DECLARATIONS - ADDITIONAL INSURED ADDED STATE FARM FL OR INSURANCE COMPANY
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POLICY NUMBER 98-CM-S680-4
JA
001626 3123 M-19-6607-F-BBO F Z
CITY OF CLEARWATER
Po BOX 4748
CLEARWATER FL 33758-4748
YOUR POLICY PROVIDES COVERAGE FOR A
CATASTROPHIC GROUND COVER COLLASPE THAT
RESULTS IN THE PROPERTY BEING CONDEMNED AND
UNINHABITABLE. OTHERWISE YOUR POLICY DOES
NOT PROVIDE COVERAGE FO� SINKHOLE LOSSES.
YOU MAY PURCHASE ADDITIONAL COVERAGE FOR
SINKHOLE LOSSES FOR AN ADDITIONAL PREMIUM.
i
pan incl
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98-CM-S680-4
DECLARATIONS(CONTINUED)
Food Slop Policy for CITE"OF CLEARWATER
Policy Number 98-CM-S680-
SECTIONI ar p .RTS � ' t
Location Location of Limit of InsUr nce* Limit of Insurance* Seasonal
Number Described In reale-
rail Coverage mr `sr�ess
Buildings r nal personal
Property property
001 -1`1998 DREW ST No Coverage $ MOO 25%
C"LEARWATER Fl- 33759
As of the!! e f( t'1ve date of this policy, thc,, f irn f of lYe7,7anIce as .l"ro1+ n includes any Incl'u'ase in file" lirril dLf' 10 Inflation CoYt,�rag .
SECTION I - D, TI L
Basic Deductible
Spaniel Deductibles:
YV7C.n(-,,,y and ' ; ?:,'6.�ritie $25 1":;'Tiployee Dishonesty $250
Other deductibles rn ay;apply relei to policy,
AUG�, 05 20�21 I , i�iit f�'E:r'arw"'"��i.i ua
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4, 153" `a
STATE FARM FLORIDA INSURANCE COMPANY
A /:;CP, G"0AIt"AiY•a' P118-11H,10A/lE..11F F IG,r IN K-17fyri r r,AV,--N, F-,F-L Lx-itd:A DECLARATIONS AME _I_ C 202!
Policy Numbef 98-CM-S680-4
f
I insured-Section 11 Ont
M-19-6607-1 13130 F Z 12 Yonl s iii 1 2021 FEB 'I 2022
ripe pool yf pr�l {, I b WW1 c n(l ends m,'1I?01 am 1�:i���3C ai d
CIT" OF CLEARWATER t-Ime atthe pre Iseflr,7"cation.
PO BOX 4748
CLEARWATER FL. 33758-4748 NamedIncur
ed
KINNEYS KITCHEN l.LE
Food Shop Policy
Automatic Rnewal, 1f 11u,,,policy R rloc1 is sls )wn as 12 inonths,this pulaey will be renevved a UtOrnatic lky sulafeul Lo the pYnniiuins,nikes and
fours In effect for i;ach s ucr; Fero! policy period. if this policy is tr'rrainatr d,vve tviH give you and the f0w, notice in
com Pkarlce With t1b policy provisions or as required by l€uvv,
Entity: Li1 iited Liability GuTspr ray
Reason for Declaraflons, Your policy is Cern nrred JUL 14 207211
ADDI"] It..?NAL °I`ZtJRED SAD i +t'.�:ID
P-ORW CMP-4i86,0 ADDED
I_:ndors r entr`'rcn- k-,n' Nore
Discounts App ied:
Fears in Business
''Enclosed Building
Prepared
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DECLARATIONS(CONTINUED)
Food Shop Policy for CITE" OF CLEARWATER
Policy Number - & -
SE
l r STM° : l 1
'The coverages and corresponding lifnits shown below apply separately to each described premises shown in these
Declarations, u nl indicated b "See Schedule." if a coveragedoes not have a corresponding limit shown below,
r` but has "Included" indicated, please refer to that policy provision for an explanation of that coverage,
LIMIT OFCOVERAGE
INSURANCE
Ars.~1OUIItr lac' twsij ,1l sa
On Prernises, $10.0100
Off Pren-,ises $5,000
Arson Reward $15_,000
Back.Uri Of Sewer r;Oi Drain $1 a`1,000
Collapse included
Daii"age T v I*'o Owne(J „ ildirn. ." r i"orn I hreft, Burglary Or, RC,t7:;=t=err - d..
,, r�C:'3 Limit
Debris Rt rnc:.vac 251%1 ot,t,vo ,cl loss
Ey�`gL.,6pr,nfm�,]1 pB�Pa;rS5_'fr'`�tn�.yyk+` rt 0311 9t,'}.
re
vice, Charge-,
Fire Exf ng iss iie Sy(.Merris Rechlarge t}..e a 4p rnse $5000
Food Corflarnination
$3-000
Per OCCLArrence $1 0000_1
Glass Expenses lire PLidr1a
increased Cost Of C;rl"iti.,lmmion And _14.rnollt[o Costs (applies only wher, brlildings are, <k%
i'nssrred Lana r pace lent cost basis",
Money And Stectiritle s, (Off P +daises) $5000
Moriey Order's And CoLAnterfeit Money $ 1000
AUIC, 01 20121
13 mi? a in����";.ji�,,1U;e�1`a�,'r
(_- 00 ,,,`i?,I .,I in 4ai� I4�nfil'" xII .al: vices off , s,C.its pe (:2'f.
G Ca.nfli-lIr(acl on 19(,wexirse Side of Page Page 3 of n
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DECLARATIONS ?NTNC )
Ford Shop Policy for CITY OF CLEARWATER
Policy Number m - -
Newly Acquired BUSineSS Personal Property (applies only Ir this policy pme'1dt),
Coverage B - Business Pemon al Property)
Newly Acquired Or Constructed Bu ldings (applies only if this policy prCr+,id s $250.000
Coverage A - Buildings)
Ordinance Or Law - Equipment Coverage Inr•[Ljded
Outdoor Property $5,000
ersC3aa Effects {pplie: imly to those pr rnisrs proviclod rtV ragc B . Business $ 3 0
Personal PropeR
{�
P'orsonal' Property er"ty Of Prel-nises $15,000
Pollutant Clean Up f^karst Rein val $110.000
Pre,servation Of Property 30 Days
Property rte OOkllel, (applies only to �those or;�Cnlsr;s Provided Co°ai 'rage B Bl.d'*r33'`?ss
l::er5i,n,al Property)
Signs $10.00 0
Spoilage (applies only to Berme prernises provided Covrmg� .. I` rra.rr ess Pt'rs(:)nali
Property)
Expediting Expenses $1,000
Oyn Prt;i iisc.,,s. $,11151,1�0 0
Valuabk e, Papers, And Record;-
On Pr�aii si r:; $i 0.00
Water Dar agtW, ()Hie, Liquids, Powder Or M ter° Ma[ellal Darnag ,Wlt,r :.r:f
-IOC_
The coverages and corresponding limits shown below are the most we will pay regardless of the number of
described pr nli shown in these l r t€ons.
LIMITOF.
COVERAGE INSURANCE
f`:ae pr`�nds,,nt 1�,ro.p)� rty ... ; civ U Incorn $5-000
PI..i:;1)ar°r rl
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rrr& v, C�d'1 1' _5° P �aYi�li tpl t, it„F r 3 S'1fi4,z VVIIIJ
CMP-40-00 �.l�
U01'Itinur�, an Next Page Page 4. r'..7f
DECLARATIONS(CONTINUED)
Food Shop Policy for CITY OF CLEARWATER
Policy Number mm1- ,4
Employee Dishonesty $50,00
EX, Utility into fUlDbOt Loss Of 1rrorm,',) $1 OMO
Loss Of I n r -ne,, And Ext a, Ex,,Pense Actual 1..oss Sustained - 2 Months
P
LiMiT OF
COVERAGE; INSURANCE
Coverage, L - Business Liability $1 M0,000
Coverage M Medical Expenses 'Any f nc,',t Person) $10,000
$i,000,41,E
LIMIT OF
AGGREGATE LIMITS MURANCE
I r t.a Cw,''C• "ilsl l
Operations atProns A1gg gate $2,000,000
t..acl"� paid c°lairn for LiabiliIW Coverage reduces the u"tnio rit of ii"IS lean e we provide dti ing [he applicable
arlrual period, Please refer to Section I Liability in the Coverage Form and any attached enclo serine ts.
Your policy consists is of those e 3}f...-,"I rations .the BUSHiEKSOWNEF S 'GOVERAGE" FORM shown J liuand any -t3', r
forms and rvaindorsernem,ts that pf:flyinCli.ding those shown below as well as those i,.,.ued SUbsequent to the
iss.iance of this policy,
FORMS AND SS
CMP-4100 Businc',ssownevs Coverage Fr rrn
t'i; P-48 60 'Al D Igri Person rOrg
CMP-4702.1 Food Cont t.I ,inatifP n
FE-6999-3 rerr rias Insu "am..e Cov Notice
CM'-'-4259A +`'1mer7dG.`.G:,1r'r' Endorsement
C MP-4561 I Policy Endorsement
P l;; 36:.70 xr c,,,Iu ("ash IPilcie Endorsrsn-ient.
tJ'€9r°ed
f.
/'CMP-4000
�+ 3 05 p�, 2yt.. c „.3
>Py;'gh ..it;r F a Psi
M -t,�.
.' AUto!'nvb
Cfll�
MP 44J0
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P14
DECLARATIONS(CONTINUED)
Food Shop Policy for CITY OF CLEARWATER
Policy Number 98-CM-S680-4
CMP-45,22.11 !_OSS Of IrrCOMre & Extra.. Expense
CMP-47,1 0 Employ (r, Disftonest
CMP-4709 Money and Secudlies
CMP-477/5 Spoilage Coo ra=ge'
CMP-4706 Back-Up of Sewer or Dm�n
CMP 4704,-1, Dependent l-rop, Loss of, liit loin-w;
¢OM1...-47ry3.t Ufil ty interruption, f oss incr
CMP-4788 Add] rnsd Mars Lessor ;
STATE FAW FLORIDA NSUPANCE COMPANY
HAW N INLAND MARINE ATTACHING DECLARATIONS
A ��VH(,"A4U'-'-'
Policy Num
GA XWOW, 98-ChIS6854
beF
Named Insured 1--, " --- -,-"......
PWI Period Effective Dam E"hathn Dme
12
M092605FBBO z �Yonths FEB 1 2021 FEB 1 2022
,sty Period begs ond ends aa!ZM wo smndard
KINNEYS KITCHEN LLC orne e[nommoi catimi,
ATTACHING INLAND MARINE
.. ...........
Aulonrafic Rwwwel - Rdta polley pedod is shown as 12 monos,IN Wy w he renewed aulomatrctial y subjectto the I and
fxms A effecthr each s"ceedig POKY We 4 his PAKY I twmhamf we will give you and he viLten, nake in
cwhmce voM he polly prowsimm ur as rquired b-,i la,,v
AwuWPWhyPremWm Induced
The above Prendurn Amourd is AxWed A he Polky Prern"�unn shuv'irt on d-le Decdarabons,
Your poky consists of Mese Dedwahons,flrt,,� INI-AN0 MARINE CONDHIONS shcmiri beflovi,and any other forms and endorsements hat
appYinduding Mose shouvrt behTni as vveH as Most,msued subsequentto the issuance of this poky,
Fo rms, 0 pflows,and E ndorsornents
FF;8739 lnL�--md Vlanrxe Cr,)06tjons
FE-8791 Amendment of Condbons
F087=1 !nWnd NAarine Computer 1'rop
c v e"'-se fees' Sc 1 a d u 1 e D; g e Uj',jf!,j
Prepared
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FD--6007 a "W"d"MI d WS"(""S""r [Cs Cff!Cpl IfIr—.r tl its PE, MS„'y;
0 1 MY-)
98-CM-S680-4
ATTACHING INLAND MARINE SCHEDULE PAGE
ATTACHING INLAND MARINE
ENDORSIMIN T LIM11 OF DIDUCTIBLE ANNUAL
W.)MBER COVERAGE INSURANCF, AMOUNT FIRFUIUM
FE-8743.1 Wiland Marine Coinputei, Prop 25 , 000 $ 500 1 r1 lUded
L',Jss of Incorne, and Ex[ra Expense 2,5 , Included
R E"IV E D
2021
171,
011,1ER LIMI FS AND EXCLUSIONS WY APPLY RF.-TFR-1-D`TOUR POLICY,
prepwed
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