CATV - CABLE TELEVISION (58)
01/31/95
15:38
. NO. 523
lJl02
!l-
JOHN I GWYDIR -+ 813 462 6488
., I
THIS BINDER IS A TEMPORARV INSURANCE CONTRACT. SUBJECT TO THE CONDmONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PlIODUCIR 1 f~~N~o ~...' 516 -7 U _ 62 82 COMPANY ul alNIIIII' .2 2 2
John L. Gwydir Company, Inc. L1J::.8t'tY Mutual Insurange Co. I
1 Old Country Road DAn ,":fllIlTlYli TIME DATE TIME
CarlB PlaCB NY 11514 Tx I AM I xJ 12:01 A~
01/27/95 12:01 n PM 01/27/96 n NOON
1l'HIS BINDeR IS Issum TO IiXTIHO COViIlAlili IN THE A80VE NAMED COMPANY
I'IiIlIXI'IIIING POUCY '1
DIICllIPTION 01' 0I'8llATION8IVIHIOLES/PROI'ERfY Uncludlng LoCll(lonl
All locations of the Named Insured where
Vision Cabl. of 'inellas, ~nd. is
profoDDing work.
CODEl
~3~~g;(,ER 10. CLEAR~ 1
IN8UIIID
City of Clearwater
City Clerks Dept.
POBOX 4748,
Clearwater. FL 34618
1
I SUB COOEl
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TYPE 01' INSURANCE
PROPIRTY CAUSES O~ LOSS
= eAGIC D eFlOAll D SPEC
COVERAOIII'ORMS
AMOUNT
DEDUCTIBLE COINS ""
OENERA~ LIABILITY
1-
GENERAL AOGREGAn .4,000,000.
pAOllUI:T$ . COM PlOP AGG .
PERSONAL & ADV INJURY .2,000,000.
EACH OCCUAI'IENC~ '2,000,000.
-
FIR! DAMAGe IAn, one l;f&1 ,
MED EXP IAnv one p&rsonl .
COMBINEO SINGLE LIMIT .
1I00lL Y INJURY (Per ptllfonl .
eOOIL Y INJURV (Por &~.;d.nll .
COMMERCIAL G&N&FIA~ LIABILITY
!i:CC: I C~AIMS MADE [!] OCCUR
......!. OWNER'S & CONTRACTOR'S PROT
X Personal Injury ~nd. #
I---'- .
End.. #cc:~r8 0 5 ReTRO DATe FOR CLAIMS MADe:
AUTOMOBILE LIABILITY
I-
I- ANY AUTO
I- ALL OWNeD AUTOS
SCHeDULeD AUTOS
_ HIRED AUTOS
NON.OWNED AUTOS
p"Opel'lTV DAMAGE
MEDICAL PAYMENTS
PERSONAL INJURY PI'IOT
uN1N5UI'IEO MOTOAIST
-
AUTO PI1YSIOAL DAMAOIl
I COLLISION:
-I OTHER THAN COL:
~AiJE LIABILITY
I-- ANY AUTO
DEDUCTIBLE ._J ALL VEHICLES
- [J SCHEDULED VEHICLES
ACTUAL CASH VALUE
SrATED AMOUNT
O'l'HEA
AUTO ONLY .SA ACCIDeNT
OTHER THAN AUTO ONLY:
EACH ACCIDENT ,
AGGREGATE ,
EACH OCCul'IAENCE .
~
f--
IKCElIS LIABILITY
R UMBRELLA FORM
OTHER THAN I,/MBRELLA FORM
RETRO OAT! FOR CLAIMS MADE:
AGGREGATE .
se~p.INSU"eD Rn&NTION .
I STATUTORY LlMI'I'5
EACH ACCIOENT ,
DISEASE. pO~'Cy LIMIT .
,.,.'...,....,'..".,,,'.
WORKIR'S COMPENSATION
AND
EMPLDYEfI'S ~lA8lUTY
DISIiA8& . EACH eMPlOyeE ,
All Locations of the Named Insured wher. Vision Cabl. of pin.llas, Inc.
is pe~forming work..
Bill ~D: Vision CahlB of Pinell.., znc clo John L. OWYdir Co., Inc.
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~;;;~:r;~:~r~n~~~~2~~~!3" ~5~;,0,., ,," i i' H =':::;' 'J~F~=;~~' '!e~';',.",;"p',,,,,,,,
1 Old. Counery Road, -~.__.-
CarlB Place, NY 11514 L~ . ~ ~ Nf'/ L
7
AUTI10RIUD FlEPIIUeNTATlV&
8~eCIAL
CONDITIONSI
OTHeR
COVEAAGES
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ACORD 76-sra/931
NOTE: IMPO"TANTSTATE:;iNFOAMATION:ON~A,ti'ACliEi'fM~E.:. ... .... ... ..QAbORDCDRPrjijAtiCil\i;19S,~:
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01/30/95
,
15:43
L GWYDIR -+ 813
6488
NO. 512
(;104
....
CONDITIONS
This Company bind! the kindle) of insurance stipulated on the reverse side. The Insuranoe Ie subjeot to the
terms, conditions and limitlltions of the policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company
stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the
Insured in accordance with the policy conditions. This binder is canc"lIlild whim replaced by EI policy. If this
binder is not replaced by a polloy, the Company Is entitled to charge a premium for the binder aooording to the
Rules and Rates in use by the Company.
Applicable In Delaware
TIle mortgagee or Obligee of any mortgage or other instrument givan for the purpose of oreatlng a lien on real
property shall accept as evidence of insurance a written binder issued by an authorized insurer or its egent jf
the binder Includes or is accompanied by: the name and eddreu of the borrower; the name and address of the
lender as loss payee; a description of the Insured relll property; a provision that th. binder may not be canoeled
within the term of the binder unless the lender and the Insured borrower receive written notice of t1w c~mcul.
lation Ilt lellst ten (101 days prior to the cancellation; except in the oage of a renewal of a policy BubaeQuent to
the closing of the 108n, !l pllld receipt of the full amount of the applicable premium, and the amount of
ilwl,lrance coverage.
Chapter 21 Title 25 Pllregreph 2119
Applicable In Nevada
Any person who refuses to accept a binder which provides ooverage of less than $1,000,000.00 when proof is
required: (A) Shell be fined not more than $500.00, and IB) is liable to the party presenting the binder as proof
of insurance for actual damages sustained therefrom.