Fort Walton Beach Council agenda — 09-21-2010 Special-City Attorney Selection — reading text

Authorized Representative Date G- 118012 -A ( Ed. 03/ 99) Page i  0 Declarations Page ZURICH Policy Number: EOC 9225966 -05 This is a Claims Made and Reported Policy. Please review the Policy carefully. THE POLICY IS LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS THAT ARE FIRST MADE AND REPORTED TO THE COMPANY DURING THE POLICY PERIOD AND ANY EXTENDED REPORTING PERIOD. Item 1. Insured by the stock company below and hereinafter referred to as the Company, Steadfast Insurance Company Item 2. Named Insured and Address DUNE TITLE COMPANY LLC 4477 LEGENDARY DR #202 DESTIN, FL 32541 Item 3. Policy Period Item 4. Limit of Liability 12:01 A.M. Standard Time at the address of the Named Insured as stated herein Each Claim $ 1, 000, OOD From:_ 7/ 112010 To: Aggregate $ 1, 000,000 7/ 1/ 2011 Item S. Retroactive Date 7/25/2002 item 6. Deductible $ 5,000. 00 Item 7. Premium: $ 2,500. 00 Surplus Lines Tax: $ 126.75 FL Stamping Fee: $ 2.54 FHCF: $ 25. 35 Policy Issuance Fee: $ 35. 00 Item B. Forms Attached at Issuance "- STF- GU- 645-A(08/ 09), STF -TPL- 381- A- FL(01110), STF -TPL -D- 300- A- CW( 10 /08), STF -TPL -380 -A CW( 11 /09), STF -TPL -304-B- CW( 03 /10), STF -TPL -382- A- FL( 01 /10), STF- TPL -300- A- CW(10 /0(8), STF -TPL -375- B- CW( 10 /DB), STF - TPL- 377- 13- CW( 01/ 10), U- GU- 726-A- FL( 7 /06), U -GU- 279- D- FL(8 /02), U- GU- 735-A- MU(08106), STF -GU- 199 -8(01/ 09), U- RET -E- 402- A -CW( 11 / 06), U -UNV -0-402A CW ( 09/06) Countersigned at: Issue Date 6/30/2010 Authorized Repr $4ntative Countersign Date: THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW, PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER, STF -TPL -D -300 -A CW ( 10/ 08) Page 1 of I  BBOP 99. 001 1007 1007 First Community Insurance Company 4908953 St. Petersburg, Florida 33733 8/ 06/ 10 BM.K ERS 800 - 627 - 0000 INSURANCE sROUP 3000 00000 BBOP AMENDED DECLARATIONS PAGE Business Owners Policy EFFECTIVE: 8/ 02/ 10 Date of Issue Page, 1 of 3 8/ 06/ 10 Term Ince otion Date . Az Ent Ent ..s .iphone From: 7/ 22/ 10 To: 7/ 22/ 11 12: 01 Standard Time 12 mos 7/ 22/ 09 12: 01 AM 00- 0089479 850) 837 -69. Agent ( 850) 837 -6242 WATERFIELD & ASSOCIATES INC 4477 LEGENDARY DRIVE CONDOMINIUM A 127 HIGHWAY 98 E STE 10 SSOCIATION DESTIN FL 32541 4477 LEGENDARY DR STE 202 DESTIN FL 32541 -5332 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 olic HL mits` `Cv era e' rovided :onT: where- General Liability General Aggregate Limit( Other Than Products - Completed Operations) $ 4, 000, 000 Products- Completed Operations Aggregate Limit $ 2, 000, 000 Personal And Advertising Injury Limit INCLUDED Each Occurrence Limit $ 220009000 Fire Damage Limit $ 50, 000 PER OCCURRENCE Medical Expenses Limit: $ 5, 000 PER PERSON Hired Auto INCLUDED Accounts Receivable $ 25, 000 Employee Dishonesty $ 10, 000 PER OCCURRENCE Electronic Media and Records $ 100000 Fine Arts $ 10, 000 Money & Securities $ 10, 000 Inside /$2, 500 Outside Valuable Papers and Records $ 25, 000 Except for Fire Legal Liability, each paid claim for the above coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Paragraph DA of the Businessowners Liability Coverage Form. This policy contains a separate deductible for hurricane losses, which may result In high out - of -pocket expenses to you. Annual Premium $ ' See Assessment Detail Notice EMPATF $ 1 FCS $: Managing General Agent Fee $. Terrorism Premium ( Certified Acts) $. 00 Total Assessment Fees $. Grand Total $ Deborah S Brcka 8/ 02/ 10 Countersigned by Authorized Representative Date Copies Sent To: As Indicated On Back Of The Property Coverage Page W.  Universal Insurance Company of North America P. O. Box 901036 Fort Worth, TX 76101 -2036 BUSINESSOWNERS POLICY Customer Service: 866 -458 -4262 Claims: 866- 999 -0898 Renewal Declarations www. universalnorthamerica. com Policy Number: UFBP0000000848 -1 Policy Period 06/ 12/ 2010 to 06/ 12/2011 12: 01 A.M. Standard Time at the address of the Named Insured stated below. NAMED INSURED AND ADDRESS PRODUCER NAME AND ADDRESS 80346 DUNE TITLE COMPANY, L.L. C. RYLAND- FISHER AGENCY 4477 LEGENDARY DR STE 202 180 POINCIANA BLVD # 3 DESTIN, FL 32550 DESTIN, FL 32550 PHONE: ( 850) 650 -1900 X' IF SUPPLEMENTAL DECLARATION Q SUPPLEMENTAL DECLARATION Business Description: Form of Business: Tenant - Title Company Corporation 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.. DESCRIBED PREMISES Premises No. Bidg:: No'.. Location Mortgage. Holder Name and Address SEE ATTACHED SUPPLEMENTAL DECLARATIONS sEE ATTACHED=SCHEDULE PROPERTY PREM. NO. BLDG : NO - PREM NO BLDG NO.' • PREM NO BLDG NO SEE ATTACHED SUPPLEMENTAL- DECLARATIONS; Deductible $ SEE•ATTACHED.SuPP.. LEMENTAL DECLARATIONS OPTIONAL COVERAGES: SEE ATTACHED SUPPLEMENTAL DECLARATIONS LIABILITY AND MEDICAL PAYMENTS Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to paragraph DA. of the Businessowners Liability Coverage Form. Limits of Insurance Liability $ a., 000, 000 Each Occurrence Medical Expense $ x. o , 000 Per Person Fire Legal Liability $ 300, 000 Each Fire Total Policy Coverages Premium: $ Total Location Coverages Premium Policy Fee: $ Emergency Mgmt Preparedness Assist. Trust Fund: $ FHCF 2006 Emergency Assessment: $ Citizens 2005 Emergency Assessment: $ 2009 Florida Insurance Guaranty Fund Assessment 4 TOTAL ADVANCED PREMIUM: $ The above premiums contemplate Terrorism Coverage as indicated below. FORM(S) AND ENDORSEMENT(S) APPLICABLE TO THIS: Refer to Fors Schedule 03/30/2010 countersignature Date - Authorized Representative INSURED COPY Paae 1 of 5