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HOME BUSINESS INSURANCE POLICY DECLARATIONS (3)a BOP1005727 Renewal of Number Policy No. BOP1005727 Named Insured and Mailing Address: Weddings On A Whim 519 Fourth Ave Ne Largo, FL 33770 RLI Insurance Company 9025 North Lindbergh Drive Peoria, IL 61615 Form Applicable HOME BUSINESS INSURANCE POLICY ❑ Standard ® Special DECLARATIONS Administrator Name and Mailing Address: FAIA Member Services, Inc. Policy Period: From 08/01/16 to 08/01/17 at 12:01 A.M.* Standard Time at your mailing address shown above. *Exceptions: PO Box 16579 Tallahassee, FL 32317 Insured's Brokering Agent: Chris Coleman Agency 12:00 noon in Michigan, North Carolina, and Puerto Rico. a. 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. BUSINESS DESCRIPTION Form of Business: ❑ Individual ❑ Joint Venture /Partnership ❑ LLC Business description: Wedding & Party Planners M Organization (Any Other) DESCRIBED PREMISES ADDITIONAL INTEREST 519 Fourth Ave Ne Largo, FL 33770 PROPERTY Limits of Insurance for Buildings *Actual Cash Value - Buildings Option (Y /N) *Automatic Increase - Business Personal Property Limit ( %) Business Personal Property PREM. NO. 1 BLDG. NO. PREM. NO. 2 BLDG. NO. PREM. NO. 3 BLDG. NO. $ N/A $ N/A $ N/A 4 % % $ 6,839 $ $ Deductible $ 250 Minimum Earned Premium $ Additonal /Optional Coverages — Applicable only if an "X" is shown in the boxes below: $ 5,000 $ $ Limits of Insurance Premises Inside the Premises Outside the 1. gi Electronic Data Processing 2. ❑ Money and Securities (Special Form only) ❑ 3. ❑ Jewelry and Watch Increased Theft Coverage 4. IN Other (specify) Additional Insured, Terrorism LIABILITY AND MEDICAL PAYMENTS Each paid claim for the following coverages reduces the amount of insurance Please refer to Section 11— Liability in the Businessowners Coverage Form and Liability and Medical Expenses $ 500,000 Medical Expenses $ 5,000 Damage to Premises Rented to You $ 50,000 Other Than Products /Completed Operations Aggregate $1,000,000 Products /Completed Operations Aggregate $1,000,000 we provide during the any attached endorsements. Limits of Insurance applicable annual period. occurrence person one premises per per any FORMS AND ENDORSEMENTS Forms and Endorsements made part of this policy at time of issue: Please see reverse side. PREMIUM Policy Florida Florida Total Premium $ 365.00 HCF Surcharge $ 0.00 CPIC Surcharge $0.00 Annual Premium $365.00 *Coveraae for Certified Acts of Terrorism $1.00 Countersigned: By Authorized Representative THESE DECLARATIONS, TOGETHER WITH THE COVERAGE FORM(S), COMMON POLICY CONDITIONS AND FORMS, AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THERE OF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1984, 1985 06/14/16 FAIA Member Services, Inc./11007 Chris Coleman Agency /11313 BOP 0001 (05/13) FL 1 FORMS AND ENDORSEMENTS (continued) Forms and Endorsements made part of this policy at time of issue: BP 00 03 (01/06) BUSINESSOWNERS COVERAGE FORM BOP 400 (07/02) EDP SYSTEMS, DATA AND MEDIA ENDORSEMENT BOP 405 (07/02) AMENDMENT TO PROFESSIONAL LIABILITY EXCLUSION BOP 410 (01/10) PERSONAL PROPERTY OFF PREMISES LIMITS ENDORSEMENT BOP 413 (07/02) EXCLUSION - WEIGHT LOSS PRODUCTS BOP 414 (07/02) EXCLUSION - MEDICAL EXPENSES COVERAGE BOP 415 (07/02) DEFINITION - VOLUNTEER WORKER BOP 426 (11/07) AUTOMATIC INCREASE - BUSINESS PERSONAL PROPERTY BOP 432 (11/07) ELECTRONIC DATA COVERAGE EXCLUSION BOP 434 (01/10) EXCLUSION - COVERAGE EXTENSIONS BOP 439 (07/10) EXCLUSION - DAMAGE TO WORK PERFORMED BY SUBCONTRACTORS ON YOUR BEHALF BP 01 59 (08/08) WATER EXCLUSION ENDORSEMENT BP 03 03 (03/16) FLORIDA CHANGES BP 04 17 (07/02) EMPLOYMENT - RELATED PRACTICES EXCLUSION BP 05 23 (01/15) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM BP 05 76 (01/06) CHANGES - LIMITED FUNGI OR BACTERIA COVERAGE BP 05 77 (01/06) FUNGI OR BACTERIA EXCLUSION (LIABILITY) BP 05 98 (01/06) AMENDMENT OF INSURED CONTRACT DEFINITION BP 06 01 (01/07) EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA BP 07 04 (01/06) BUSINESS LIABILITY COVERAGE - PROPERTY DAMAGE LIABILITY DEDUCTIBLE BP 04 02 (01/06) ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES BP 04 10 (01/06) ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAD BEEN LEASED ILF 0001 (01/01) SIGNATURE PAGE s L • Policy Number: BOP1005727 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS BEEN LEASED This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph C. Who Is An In- sured in Section II — Liability: 3. 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 land leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" that takes place after you cease to lease that land; or b. Structural alterations, new construction or demo- lition operations performed by or for the person or organization shown in the Schedule. SCHEDULE A. Name Of Person Or Organization: City Of Clearwater 100 S Myrtel Clearwater, FL 33756 B. Designation Of Premises (Part Leased To You): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. BP 04 10 01 06 © ISO Properties, Inc., 2004 Page 1 of 1 RLI City Of Clearwater 100 S Myrtel Clearwater, FL 33756