4819 Unauthorized Business Card Use CMP -4706 Back -Up of Sewer or Drain CMP -4704 Dependent Prop Loss of Income CM P-4710 Employee Dishonesty CMP -4709 Money and Securities CMP -4703 Utility Interruption Loss Incm Prepared AUG 26 2013 CMP -4000 009647 290 N CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF CLEARWATER Policy Number 94 -LR- 3824 -2 CMP -4705 Loss of Income & Extra Expense FD -6007 Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. )11 Secretary President Prepared AUG 26 2013 CMP -4000 009647 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 6 StateFarm 00 STATE FARM FIRE AND CASUALTY COMPANY 2A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS loomington, Lro617o9 -0001 F -18- 3784 -FB02 F Z Named Insured HESSPORT LLC C/O HESS, PATRICK 134 S MORTON ST KENDALLVILLE IN 46755 -1635 ATTACHING INLAND MARINE INLAND MARINE ATTACHING DECLARATIONS Policy Number 94 -LR- 3824 -2 Policy Period Effective Date Ex iration Date 12 Months APR 4 2013 AIR 4 2014 The policy period begins and ends at 12:01 am standard time at the premiseslocatlon. Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee /Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium $ 245.00 The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE -8739 FE -8743 FE -8753 Inland Marine Conditions Inland Marine Computer Prop Commercial Articles Form See Reverse for Schedule Page with Limits Prepared AUG 262013 FD -6007 009648 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 -686 a.2 05 -31 -2011 (o1f32320 94 -LR- 3824 -2 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -8743 Inland Marine Computer Prop $ 25, 000 $ 500 Included Loss of Income and Extra Expense $ 25 , 0 0 0 Included FE -8753 Commercial Articles Form $ 18 , 0 0 0 $ 1, 0 0 0 $ 245 . 0 0 Property: Photographic Equipment Prepared AUG 26 2013 FD -6007 009648 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 -686 a.2 05 -31 -2011 101132330 StateFarm 94 -LR- 3824 -2 00 . trIY C till At INOult.N<I_ 009649 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4786 ADDITIONAL INSURED (Scheduled) CMP.4786 Page 'I of 1 OWNERS, LESSEES, OR CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 94 -LR- 3824 -2 Named Insured: HESSPORT LLC C/O HESS PATRICK 134 S MORTON ST KENDALLVILLE IN 46755 -1635 Name And Address Of Additional Insured Person Or Organization: CITY OF CLEARWATER PO BOX 4748 CLEARWATER FL 33758 -4748 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage ", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or CMP -4786 b. Products - Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard ". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. ®, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 94 -LR- 3824 -2 009649