Loading...
HomeMy WebLinkAboutInsurance Proposals Ap P R E M I U M 0 U 0 T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VNrn7 All Risk Annual Cost $ 500 $15,290 $1289 $16,579 5000 12,655 1066 13,721 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 , w Premi= Payment Plan: Ouarterly Comments: _See Schedule A B. Valuable Papers $SO,Qoo Deductible S500 $65 S 5000 55 Carrie.—.- Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Quarterly Cor.-.*gents: C. Comprehensive General Liability a. First dollar cov er`:re : $139,470 b. (13) Folice Prc_�sc_o�al liability•, add'i tional cost: 1. First Dollar Coverage : $74,060 (See Schedule B) r l ,r C. Comprehensive General Liability Rating basis: -Expenditures/Road Mileage/Food Receipts Carrier: Continental Casualty Company (CNA) Premium Payment Plan: Quarterly Comments: See Schedule C) D. Automobile Insurance � �y.e�.;�:.�, Limits — $500,000 (includes Co lision and Comprehensive) Rate per vehicle: $992.00 (88 automobiles) Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: quarterly E. Contractors Equiwmant :loafer Deducti 1e Rate rer 100 --7os a 500 1.50* Carrier: St. Paul Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Annual - - Comments: Total values: $904,889 * deductible of $1000 F. Umbrella Liability First $ 5,000,00-1-0: $160,000 Next S 5,000,000: For options see Schedule F Rating Basis : Premium of underlyinq coverages Carrier: Landmark Insurance Company F. Umbrella Liability Policy Period: 12/86 to 12/87 Premium Payment Plan: Annual Comments: See Sc-h d it e F f G. Yacht Insurance _ Physical Damage - Deductible $ 500 Premium: $3.394 Carrier: R=1 Insurance C_omy Policy Period: 1 /22/R6 to 1 /22/87 CC^-er_ts: Premium of �, 39 _Sn i nc i iidpg T.i ahi 1 i ty of 500.000 H. F,;blic -'Employee Blar et Bond Premiur: $1 Carrie:: Continental Insurance Company Policy Period: 1/1/85 to 1/1/88 Cou gents: Premium of $1,488 is for three years with a $25,000 limit for each employee. Additional indemnity for the following: Supervisor $190,000 Deputy'Supervisor 190,000 Tax Receiver 75,000 Town Clerk 50,000 PREMITrq OUOTATIOPI SMOIARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible : $ 494,953 $ 5,000 Deductible : 492,085 _ The premium summary does not include the Public Officials policy. Please see schedule P for coverages and premium. S f2 '�g 1 • Val Stype & Sons Inc Name of Agent/Broker Main Road Street or P.O. Box Mattituck. NY 11952 C_ty , State, and Zip Valentine W. Stype. Jr. i.a_:ne of Person Co:� _�let_ z Quo-LL-,a--_on a S_o a pure Pr Sid e T_tle Date: December 12, 1986 SCHEDULE A 1. Building values should be increased to take into account increased building costs. �"z" S 2. A dedutible of $1,000 could be a better value. 3. Contents limits at each location should be reviewed for adequacy. {cw.- 4. Money and Securities protection should be considered for the Tax Assessor's office, expecially for tax collection periods, January and May. (Our current policy provides this coverage but the proposal does not ask for this pro- tection.) ro-tection.) 4�� 5. Our annual cost uses the coverages stated in your proposal however, our current policy provides coverage for additional subjects of insurance. A thorough review of each location is recommended. i 3. A V�a�� Ck 12/12/86 SCHEDULE B $1,000,000 limit $74,060 no deductible 66,654 2500 deductible 62,951 5000 deductible 59,248 10000 deductible 55,545 25000 deductible (The Umbrella carrier requires one million limit. The malice Professional and Public Officials policies could be excluded from the Umbrella policy. ) 2. $500,000 limit $55,742 no deductible 50,168 2500 deductible 47,381 5000 deductible 44,594 10000 deductible 41,807 25000 deductible 3. Insurance Company: AIG =_ - - /86 SCHEDULE C 1. Includes coverage fcr two Railroad station parking areas (Southold and Mattit:ck), storage area in Peconic and parking area on Main Street, Southold. Owners of respective properties are added as additional insureds. 2. Includes Broad Form CGL protection. 3. The XCU Exclusion mat- be deleted for codes 91252, municipalities and 92151, streets/rcads at an additional cost. Our current 34 0 policy provides this coverage.-) 4. The-Home Aid prcgrar.. administered by the Township and funded by Suffolk County am.y be added for an additional premium. Our cur- 2,=� rent policy provides :his coverage.) 5. Exclusions: Police =rofessional, Pollution (GL and Property), First for recreation activities, Saddle Animal Liabi3_�r Exclusion 6. Limit: $500,000 12/12/86 SCHEDULE F 1. The Umbrella premium includes the Public Officials, Police Professional and Watercraft policies. 2. To exclude Public Officals and Police Professional from the Umbrella premium would reduce cost by 5%. 3. Optional Limits: $ 80,000 one million 140,000 three million (Both options include Public Officials and Police Professional) 4. Exclusions: ERISA, Asbestos, Pollution, Care, Custody and Control, Directors and Officers, Airport/Aircraft and Munici- pality E & 0. 12/12/86 SCHEDULE P Public Officals Liability: One million limit Claims Made policy form $10,000 each loss/$1,000 each official Deductible Exclusions: Discrimination, Kiring and Firing, Punitive Damage, Failure to maintain adequate insurance and Pending and Prior litigation. Annual Cost: $12,482 12/12/86 31z41k� Type Recommended Site of Insurance No. Structure Amount 1 . ,Town Hall $1 ,100 ,000 .00 2. Beach Building 15 ,000 .00 3 . Animal Shelter 50 ,000 .00 4 . Animal Shelter 20 ,000.00 5 . Land:ill 310 ,000 .00 c . Lar.d`_'i11 35 , 000 . 00 .; Highway Deca-' meat 375 ,000 . 00 B., Hi hway De^artnent 40 , C00 OC c . Highway Depa-'ment 150, 000 . 00 10. Highway De-,a." .^ent 21 ,000 .0C 11: Hishway Dom^ -tt^er * 20 , 000 .00 ?'. Pclice Depar- ment 275 , COC .O;, r cr/Pout n" is if I I ii I i - :i i! I , I -6- Site No. 1. TOWN HALL Main Road Southold, New York 11971 Ccnstruction. . . . . . . . . . . ... . . .Frame Stories . . . . . . . . . . . . . . . . . . . . .one Con 4ition. . . . . . . . . . . . . . . . . . .excellent Area. . . . . . . .First Floor. . . . .9 ,700 sq . ft . Basement . . . . . . . . . . . . . . . . . . . . yes-finished !' Interior. . . . . . . . . . . . . . . . . . . . finished iFeat . . . . . . . . . . . . . . . . . . . . . . . . yes .i t{ i t` Replacement cost . . . . . . . . . . . . s1, 100, 000 .00 1 ( Current Insurance. . . . . . . . . . $ 80! 03C- 00 J J'v it t in:.:rance �t 1 ' �j .1 t 1 � 4 ' iI -6- :"1t1_.'*r►�a=.... - .. t. ,.._ .._.. :. ..�.�;,�_: ._-._ � -.. _ _ _ _ ,.ti .. �s�._,•.'?�3i.-^+s.. :.-9+i:=--.,�, 1tt 5.. -'Yy"7�A :�..�.v _ - ` _7' , Site NT. 2, BEACH F 'ILDINC New Suffolk, h-w York 11956 Construction. . . . . . . . . . . . . . . .Frame Stories. . . . . . . . . . . . . . . . . . . . .one ' Condition. . . . . . . . . . . . . . . . . . .good Area. . . . . . . . . . . . . . : . . . . . . . .420 sq . ft. Basement. . . . . . . . . . . . . . . . . . . .no Interior. . . . . . . . . . . . . . . . . . . .finished Heat . . . . . . . . . . . . . . . . . . . . . .no i I� f Replacement cost . . . . . . . . . . .W15 , 000 .00 (Current Insuranc= . . . . . . . . .$1^ , OOn.00 Recommended '_n^uranc +I 1 Sites Nos . 3 & 4 . ANIMAL SHELTER Peconic , New York 11958 Site Site # 3 . # 4 . Construction. . . . . .Brick - Concrete block 1Stories. . ::. . . . . . .one - one Condition. . . . . . . . .good - very good Area. . . . . . . . . . . . . .1,400 sq. ft. - 480 sq . ft . Basement. . . . . . . . . .no - no Interior. . . . . . . . . .finished - unfinished Heat . . . . . . . . . . . . . .yes - no 1 Site No. 3 . Replacement cost . . . . . . . . . . .W50 ,000.00 ( Current In--urarce) . . . . . . . . y5 ,000.00 i Reccrrne..d..d Insurance :roan„ for Site t.o. .150 , 000 . 00 t i Site No. 4 . Replacement cost . . . . . . . . . . .$20,000.00 ( Current Insurance ) — , , . . . .$10,000.00 Recommended Insurance Amount for Site No. 4 . . . . $20 , 000.00 I t- .. ".`~,- !C":-. .. .3.F--'-'%4"k.'►.s�<�y _ -•i � .i �,�...�-_ —� .-y � --.-a9Y*aw.{`�t�Y'ti+x+"�'�t,.'. �`-.a4, mak. � .._ .��'-.�. _. LANDFILL Cutchogue , New York 11935 Site Site # 5 . # 6 . Construction. . (Non-Combustible) Metal - Concrete block Stories . . . . . . . .one plus - one Condition . . . . . .excellent - very good Area . . . . . ::. . . .10 ,197 sq . ft. - 780 sq . ft. Basement . . . . . . .no- - no Interior. . . . . . .mostly unfinished - partia,lly finished Heat . . . . . . .. . . . .yes ( partial ) - yes (partial ) ,I I Site *;o. 5. Replacement cos. . . . . . . . . . . .�31C , 000.00 ( Current insurance ) . . . ... . . . W22^ , COC .OJ Reco^inended T^surance Anount for Site No. i Site No. 6. Replacement cost . . . . . . . . . . ..35 , 000 .00 ( Current Insurance ) . . . . . . . ..25 , 000.00 Recommended Insurance Amount for Site ;1o. 6 . . . . $35 , 000 .00 I I ..... - a-s._: -. -. -...�.T.e,- -. • - ,. —� .,:t-rr�:;.... -7f".. 3= ��Y.'t^{..v}{S:L. :.y_�_+, .,r."{` Site No. 7. HIGHWAY DEPARTMENT Peconic., New York 11958 Construction. . . . . . . . . . . . . . . .Concrete block Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . . . . . . . . . .very good Area . . . . . . . . . . . . . . . .. . . . . . . .12,294 sq. ft. Basement. . . . . . . . . . . . . . . . . . ...no interior. . . . . . . . . . . . . . . . . . . .partially finished Heat . . . . . . . . . . . . . . . . . . . . . . . .yes , (partially) I! i' . . . . . . Replacement cost . . . . . .w375 , 000.^0 ( Current Insurance ) . . . . . . . . .W200 ,000 .00 . Recommender: Tr.surar.ce Amnunt_ x'375 , 000 .00 i • i - �.., �..a,j•_, f,...,-.:_. �if.^f�-':�•-.., �ra:..,.y �..: :,:,, - . -. � ;".�.���!'tK-�r t c HIGHWAY DEPARTMENT Peconic, New York 11958 Site Site # 8. # 9. Construction. . . .Frame - Frame Stories. . . . . . . . .1-112 - one Condition. . . . . . .good - good `Area . .lst *F1r. . .1,040 sq. ft. - 5 ,57.6 sq . ft. Basement. . . . . . . .no - no Interior. . . . . . . .unfinished - unfinished Beat . . . . . . . . . . . .no - no i Site No. 8. Replacement cost. . . . . . . . . . . . . . . . . .$40 ,000 .00 ( Current Insurance) . . . . . . . . . . . . . . .$25 , 000 .00 } Pecommended Insurance Anount T40 ,COC00 i i Site No. 9 ., '.' Replacement cost. . . . . . . . . . . . . . . . . .$150 ,000.00 (Current Insurance ) . . . . . . . . . . . . . . .$ 60,000 .00 Recommended Insurance Amount . . . . . .$150 ,000.00 ii i I 4 � � HIGHWAY DEPART*LENT Peconic , New York 11958 Site Site # 10. # 11 . Construction. . . .Frame - Concrete block Stories. . . . . . . . .one - one Condition. . . . . . .good - good ` Area. . . . ...`. . . . . .730 sq. ft. - 800 sq . ft. Basement. . . . . . —no - no Interior. . . . . . . .unfinished - unfinished Heat . . . . . . . . . . .no - no I Si'e No. 10 . I Replacer.:ent cost. . . . . . . . . . . . . . . . . . . .$21 ,000.00 ( Current Insurance) . . . . . . . . . . . . . . . . .,$.15, 000.00 Recommended Inournnce 'imount . . . . . . . . t21 ,00^ .00 i Site No. 11. I i Replacement• cost . . . . . . . . . . . . . . . . . . . .W20 ,000 .00 (Current Insurance ) . . . . . . . . . . . . . — . .$151000.00 Recommended Insurance Amount. . . . . . . .$20,000.00 I -12- _ . ILI. - . - -13- Site No. 12. POLICE DEPARTMENT Main Road Southold , New York 11971 Construction. . . . . . . . . . . .. . . . .Brick/concrete block ' Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . .=. . . . . . . .excellent Area. . . . . .First Floor. . . . . . .4 ,000 sq. ft. Basement. . . . . . . . . . . . . . . . . . . .yes , finished Interior. . . . . . . . . . . . . . . . . . . . finished Heat. . . . . . . . . . . . . . . . . . . . . . . .yes I Replacement cost . . . . . . . . . . . . . . $275 , 000.00 i (Current Insurance) . . . . . . . . . . . . . .$180,000 .00 I f f 4 II Recommended Irsuranca Amcu^.t. . . . . . . t275 , 000.00 I ..:. ..- . ,..,,Y, ._ .�s_. . -.y, _�xac,�'�., --...::„r, i":.s:�'c..�+ - ._ - � •�•...arr;:--..� ';s:�..,e�."Y+..:".'�� s..�teh,.. ,> _-_-.. _4.. _ 1 .' � F ., -14- Site 14_Site No. 13. SENIOR/YOUTH CENTER Peconic , New York 11958 Construction. . . . . . . . . . . . . . . .Metal Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . . . . . . . . . .excellent Area. . . . . . . . . . . . . . . . . . . . . . . .6,640 sq. ft. Basement. . . . . . . . . . . . . . . . . . . .no Interior. . . . . . . . . . . . . . . . . . . .finished Feat . . . . . . . . . . . . . . . . . . . . . . . .yes , I Replacement co_t : . . . . . . . . . . . $325 ,000.00 # - (Current Insurances . . . . . . . . .. 0.0 ,000 .00 1 Reccnmended Insurance Amount . . .?325 , 000 . 0,0 j t Appraiser: Andrew D. Stype, C.A.R. P.O. Box 63 Mattituck, New York 11952 f� 1 � 1 _14_ SCHWULE OF VESSELS HULL AM MCHMERY VESSEL : VALUE DEDUCTZBLS PREMIUM OGam., 1 ) 1081 24' Privateer T1150 H.P.O.B. S36-'-008 $ 500. $ 990. 165 3) 1967 131 Boston Whaler'40 H.P.O.B. $ 20F000. $ 250. $ 1650 -4) 1968—191 Welleraft-150 H.P4A. -- S -2,s00: $ 250. $ 165. 5) 1903 230 Sea OX 200 11.P.O.B. $11,000. $ -500. $ 385,. 19 Er lY 'e-e cee,F-h w:A'�" rra:@tr !4t foo PROTECTIMT AND 11ME:W= VESSEL, LSMIT 0" LIABILITY ? 1901 Privateer $ Soo Oka00. $ 3.35. : ) 1966 Boston ilhaler. S 500 tDOO. $ 220. 3) 1967 Boston 'Wha .er $ 5004000. $ 220. 4) 1950 wellcraft $ 5008000. $ 423.50 5) 1933 Sea Ox $ 500,000. S 275,. Each vessel is to be considered :separately insur o i. 12/31/86 VEHICLE SUMMARY PAGE AS OF 12/31./86) SOUTHOLD TOWN CONTINENTAL. CASUALTY CO 102027573 01./01./86 -- 01 /01 /87 COMMERCIAL AUTO TOTAL PREMIUM. $59, 523.00 --------------- COVERAGE DESCRIPTION1 BUSINESS AUTO VEH YEAR MAKE/MODEL/BODY TYPE WN 1 1981 CHEV 2GlAL3SJ6BllSOO63 COMP DED: $500 COLL_ DED: $500 ACV = 7 00 0 35. 74. 2 1968 JEEP 29859 ACV 3 1979 AMC A9AOS 7E234661 COMP DED. $500 COLI_ DED: $500 ACV 4 1982 FORD 2FASP35FSC821223 COMP DED. x}500 COL.L. DED: $500 ACV 80 ;,o 84. /a4. 5 1978 FORD F26HECE1S3S COMP DED: $SOO COLL_ DED: $500 ACV 114. 4*. 6 1980 PLYMOUTH JL42LAA141.294 COMP DED: $SOO COLL DED: $SOO ACV 512" 7 1982 PLYMOUTH 2P3B826L2CR133594 COMP DED: $SOO COLL DED. $500 ACV 81. I s.1.. 8 1982 PLYMOUTH 2P38826N4CR183382 COMP DED: $500 COLL_ DED: $SOO ACV 1000 Sb c 11. t W. 9 1983 PLYMOUTH 2P38826S32R229386 COMP DED: $SOO COLL_ DED: ti>500 ACV 89. Mo. 10 1984 PLYMOUTH 1P38826P3EX542615 COMP DED: $500 COLI_ DED: $500 ACV IT. 133. it 1984 PLYMOUTH 1P3BB26S3EXS80532 COMP DED: $SOO COLL DED: $500 ACV 3t%000 lot, 1S3. 12 1984 PLYMOUTH 1P38M18C4ED27S873 COMP DED: $SOO COLL. DED; $500 ACV $ -1,000 S44, 13 1984 PLYMOUTH 1P3BM18C2ED302293 COMP DED: $SOO COLL. DED: °$500 ACV f -1t 000 54. M. 12/31/86 VEHICLE SUMMARY PAGE AS OF .1.2/:31/86 SOUTHOLD TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN 14 19718 FORD 8663SI6337 COMP DED: $500 COLL DED. $SOO ACV $S;.;O O 15 1966 INTL 211912 G20S375 ACV 16 1963 INTL FD37896G ACV 17 1962 INTL. FD5293F ACV 18 1966 INTL. RD40666889 ACV 19 1964 INTL. RD406192699 ACV 20 1958 INTL. 80406100565 ACV 21 1969 INTL. RD406119167 ACV 22 1960 INTL. RD406142890 ACV 23 1967 INTL. 2119126229173 - ACV 24 1966 INTL 12012G2789SO ACV 25 1969 INTL 71791IG329500 ACV 26 1972 INTL 7072116475279 ACV 27 1973 INTL 70721CGB110S8 ACV 28 1974 INTL 7072IDG813421 ACV 12/31/86 VEHICLE SUMMARY PAGE AS OF 1.2131.186) SOUTHOLD TOWN VEH YEAR I"(AKE/MODEL./BODY TYPE VIN 29 1975 FORD F37YEV63895 COMP DED: $SOO ACV 3t, 30 1977 DODGE D81.GR7J001.Lt3i. COMP DED: $SOO ACV 40,000 31 1.977 DODGE D81.GR7JOO1.Lt32 COMP DED: $SOO ACV 4131000 t,t 32 1.952 GMC 8002902 00 ACV 33 1981 CHEV 1GBJC34M8BV101386 COMP DED. !1>500 COLI._ DED'. $SOO ACV 34 1981 CHEV 1GBJC34M2BV1C)1383 COMP DED: $500 COLL DE-D: $500 ACV i 0. i.13 k 35 1978 INTL D122HG818578 COMP DED: $500 ACV A OO, c o c b"1. 36 1970 INTL 7072116374933 ACV 37 1979 INTL CA252JHA33268 COMP DED: $500 COL(._ DED: $500 ACV 4;Z%, y o" 38 1981 INTL CA255BMA10967 COMP DED: $500 COLI.. DED: $SOO ACV $35, 5 139. 39 1981 INTL 1TK.CA25568HA27031 COMP DED: $500 COLL DEC?: $SOO ACV 3 3 4-1 0,0 30, 40 1977 FORD FIDGEY44701 COMP DED: $500 ACV f 4, 2 0 41 1966 INTL F0112534H ACV 42 1978 FORD FlOGEBA3544 COMP DED: $SOO COLI.. DED: !i'>SOO A(;V E S, i 0c 1i. Vic, 43 1.976 FORD (=37YEC26061 COMP DED: $500 COLL DED: q>50i i ACV 6 13 T,3 i 12/31/86 VEHICLE SUMMARY PAGE AS OF 12/31/86 SOUTHOLD "('C?WN VEH YEAR MAKE/MODEL/BODY TYPE VIN L14 1.975 FORD F1OBEV62286 ACV 45 1971 BROCKWAY 72488 ACV 46 1984 STECO/TRAILER iS9ESR2T4E1007077 COMP DED: $500 COLL_ DED: $500 ACV 46 4 47 1984 STECO/TRAILER 1S9ESR2T2E1007076 COMP DED: $500 COLL DED: $500 ACV s 4 �, `ioc 48 1984 FORD 1FDYK8040EVA05820 COMP DED: $SOO COLI_ DED: $500 ACV %K�, 49 1982 DODGE J87FP2474CY7041(=)4 COMP DED: $500 COLL_ DED: $S00 ACV '% 13, 7 c 50 1982 DODGE J87FP2472CY704067 COMP DED: $500 COLI._ DED: $SOO ACV ic. 1L1. 51 1982 DODGE 287FB13E6CY704067 COMP DEQ: $500 CULL DED: $500 ACV 4� c 3 S, 7 , 52 1983 DODGE 284HB23HODK353964 COMP DED: $500 COLI_ DED: $500 ACV s-7,3 c 40, 3`F. 53 1984 PLYMOUTH 1GBHC34M6EV127732 COMP DED: $500 COLI._ DED: $SOO ACV 1121 i c e 54 1984 DODGE J87FP24D6EY70()869 COMP DED: $SOO COLI.. DED: $SOO ACV '$ $, ^c 53. ,1'3, 55 1984 CHEV 1GBMC34M3EV127963 COMP DED: $500 COL_L DED: 11500 ACV 112, i c k 3. .254. 56 1971 FORD F90HVM142276 COMP DED: $SOO COL.L. DED: $SOO ACV 57 1.965 INTL F D907 9OF A(-.'IV 58 1966 FORD F60EE875478 COMP DED: $500 COLI._ DED: $S00 ACV } ; n, 3�, ~ - 12/31/86 VEHICLE SUMMARY PAGE AS OF 12131/86 SOUTHOLO TOWN VEH YEAR MAKE/MODEL./BODY TYPE VIN ___ ____ ____________________ 59 1.978 FORD F10BECC1228 COMP OED: $500 COLL DEO: $500 ACV -3 '4.5-o"o 13. `f^. 60 1978 PLYM 8C28E8K1246621 COMP DED: $500 COLL DED: $500 ACV at. 4/+^ 61 1.980 DODGE B323EAK111393 COMP OED: $500 COLL OED: $500 ACV at. ^44. ` 62 1980 PLYM BC6KTAK137973 COMP DED: $500 COLL DED: $500 ACV ; /\oc -z� 33` 8u,. 63 1.982 PLYM W—EBB26N1CR183386 COMP DED: $500 COLL DED: $500 ACV ,uoc^ S cl. 64 1976 FORD F8B53A221502 COMP DED: $500 COLL OED: $500 ACV 41. 0`cz '15. 7.2^ 65 1.962 FWD/DUMP J31072 ACV 66 1985 PLYM 1P38826S3F632773 COMP DED: $500 COLL DED: $500 ACV /p1. Cs 3^ 67 198S PLYM 1P38826SIFX632772 COMP OED: $500 COLL DED: $500 ACV 7�c` /o\. /cr3, 68 1985 PLYM 1P38826SXFX632771 COMP DED: $500 COLL DED: $500 ACV S 6D.-7 ^C\. 5 3. 69 1985 PLYM 1P3B826S8FX632770 COMP DED: $500 COLL DED: $500 ACV $ /o\ 7�o /=%. IV3 . 70 1985 PLYMOUTH 1P38826S2FX632769 L COMP DED: $500 COLL DEO: $500 ACV � /0, 7� o 7'1 1985 PLYM 1P3BB26SXFX632768 COMP DED: $500 COLL DED: $500 ACV \ CS 3. 72 1985 FORD 1FMDU15H1FLA87985 COMP DED: $500 COLL DED: $500 ACV 1 (`4. jQ'I` 11,114. 73 1977 FORD E14HH240410 COMP OED: $500 COLL DED: $500 ACV $(I^ yxl '� 52. �i 3. ' ' - ' ~ VEHICLE SUMMARY PAGE 12/31/86 AS OF 12/31/86 SOUTHOLD TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN ___ ____ ____________________ 1P3BB26PXFX652563 74 1985 PLYMOUTH COMP OED: $500 COLL OED: $500 ACV / 'f-,%` /33. 1HTZLTVR4FHA58099 75 1.985 INTL./DUMP ACV m 4a` COMP DED: $500 COLL DED: $500 3`:L 1FDNF60H4FUA71660 76 1985 FORD/DUMP ACV � �� o��» COMP DED: $500 COLL DED: $500 / 14;L5-;:z5"7. 1838E18C800159209 77 1986 DODGE/OMNI ACV � � �o�� COMP DED: $500 COLL OED: $500 . 79. 1*,r. 1HTLAHEM1FHA61054 78 1985 INTN' L HARyES � ���u COMP DED: $500 COLL DED: $500 ACV � 4S-1 454. 2B4FK41G2GR775002 79 1.986 DODGE/CARAVAN ACV /\ om�� v COMP OED: $500 COLL OED: $500 , `+n. 20CEK24L5G1193017 80 1986 CHEV/pICK Up ACV COMP OED: $k500COLL DED: $500 , /01`. 2GCEK24L8G1193013 81 1.986 CHEV/pICK Up , $500 ACV COLL OED COMP DED: $500 . /mt. `-t8' 2GCEK24L4G1193042 82 .1.986 CHEV/pICK Up ACV COMP DED: $500 COLL OED: $500 ` 1P86826S2HX716344 83 .1.987 PLYMOUTH ACV COMP OED: $50O COLL DED: $500 , �1' 7l / . 1P3BB26S4HX716345 84 .1.987 PLYMOUTH ACV COMP DED: $500 COLL DEO: $500 / �l � /�J. . 1P31B826138HX716347 85 .1.987 PLYMOUTH COLL DEO: $500 ACV COMP DEO: $500 � '7l. /�u'. 1P3BB26S01- X716343 '6 1987 PL�MOUTH . ACV - $500 COLL OEO^ $500 ' _. COMP OED: /��2 ��' ^ 1P3BB26S61- X716346 87 1987 PLYMOUTH COLL DEO, $500 ACV �r�� _m m COMP DED: $500 . , � J^ /o�, ll^ ~ 1P3BB26SXHX716348 — 88 1987 PLYMOUTH COMP OED: $500 COLL DED: $500 ACV -I -%I/��. PRE M I U M 0 U 0 _T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec ani? VPLN1 All Risk Annual Cost 500 $15,290 $1289 $16,579 $ 5000 12,655 1066 13,721 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Ouarterly Co=ents : _Bee Schedule A B. Valuable Papers $so;opo Deductible S 500 $65 $ %C0.0 55 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Quarterly Cor,Lments C. Comprehensive General Liability a. First dollar cov erae : $139,470 b. (13) Police Pro sc_.,ral iabi,l ;y-• ad 1 - _,�, au i ,,,onal cost 1. First Dollar Coverage : $74,060 (See Schedule B) C. Comprehensive General Liability Rating basis: Expenditures/Road Mileage/Food Receipts Carrier: Continental Casualty Company (CNA) Premium Payment Plan: Quarterly Comments: See Schedule C) D. Automobile Insurance Limits — $500,000 (includes Collision and Comprehensive) Rate per vehicle: $992.00 (88 automobiles) � 81►19� • Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premii= Payment Plan: quarterly E. Contractors Equip-tent Floater Deductible Rete rer 100 -^o $ 500 1.50* Carrier: St. Paul Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Annual -- Comments: Total values: $904,889 1L 13,5 `{ * deductible of $1000 F. Umbrella Liability First $ 5,000,000: $160,000 Next S 5,000,000: For options see Schedule F Rati::g Basis : Premium of underlyinq coverages Carrier: Landmark Insurance Company / F. Umbrella Liability Policy Period: 12/86 to 12/87 Premium Payment Plan: Annual Comments: SPP Sc,hedul P F R G. Yacht Insurance _ Physical Damage - Deductible . $ 500 Premium: $3,394 Carrier: RQyZ1 Tnsuranc-P cQmmnv Policy Period: 1 /22/86 to 1/22/87 CC=-"-eats Premi iim of S1,0191-90 l nchir1Ps T i alai 1 i ty of S500,000 H. Riblic E=Ioyee Blanket Bond Carrier: Continental Insurance Company Policy Period: 1/1/85 to 1/1/88 COQ-ents: Premium of $1,488 is for three years with a $25,000 limit for each employee. Additional indemnity for the following: Supervisor $190,000 Deputy•Supervisor 190,000 Tax Receiver 75,000 Town Clerk 50,000 PPFMIMM QUOTATION SMg4ARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 494,953 $ 5,000 Deductible : 492,085 _ The premium sumiary does not include the Public Officials policy. Please see schedule P for coverages and premium. val Stype & Sons Inc ;:ame of Agana/Broker Main Road Street or P.O. Box Mattituck NY 11952 CitS�, State, and Zip Valentine W Stype. Jr. Name of Person Completing Quota._on S a Lure Pr eid nt Title Date : December 12, 1986 SCHEDULE A 1. Building values should be increased to take into account increased building costs. "JJ i X16 ,0 2. A dedutible of $1,000 could be a better value. 3. Contents limits at each location should be reviewed for adequacy. 4. Money and Securities protection should be considered for _-J Y o� the Tax Assessor's office, expecially for tax collection periods, January and May. (Our current policy provides this coverage but the proposal does not ask for this pro- tection.) ro-tection.) - 4 5. Our annual cost uses the coverages stated in your proposal however, our current policy provides coverage for additional subjects of insurance. A thorough review of each location is recommended. Y1�:fti'f'.-i-v r K i IJ 1"'o.t .. '`T:o N ��V`•� � � 3S, � 12/12/86 SCHEDULE B 1. $1,00O,CCO i---it Too :amu - tR d(o $74,C60 no deductible 66,654 2500 deductible 62,951 5000 deductible 59,2'_8 10000 deductible 55,5=5 25000 deductible (The Lz^ -e' a zarrier requires one million limit. The Police Profess_cr� and Public Officials policies could be excluded frcm thella policy. ) 2. $500,CCO liri_ $55,;== no deductible 50,13 2500 deductible 47, 5000 deductible == 10000 deductible 41,EC� 25000 deductible 3. Insurance C=pa::y: AIG 12/12/E0 SCHEDULE C 1. Includes coverage for two Railroad station parking areas (Southold and Mattituck), storage area in Peconic and parking area on Main Street, Southold. Owners of respective properties are added as additional insureds. 2. Includes Broad Form CGL protection. 3. The XCU Exclusion may be deleted for codes 91252, municipalities and 92151, streets/roads at an additional cost. (Our current policy provides this coverage.-) 4. The-Home Aid program administered by the Township and funded by Suffolk County amy be added for an additional premium. (our cur- rent policy provides this coverage.) 5. Exclusions: Police Professional, Pollution (GL and Property), First Aid for recreation activities, Saddle Animal Liability Exclusion 6. Limit: $500,000 12/12/86 SaIE DULE /F 1. The Umbrella premium includes the Public Officials, Police Professional and Watercraft policies. 2. To exclude Public Officals and Police Professional from the Umbrella premium would reduce cost by 5%. 3. Optional Limits: _$80,000 one million 140,000 three million (Both options include Public Officials and Police Professional) 4. Exclusions: ERISA, Asbestos, Pollution, Care, Custody and Control, Directors and Officers, Airport/Aircraft and Munici- pality E & O. 12/12/86 SCHEDULE P Public Officals Liability: One million limit Claims Made policy form $10,000 each loss/$1,000 each official Deductible Exclusions: Discrimination, Kiring and Firing, Punitive Damage, Failure to maintain adequate insurance and Pending and Prior litigation. Annual Cost: $12,482 12/12/86 s1241k� Type Recommended Site of Insurance NO. Structure Amount 1. ,Town Hall $1 ,100 ,000.00 2. Beach Building 15 , 000.00 I 3 . Animal Shelter 50 ,000 .00 , 4 . Animal Shelter 20 ,000.00 ! 5 . Landfill 310 ,000 .00 � . Lan,-"- ill 35 , CC0 . 00 .� 7 . Highway Devar'_ment 375 ,000 . 00 &_ Hi hway De- ,tment 40 ,COO . CC c . Hizhwav Depa� :ment - 150,000 . 00 G. Highway D , ca h e..a, .mens 2� ,00G .�� 11 Highway D-_r rhe:,* 20 , 000 .00 Pcl ice Dez.ar' ^:ent 2 i` , COC :0C s.3 . Senior/Your;: Center 325 ,000.CO i! i ;f i I i 1- i Site No. 1 . TOWN HALL Main Road Southold, New York 11971 Ccnstruction. . . . . . . . . . ..... . . .Frame Stories . , . . . . . . . . . . . . . . . . . . .one Con-lition. . . ... . . . . . ... . . . . . . .excellent Ar,c�a. . . . . . . .First Floor. . . . .9 ,700 sq. ft . Basement . . . . . . . . . . . . . . . . . . . .yes-finished ' Interior . . . . . . . . . . . . . . . . . . . . finished , iFeat . . . . . . . . . . . . . . . . . . . . . . . . }reg }j I} i 1� Replacement cost . . . . . . . . . . . .s1, 100, 000 .DO ' !!f ( Current Insurance. . . . . . . . . .w (l ' ►1 I i; i is }I I -6- .S9lY:.M�:`- ... .... ,r- .:.. r:, `c. .- .: �_..�_ t... -.. .. _ ._. .y. .. -_ . .. .. v..;a'.. w.-a�:frcaa :.�8+tr..-.-.,:L >r::�!-4�=31►:�w.:-•.�. Site N, 2. BEACH F -ILDINC New Suffolk, N-w York 11056 Construction. . . . . . . . . . . . . . . .Frame Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . . . . . . . . . .good Area. . . . . . . . . . . . . . .. . . . . . . . .420 sq . ft. Basement . . . . . . . . . . . . . . . . . . . .no Interior. . . . . . . . . . _ . . . . . . . . .finished Heat . . . . . . . . . . . . . . . . . . . . . .no Replacement cost . . . . . . . . . . .w15 , CCC .00 (Current Insuranc. . . . . . . . . .$1^ , 000.00 i . Feco►^r.:ended Tn^urar.c .noun'. . .$25: '000.00 Sites Nos . 3 & 4 . ANIMAL SHELTER Peconic , New York 11958 Site Site # 3 . # 4 . Construction. . . . . .Brick - Concrete block 'Stories. . :: . . . . . . .one - one Condition. . . . . . . . .good - very good Area. . . . . . . . . . . . . .1,400 sq. ft. - 480 sq . ft . Basement. . . . . . . . . .no no Interior. . . . . . . . . . finished - unfinished Heat . . . . . . . . . . . . . . - no _ I Site No. 3 . Replacement Cost . . . . . . . . . . ..50 ,000 .00 ( Current Insurar.ce) . . . . . . . . w35 000.00 Recommended Insurance ;^count for Site t'o. ' • - • •t50, 000 • CO I Site No. 4 . Replacement cost . . . . . . . 0 . . .$20 ,000.00 ( Current Insurance ) . . . . . . . .$10,000 .00 Recommended Insurance Aircunt for Site No. 4 . . . .$2^ , 000 .00 I LANDFILL Cutchogue , New York 11935 Site Site # 5 . # 6 . Construction. . (Non-Combustible) Metal - Concrete block Stories . . . . . . . .one plus - one Condition . . . . . .excellent - very good �Area. . . . . . .`. . . .10,197 sq. ft. - 780 sq , ft. Basement . . . . . . .no. - no Interior. . . . . . .mostly unfinished - partially finished Heat . . . . . . . . . . .yes ( partial) - yes (partial ) `) I t Site No. 5 . Replacement cost . . . . . . . . . . .°31C , 000.00 ( Current Insurance ) . . . . . .!2 , 00C .-00 Recon ^end2d insurance Amount for Site No. 1 Site No. 6. Replacement cost . . . . . . . . .$35 ,000 .00 ( Current Insurance ) . . . . . . . .$25 , 000.00 Recommended Insurance Amount for Site 111o. 6 . . . . $35 ,000 .00 I Site No. 7. HIGHWAY DEPARTMENT Peconic , New York 11958 Construction. . . . . . . . . . . . . . . .Concrete block Stories. . . . . . . . . . . . . . . . . . . . .one ' Condition. . . . . . . . . . . . . . . . . . .very good Area . . . . . . . . . . . . . . . . . . . . . .12,294 sq . ft. Basement. . . . . . . . . . . . . . . . . . ...no Interior. . . . . . . . . . . . . . . . . . . .partially finished Heat . . . . . . . . . . . . . . . . . . . . . . . .yes (partially) i Replacement cost . . . . . . . . . . . .W375 ,000 .^0 ( Current Insurance ) . . . . . . . . .W200 ,000 .CO Recommende.. inzurar.ce Annunt 1275 , 000 .00 • f HIGHWAY DEPARTMENT Peconic, New York 11958 Site Site # 8. # 9. Construction. . . .Frame - Frame Stories. . . . . . . . .1-112 - one Condition. . . . . . .good - good 'Area. .lst 'Flr. . .1 ,040 sq. ft . - 5 , 57.6 sq . ft. Basement. . . . . . . .no - no Interior. . . . . . . .unfinished - unfinished Beat . . . . . . . . . . . .no - no ' i Site No. 8. I Replacement cost . . . . . . . . . . . . . . . . . . $40,000.00 ( Current Insurance) . . . . . . . . . . . . . . .$2 . 000 .00 i Pecom-nended Insurance Amount . . , . .c40 , 00:J .00 Site No. 9 . j Replacement cost. . . . . . . . . . . . . . . . . .$150 ,000.00 (Current Insurance ) . . . . . . . . . . . . . . .$ 60,000 .00 Recommended Insurance Amount . . . . . . $150 ,000.00 I i i .... ,<;w.a .. _"" - ' -=si.-;-st c-„s,r.... ._ _.: I a.':-f:i,._.a.a. ..•?;. _ 'rt<F+-#�.i?.!s. .» r-x'r.- +� .,_ HIGHWAY DEPARTMENT Peconic , New York 11958 Site Site # 10. 41 11. Construction. . . .Frame - Concrete block Stories. . . . . . . . .one - one Condition. . . . . . .good - good ' Area . . . . .'.`. . . . . .730 sq. ft. - 800 sq . ft. Basement. . . . . . . .no - no Interior. . . . . . . .unfinished unfinished Heat . . . . . . . . . . .no - no I Site No. 10 . IReplacernent cost. . . . . . . . . . . . . . . . . . . .$21 ,000 .00 ( Current Insurance) . . . . . . . . . . . . . . . . . .1.1R, 000.00 Recommended Insurance Amount . . .-21 , 000 .00 i I Site No. 11. Replacement cost . . . . . . . . . . . . . . . . . . . .W20 ,000 .00 (Current Insurance) . . . . . . . . . . . . . . . . .$15 ,000.00 Recotrmer.ded Insurance Amount. . . . . . . .$20 ,000.00 Y'"y .7;r;.. - .. r.. w.' ,'Y.> +vak-.1G-•Pt?'ri.il s�. 12— -;,; 'V-, ' 1 ► -13- Site No. 12. POLICE DEPARTMENT Main Road Southold , New York 11971 Construction. . . . . . . . . . . ... . . .Brick/concrete block ' Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . . . . . . . .excellent Area. . . . . .First Floor. . . . . . .4 ,000 sq. ft. Basement. . . . . . . . . . . . . . . . . . . .yes , finished Interior- - * . . . . . . . - - finished Heat . . . . . . . . . . . . . . . . . . . . . . . .yes 1 . 1 Replacement cost . . . . . . . . . . . . . . *. $275 ,000.00 ( Current Insurance) . . . . . . . . . . . . . .$180 ,000 .00 f� ,!!! P.ecomr:ended Insuranc= Amcu^.t �I ,I I .R - -13- -14- Site No. 13. SENIOR/YOUTH CENTER Peconic , New York 11958 Construction. . . . . . . . . . . . . .Metal , Stories. . . . . . . . . . . . . . . . . . . . .one Condition. . . . . . . . . . . . . . . . . . .excellent Area. . . . . . . . . . . . . . . . . . . . . . . .6,640 sq. ft. Basement. . . . . . . . . . . . . . . . . . . .no Interior. . . . . . . . . . . . . . . . . . . .finished Heat . . . . . . . . . . . . . . . . . . . . . . . .yes Replacement cocti . . . . . . . . . . .w325 ,000.00 + - ( Currentinsurance ) . . . . . . . . . .Z0.0 ,000 .00 Reccmr^.ended Insurance Amount . . .W325 .000 . 00 i i t I Appraiser: Andrew D. Stype, C.A.R. P.O. Box 63 Mattituck, New York 11952 � I l I � I -14- SCHEDULE OF VESSELS HULL AND MCHMIt VESSEL ` VALUE DEDUCTIBLE PA=UM X90 0 0 1} 1981A -_� 124' �Privateer T/150 H.P.O.B. $36 x&98 $ 500. $ 990. 2 365 3) 1967 139 Boston Whaler'40 H.P.O.B. $ 2:000. $ 250, $ 165. -4 396@ 19,—wellCZaft 150 H.p.O,B. --$ 2-,59fl-, $ i5v. $ , ..� 5} 1903 23' Seca QX 200 H.P.O.B. $11/00Q. $ -500. $ 335, 1 9 8"v I Y" S-F e a g e r cr•eF-'t w:��n. Trs:l-C� t 4 Z�c PRO'.rCTI MT�ME; Ij y VESSEL LIMIT Or LIABILITY FEEMIUM � ) 1901 Privateer $ 500'Oc�C. $ 385, 1 1.1-066 Boston Wha er S 500*COQ. $ 220. 3} 1967 Boston uha:?er $ 5000000. $ 220. +} 1363 Wallc.raxt $ 5000000. $ 423.50 5: 1903 :Sea Ox $ 5000000. $ 375. Each vessel is to be considered separately insur*d, ' ~ VEHICLE SUMMARY PAGE 12/31/86 AS OF 12/31/86 SOUTHOLD TOWN CONTINENTAL. CASUALTY CO 102O27573 01/01/86E—nIu{}1/01/87 TOTAL rRr,: $59, 523.00 COMMERCIAL AUTO --------------- COVERAGE DESCRIPTION: BUSINESS AUTO VEH YEAR MAKE/MODEL/BODY TYPE VIN ___ ____ ____________________ 2G1AL353681150063 ^ 1 1981 CHEV$50� COLL QED $500 ACV 1100-0COM� DED: . 3s. 29859.=^ 2 1968 JEEP ACV A9A057E234661 3 1979 AMC COLL DED: $500 ACV COMP DEQ: $500 , 11, 2FABP35F5C921223 COMP 4 1�82 DED: FORD$500 COLL DED: $500 ACV SOO" 2,4. F26HECE1535����. 5 19�8 FORD � COLL DED: $500 ACV S^Wo"*0 COMP DED: $500 . �w I�. ^ JL42LAA141294 6 1980 PLYMOUTH COLL DED: $500 ACV 5 -420* , COMP DED: $500 n�^ 3isr, 2P3B826L2CR133 94 7 1982 PLYMOUTH ACV COMP DEO: $500 COLL DED: $500 11. ING^ 2P3BB26N4CR183382 8 1982 PLYMOUTH �« COLL DED: $500 ACV o» �bo COMP QED: $500 . it. 2P38826S32R229386 9 1983 PLYMOUTH COLL DED, $500 ACV S ��^x*w�** COMP DED: $500 . ��. . 1P3BB26P3EX542615 1(} 1984 PLYMOUTH ^COLL DED $500 ACV 1 1"��� COMP DED: $500 , I$. 1P3B826S3EX580532 11 1984 PLYMOUTH COLL DED: $500 ACV 01000COMP DED: $500 . lot. xSK 1P3BM18C4EO275873 12 1984 PLYMOUTH ACV $ -1,000COMP DED: $500 COLL DED: $500 »«x S44, . 1P3BM18C2EO302293 13 1984 PLYMOUTH COLL DED: $S00 ACV COMP OED: $500 ' ~ , v�« 54. . 12/31/86 VEHICLE SUMMARY PAGE AS OF 1.2/31./86 SOUTHOLD TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN 14 1978 FORD 8863S16337 COMP QED: $500 COLL DED. $500 ACV $S;:.0 c 15 1966 INTL 211.9126205375 ACV 16 1963 INTL FD37896G ACV 17 1962 INTL. FD5293F ACV 18 1966 INTL. RD40666889 ACV 19 1964 INTL. RD406192699 ACV 20 1958 INTL. RD406100565 ACV 21 1969 INTL. RD406119167 ACV 22 1960 INTL. RD406142890 ACV 23 1967 INTL. 211912G229173 - ACV 24 1968 INTL 120126278950 ACV 25 1969 INTL 7179116329500 ACV 26 1972 INTL 7072116475279 ACV 27 1973 INTL 70721CG811058 ACV 28 1974 INTL 70721OG813421 ACV - 12/31/86 VEHICLE SUMMARY PAGE AS OF 12/31/86 SOUTHOLQ TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN ___ ____ ____________________ 29 1975 FORD F37YEV63895 COMP DED: $500 ACV $6,20<�' 3k^ 80 1977 DODGE D81GR73001431 COMP OED: $500 ACV 31 1977 DODGE, D81GR7J001432 COMP DEO: $5O0 ACV 6131coo ��. 32 1952 GMC 800290208 ACV 33 1981 CHEV 1G8JC34M8BV101386 COMP DED: $500 COLL DED: $500 ACV 9. ^+k, |2\. 34 1981 CHEV 1GBJC34M2BV101383 COMP DED: $500 COLL DED: $500 ACV 4\. /l3` 35 1978 INTL 0122HGB18578 COMP DED: $500 ACV � ':]c' cmm �7. 36 1970 INTL 707211G374933 ACV 37 1979 INTL CA252JHA33268 COMP DED: $500 COLL DED: $500 ACV I al. 8l. .2x1. 38 1981 INTL CA255BMA10967 COMP DED: $500 COLL DED: $500 ACV $35, ��oo 39 1981 INTL 1TKCA25568HA27031 COMP DED: $500 COLL DED: $500 ACV 8 34-1o'�^� /l-ti' 30, 48 1977 FORD F1OGEY44701 COMP DED: $500 ACV f4. 3-oz w. 41 1966 INTL FO112534H ACV 42 1978 FORD F10GE8A3544 COMP DEQ: $500 COLL DED: $500 ACV sS- toc 43 1976 FORD F37YEC26061 COMP DED: $500 COLL DED: $500 ACV 613 5'C30 12/31/86 VEHICLE SUMMARY PAGE AS OF .1.2/31./86 SOUTHOLD TOWN VEH YEAR MANE/MODEL/BODY TYPE VIN 44 1975 FORD F10BEV62286 ACV 45 1971 BROCKWAY 72488 ACV 46 1984 STECO/TRAILER lS9ESR2T4ElOO7077 COMP DED: $SOO COLL DED: $500 ACV A 41. y'a� 28t. ioia. 47 1984 STECO/TRAILER 1S9ESR2T2E1OO7O76 COMP DED: $500 COLL. DED: $500 ACV 1 S�• �tt-1. 48 1984 FORD IFDYK8040EVAOS820 COMP DED: $SOO COLL DED: $500 ACV %q-1. 49 1982 DODGE J67FP2474CY7041.04 COMP DED: x$500 COLL. DED: $500 ACV �% i 3, 7 c c '70. 12-7. SO 1982 DODGE J87FP2472CY704067 COMP DED: $SOO COLI.. DED: $500 ACV '.I c• 12--l. 51 1982 DODGE 267FB13E6CY704067 COMP DED: $SOO COLL DED: $500 ACV Vit ;o e 3T, 14% 52 1983 DODGE 284HB23HODK3S3964 COMP DED: $500 COLL DED: $500 ACV 40' 3%F- 53 1984 PLYMOUTH 1GBHC34M6EV127732 COMP DED: $500 COLI.. DED: $500 ACV 112, ice 54 1984 DODGE J67FP24D6EY700869 COMP DED: $SOO COLL. DED: $SO0 ACV 53. 1Q. 55 1984 CHEV 1GBMC34M3EV127963 COMP DED: $500 COLL DED: $500 ACV 1(.21 i n c 9 3. .254. 56 1971 FORD F90HVM142276 COMP DED: $500 COLL DED: $SOO ACV j, cc, t� 57 1965 INTL FD9079OF ACV 58 1966 FORD F60EE875478 COMP DED: $SOO COLL. DED: $SOO ACV } 1 c�� ik. 35, � , 12/31/86 VEHICLE SUMMARY PAGE AS OF 12131/86 SOUTHOLO TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN ___ ____ ____________________ 59 1.978 FORD F10BECC1228 COMP DED: $500 COLL DED: $500 ACV 60 1978 PLYM BC28E8K1246621 COMP DED: $500 COLL DEO: $500 ACV it. 4/+^ 61 1.980 DODGE B22JEAK111393 COMP DEO: $500 COLL OED: $500 ACV 2\. `+4. ' 62 1.980 PLYM 8C6KTAK137973 COMP OED: $500 COLL DED: $500 ACV 4 /ISO ocl, 63 1.982 PLYM W—EBB26N1CR183386 COMP DED: $500 COLL OED: $500 ACV 1/.2,moc3 S cl. 64 1976 FORD F6B53A221502 COMP DED: $500 COLL DED: $500 ACV x 7. oc�o 415^ la. 65 1.962 FWD/DUMP J81072 ACV 86 1985 PLYM 1P38828S3F632773 COMP DED: $500 COLL QED: $500 ACV 11 /0 1 -1c»�z' 87 1985 PLYM 1P3B826SIF%632772 COMP DEQ: $50O COLL QED: $500 ACV 7�c` /sr3, 68 1985 PLYM 1P38826SXFX632771 COMP DEO: $500 COLL DED: $500 ACV (53. 69 1985 PLYM 1P38826S8F)<632770 COMP DED: $500 COLL DED: $500 ACV $ /c\ 7�o /=%. 70 1985 PLYMOUTH 1P38826S2FK632769 | COMP DED: $500 COLL DED: $50( ACV `~ (��^ /5]. 71 1985 PLYM 1P3B828S%FX632768 COMP DED: $5O0 COLL � m DED: $500 ACV � ^-1cla I c\. %53. 72 1985 FORD 1FMDU15H1FLA87985 m COMP OED: $500 COLL DED: $500 ACV 73 1977 FORD E14HH240410 COMP DED: $500 COLL DED: $500 ACV ` 5-0 �, 5I. 't 3' 12/31/86 VEHICLE SUMMARY PAGE AS OF 1.2/31/86 SOUTHOLD TOWN VEH YEAR MAKE/MODEL/BODY TYPE VIN 74 1985 PLYMOUTH 1P3BB26PXFX6S2563 COMP DED: $500 COLL DED: $SOO ACV rc1. 133. 75 1.985 INTL./DUMP 1.HT7.LTVR4FHA58099 COMP DED: $500 COLL OED: $500 ACV b a 312. 76 1985 FORD/DUMP 1FDNF6OH4FUA71.660 COMP DED: $500 COLL QED: $500 ACV 1; 3 y/ C� zS^Y, 77 3.986 DODGE/OMNI 1B3BE18C8GD1.S9209 COMP DED: $500 COLL DED: $500 ACV b 1, 7 o.r 19, 1`kyr. 78 1985 INTN' L HARVES IHTL.AHEMIFHA61.054 COMP DED: $500 COLL DED: $SOO ACV $ 45*1 3 cc, 45+- 4a1. 79 1.986 DODGE/CARAVAN 2BI4FK41.G2GR775002 COMP DED: $500 COLL DED: $500 ACV 1`41. x RR, 80 1.986 CHEV/PICK UP 2GCEK24LSG1193017 COMP DED: $k SOO COLL DED: $500 ACV 1c�+ c..18. 81 1.986 CHEV/P]'CI UP 2GCEK24L8G1.193013 COMP DED: $500 COLL DED: $500 ACV �t,toc let, 82 1.986 CHEV/PICK UP 2GCEK24L461.1.930142 COMP DED: $500 COLL DED: $500 ACV +,►ate Io1. I'1$, 83 1987 PLYMOUTH 1P3BB26S2HX716344 COMP DED: $SOO COLL DED: $500 ACV Za i 1 c:1. '7'1 84 1987 PLYMOUTH 1PSBB26SL• HX71.6314S COMP DED: $SOO COLL DED: $500 ACV 1 S.1 S% 85 1.987 PLYMOUTH 1.P3BB26S8HX71.63I47 COMP DED: $500 COLL DED: $500 ACV l IT,SO C4 /cl. '71, 86 1.987 PLYMOUTH 1P31:3B26SOHX71.6343 COMP OED: $500 COLL DED: $500 ACV 1 S', 3 1.131, -11. 87 1.987 PLYMOUTH 1P30826S61AX71.63146 COMP DED: $SOO COLL DED: $SOO ACV J t! �a d� '-C�a 88 1.987 PLYMOUTH 1.P3BB26SXHX71.6348 COMP DED: $SOHO COLL DED: $SOO ACV /0Z -1-%, P R E M I U M 0 U 0 T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VYN All Risk Annual Cost $ 500 $15,290 $1289 $16,579 $ 5000 12,655 1066 13,721 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Ouarterly Co=ents: See Schedule A B. Valuable Papers Deductible 500 $65 %U00 55 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/l/88 Premium Payment Plan: Quarterly Corzments : C. Com,:)rehensive General Liability a. $139 470 First dollar co���era�e b. (13) Police Pro s--_cnal liability, additional co t: 1. First Dollar Coverage : $74,060 (See Schedule B) --� 1 l.. Comprehensive General Liability Rating basis: Expenditures/road .Mileage/Food Receipts Carrier: Continental Casualty Company (CNA) Premium Payment Plan: Quarterly Comments: See Schedule C) D. Automobile Insurance Limits - $500,000 (includes Collision and Comprehensive) Rate per vehicle: $992.00 (88 automobiles) Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: quarterly E. Contractors Equip-e-t Floater Deductible Rate Der 100 $ 500 1.50* Carrier: St. Paul Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Annual Comments : Total values: $904,889 * deductible of $1000 F. Umbrella Liability First $ 590009000: $1604000 Next S 5,000,000: For options see Schedule F Rating Basis : Premium of underlying coverages Carrier: Landmark Insurance Company F. Umbrella Liability Policy Period: _ 12/86 to 12/87 Premium Payment Plan: Annual Comments: See Schedule F G. Yacht Insurance _ Physical Damage - Deductible 500 Premium: 53.394 Carrier: Royal Tnsuranrp CQMLQny Policy Period: 1 /22/86 to 1/22/87 Co=e:?ts : Premium of $30393.50 inc-ludg , T.iahi1ity of 500-000 H. -- Fublic Employee Blanket Bond Premium: $1 IRA Carrier• Continental Insurance Company Policy Period: 1/1/85 to 1/1/88 Cou gents: Premium of $1,488 is for three years with a $25,000 limit for each employee. Additional indenmity for the following: Supervisor $190,000 Deputy-Supervisor 190,000 Tax Receiver 75,000 Town Clerk 50,000 PREMIL714 QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible : $ 494,953 $ 5,000 Deductible: 492,085 The premium summary does not include the Public Officials policy. Please see schedule P for coverages and premium. Val Stype & Sons Inc Name of Agent/Broker Main Road Street or P.O. Box M t t i tuck. NY 11952 City, State, and Zip Valentine W. Stype. Jr. Name of Person Completing Quotation �C S i dna ture -- Present Title Date : December 12, 1986 SCHEDULE A 1. Building values should be increased to take into account increased building costs. 2. A dedutible of $1,000 could be a better value. 3. Contents limits at each location should be reviewed for adequacy. 4. Money and Securities protection should be considered for the Tax Assessor's office, expecially for tax collection periods, January and May. (Our current policy provides this coverage but the proposal does not ask for this pro- tection.) 5. Our annual cost uses the coverages stated in your proposal however, our current policy provides coverage for additional subjects of insurance. A thorough review of each location is recommended. 12/12/86 SCHEDULE B 1. $1,000,,000 limit $74,060 no deductible 66,654 2500 deductible (52,951 5000 deductible 59,248 10000 deductible 55,545 25000 deductible (The Umbrella carrier requires one million limit. The Police Professional and Public Officials policies could be excluded from the Umbrella policy. ) 2. $500,000 limit $55,742 no deductible 50,168 2500 deductible 47,381 5000 deductible 44,594 10000 deductible 41,807 25000 deductible 3. Insurance Company: AIG 12/12/86 r � SCHEDULE C 1. Includes coverage for two Railroad station parking areas (Southold and Mattituck), storage area in Peconic and parking area on Main Street, Southold. Owners of respective properties are added as additional insureds. 2. Includes Broad Form CGL protection. 3. The XCU Exclusion may be deleted for codes 91252, municipalities and 92151, streets/roads at an additional cost. Our current policy provides this coverage. 4. The Home Aid program administered by the Township and funded by Suffolk County amy be added for an additional premium. (Our cur- rent policy provides this coverage.) 5. Exclusions: Police Professional, Pollution (GL and Property), First Aid for recreation activities, Saddle Animal Liability Exclusion 6. Limit: $500,000 12/12/86 ♦ M SCHEDULE F 1. The Umbrella premium includes the Public Officials, Police Professional and Watercraft policies. 2. To exclude Public Officals and Police Professional from the Umbrella premium would reduce cost by 5 3. Optional Limits: $80,000 one million 140,000 three million (Both options include Public Officials and Police Professional) 4. Exclusions: ERISA, Asbestos, Pollution, Care, Custody and Control, Directors and Officers, Airport/Aircraft and Munici- pality E & 0. 12/12/86 1 _ _ SCHEDULE P Public Officals Liability: One million limit Claims Made policy form $10,000 each loss/$1,000 each official Deductible Exclusions: Discrimination, Kiring and Firing, Punitive Damage, Failure to maintain adequate insurance and Pending and Prior litigation. Annual Cost: $12,482 12/12/86 C= . Lr) Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 ,JUDITH T. TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 18, 1986 Valentine W. Stype, Jr. , President Val Stype S Sons Inc. Main Road Mattituck, New York 11952 Dear Val: The Southold Town Board, at their regular meeting held on December 16, 1986, accepted your proposal for providing the Town with complete insurance coverage for the period January 1 , '1987 through January 1, 1988, all in accordance with your premium quotation proposal received on December 12, 1986. Veryy truly yours, Judith T. Terry e y Southold Town Clerk P R E M I U M 0 U 0 T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and =21 All Risk Annual Cost $ 500 $15,290 $1289 $16,579 $ 5000 12,655 1066 13,721 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premi= Payment Plan: Quarterly Comments : See Schedule A B. Valuable Papers Def b 1 e 500 $65 5000 55 Carrier: Continental Casualty Company (CNA) Policy Period• 1/1/87 to 1/1/88 Premium Payment Plan: Quarterly Comments : C. Co,=)rehensive General Liability a. First dollar co,v•era:7e : $139,470 b. (13) Police Profess_c::al liabilit-Y additional�,, , al cot: 1. First Dollar Coverage : $74,060 (See Schedule B) t C. Comprehensive General Liability Rating basis: Expenditures/Road Mileage/Food Receipts Carrier: Continental Casualty Company (CNA) Premium Payment Plan: Quarterly Comments: See Schedule C) D. Automobile Insurance Limits — $500,000 (includes Collision and Comprehensive) Rate per vehicle : $992.00 (88 automobiles) Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: quarterly E. Contractors Equipment Floater Deductible Rale ner 100 $ 500 1.50* Carrier: St. Paul Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Annual Comments : Total values: $904,889 * deductible of $1000 F. Umbrella Liability First $ 5,000,OCO: $160,000 Next S 5,000,000: For options see Schedule F Rating Basis : Premium of underlying coverages Carrier: Landmark Insurance Company F. Umbrella Liability Policy Period: 12/86 to 12/87 Premium Payment Plan: Annual Comments : SPP Sch d ]1 P F F G. Yacht Insurance - Physical Damage - Deductible $ 500 Premium: 53.394 Carrier: Rnval Tnsuran .P Company Policy Period: 1 /22/86 to 1 /22/82 Co=ents : p-ri-mi um_nf $1,1q3 90 i 1"1(`l udi-s Li ahi 1 i ty of S500,000 H. Public E=,ployee Blanket Bond Premium: $,asgsa Car tier• Continental Insurance Company Policy Period: 1/1/85 to 1/1/88 Comments: Premium of $1,488 is for three years with a $25,000 limit for each employee. Additional indemnity for the following: Supervisor $190,000 Deputy-Supervisor 190,000 Tax Receiver 75,000 Town Clerk 50,000 PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible : $ 494,953 $ 5,000 Deductible : 492,085 The premium summary does not include the Public Officials policy. Please see schedule P for coverages and premium. Val Stype & Sons Inc Name of Agent/Broker Main Road Street or P.O. Box Mattituck. NY 11952 City, State, and Zip Valentine W. Stype. Jr. Name of PersonCompletingQuotation Cfa&;6� �X. Sib-nature G i d ent Title Date : December 12, 1986 SCHEDULE A 1. Building values should be increased to take into account increased building costs. 2. A dedutible of $1,000 could be a better value. 3. Contents limits at each location should be reviewed for adequacy. 4. Money and Securities protection should be considered for the Tax Assessor's office, expecially for tax collection periods, January and May. (Our current policy provides this coverage but the proposal does not ask for this pro- tection.) 5. Our annual cost uses the coverages stated in your proposal however, our current policy provides coverage for additional subjects of insurance. A thorough review of each location is recommended. 12/12/86 SCHEDULE B 1. $1,000,000 limit $74,060 no deductible 66,654 2500 deductible 62,951 5000 deductible 59,248 10000 deductible 55,545 25000 deductible (The Umbrella carrier requires one million limit. The Police Professional and Public Officials policies could be excluded from the Umbrella policy. ) 2. $500,000 limit $55,742 no deductible 50,168 2500 deductible 47,381 5000 deductible 44,594 10000 deductible 41,807 25000 deductible 3. Insurance Company: AIG 12/12/86 SCHEDULE C 1. Includes coverage for two Railroad station parking areas (Southold and Mattituck), storage area in Peconic and parking area on Main Street, Southold. Owners of respective properties are added as additional insureds. 2. Includes Broad Form CGL protection. 3. The XCU Exclusion may be deleted for codes 91252, municipalities and 92151, streets/roads at an additional cost. Our current policy provides this coverage. 4. The Home Aid program administered by the Township and funded by Suffolk County amy be added for an additional premium. Our cur- rent policy provides this coverage. 5. Exclusions: Police Professional, Pollution (GL and Property), First Aid for recreation activities, Saddle Animal Liability Exclusion 6. Limit: $500,000 12/12/86 SCHEDULE F 1. The Umbrella premiLun includes the Public Officials, Police Professional and Watercraft policies. 2. To exclude Public Officals and Police Professional from the Umbrella premium would reduce cost by 5%. 3. Optional Limits: $80,000 one million 140,000 three million (Both options include Public Officials and Police Professional) 4. Exclusions: ERISA, Asbestos, Pollution, Care, Custody and Control, Directors and Officers, Airport/Aircraft and Munici- pality E & 0. 12/12/86 SCHEDULE P Public Officals Liability: One million limit Claims Made policy form $10,000 each loss/$1,000 each official Deductible Exclusions: Discrimination, Kiring and Firing, Punitive Damage, Failure to maintain adequate insurance and Pending and Prior litigation. Annual Cost: $12,482 12/12/86 P R E M I U M 0 U 0 T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VDSS All Risk Annual Cost 500 $15,290 $1289 $16,579 S 5000 12,655 1066 13,721 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premi= Payment Plan: Ouarterly Co=ents: See schedule A B. Valuable Papers Deductible S 500 $65 $ 5000 55 Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Quarterly Comments : C. Co=)rehensive General Liability a First dollar cov erase : $139,470 b. (18) Police Pro`essliability, additional cost: 1. First Lo11ar Coverage : $74,060 (See Schedule B) C. Comprehensive General Liability Rating basis: _Expenditures/Road Mileage/Food Receipts Carrier: Continental Casualty Company (CNA) Premium Payment Plan: Quarterly Comments: See Schedule C) D. Automobile Insurance Limits — $500,000 (includes Collision and Comprehensive) Rate per vehicle: $992.00 (88 automobiles) Carrier: Continental Casualty Company (CNA) Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: quarterly E. Con tractors Equipment -Floater Deductible Rate ner 100 --^o�••�� $ 500 1.50* Carrier: St. Paul Policy Period: 1/1/87 to 1/1/88 Premium Payment Plan: Annual Comments: Total values: $904,889 * deductible of $1000 F. Umbrella Liability First $ 5,000,000: $160,000 Next S 5,000,000: For options see Schedule F Rating Basis: Premium of underlying coverages Carrier: Landmark Insurance Company , F. Umbrella Liability Policy Period: 12/86 to 12/87 Premium Payment Plan: Annual Comments: SPP Sc-hpd ,l P F G. Yacht Insurance - Physical Damage - Deductible $ 500 Premium: 53.394 Carrier: Royal Tnsijranc-P Company Policy Period: 1 /22/86 tn 1 /22/87 Co:.^gents: Prpmium of $1,393-90 i nc-liAps T.i ahi l i i-y o �) 05 0.000 H. __ Public Employee Blanket Bond Premium: .,$1,488 Carrier: Continental Insurance Company Policy Period: 1/1/85 to 1/1/88 Comments• Premium of $1,488 is for three years with a $25,000 limit for each employee. Additional indemnity for the following: Supervisor $190,000 Deputy'Supervisor 190,000 Tax Receiver 75,000 Town Clerk 50,000 PRB'MIMM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: . $ 494,953 $ 5,000 Deductible: 492,085 The premium summary does not include the Public Officials policy. Please see schedule P for coverages and premien: . - Val Stype & Sons Inc ;:are of Agen'E/I-:Iroker Main Road Street or P.O. Box MattitU". NY 11952 City, State, and Zip Valentine int. Stvne. Jr. Name of Pe.-son Completing Quotation Sio a Lure President Title r _sid nt-- Title Date : December 12, 1986 SCHEDULE A 1. Building values should be increased to take into account increased building costs. 2. A dedutible of $1,000 could be a better value. 3. Contents limits at each location should be reviewed for adequacy. 4. Money and Securities protection should be considered for the Tax Assessor's office, expecially for tax collection periods, January and May. (Our current policy provides this coverage but the proposal does not ask for this pro- tection.) 5. Our annual cost uses the coverages stated in your proposal however, our current policy provides coverage for additional subjects of insurance. A thorough review of each location is recommended. 12/12/86 SCHEDULE B 1. $1,000,000 limit $74,060 no deductible 66,654 2500 deductible 62,951 5000 deductible 59,248 10000 deductible 55,545 25000 deductible (The Umbrella carrier requires one million limit. The Police Professional and Public Officials policies could be excluded from the Umbrella policy. ) 2. $500,000 limit $55,742 no deductible 50,168 2500 deductible 47,381 5000 deductible 44,594 10000 deductible 41,807 25000 deductible 3. Insurance Company: AIG 12/12/86 SCHEDULE C 1. Includes coverage for two Railroad station parking areas (Southold and Mattituck), storage area in Peconic and parking area on Main Street, Southold. Owners of respective properties are added as additional insureds. 2. Includes Broad Form CGL protection. 3. The XCU Exclusion may be deleted for codes 91252, municipalities and 92151, streets/roads at an additional cost. 'Our current policy provides this coverage) 4. The Home Aid program administered by the Township and funded by Suffolk County amy be added for an additional premium. Our cur- rent policy provides this coverage. 5. Exclusions: Police Professional, Pollution (GL and Property), First Aid for recreation activities, Saddle Animal Liability Exclusion 6. Limit: $500,000 12/12/86 SCHEDULE F 1. The Umbrella premium includes the Public Officials, Police Professional and Watercraft policies. 2. To exclude Public Officals and Police Professional from the Umbrella premium would reduce cost by 50. 3. Optional Limits: $ 80,000 one million 140,000 three million (Both options include Public Officials and Police Professional) 4. Exclusions: ERISA, Asbestos, Pollution, Care, Custody and Control, Directors and Officers, Airport/Aircraft and Munici- pality E & 0. 12/12/86 SCHEDULE P Public Officals Liability: One million limit Claims Made policy form $10,000 each loss/$1,000 each official Deductible Exclusions: Disci;imi.nation, Kiring and Firing, Punitive Damage, Failure to maintain adequate insurance and Pending and Prior litigation. Annual Cost: $12,482 12/12/86 BIDS FOR INSURANCE PROPOSALS: (if mailed to any prospective bidder,) they must mail request tog*#her with $3.00 postage cost 1 . McMann-Price Agency 2. Stype Agency 3. ��./� -o -�, .t'��►-. /3 7.3 - Cdr vim- 7 �,` ,d�```�'�°�` ` 4. 7y1 lew ?hut V7�t-7 5. Peter Demetriou 6 Sons, Inc. , 29-14 Queens Plaza East 212-784-7402 6. 7. 8. 9. 10. COUNTY OF SUFFOLK STATE OF NEW YORK ss: Patricia Wood, being duly sworn, says that she is the Editor, of THE LONG ISLAND TRAVELER-WATCHMAN, a public newspaper printed at Southold, in Suffolk County; and that the notice of which the annexed is a printed copy, LEGAL NOTICE has been published in said Long Island Traveler-Watchman � EXTEND RECEIPT once each week for . . . . . . . . . . . . . . . . . . . . . . . . . . . weeks DATE FOR REQUEST FOR PROPOSALS — TOWN INSURANCE successively, commencing on the . . . . . . . . . . . . . . . . . . . . . . NOTICE IS HEREBY GIV- day �! , f��- 9 EN that the Town Board of the Town of Southold hereby ex- tends the receipt date to 11:00 A.M., Friday, December 12, 1986, for receipt of proposals for their Insurance Program for Fiscal Year 1987,and/or alter- r nate years 1987e�988,1989.Policies Sworn to before me this . . . . . . . . . . . /. .�. . . . . . day of and Loss Run figures are 1 available at the Southold Town / p Clerk's Office,Southold Town l .. . . . . • • • • • , 19 • • Hall, Main Road, Southold, i New York. All proposals must be signed and sealed in envelopes plainly marked:"Town Insurance Pro- . . . . �� � %zO gram Proposal." DATED: November 3, 1986. Notary Public JUDITH T. TERRY`` SOUTHOLD TOWN CLERK 1T-11/6/86(55) Notary i. "_, : rt ;, Pde.a Ycrk cca-nty i LEGAL NOTICE STATE OF NEW YORK ) EXTEND RECEIPT DATE ) SS: FOR REQUEST FOR PROPOSALS COUNTY OF SUFFOLK ) - TOWN INSURANCE NOTICE IS HEREBY GIVEN that the Town Board of the Town of Greenport, In of Southold hereby extends the �Sr 8 a /.. receipt date to 11:00 A.M., Fri- day, he/she December 12, 1986 for re- Principal Clerk of THE SUFFOLK TIMES, a Weekly ceipt of proposals for their Insur- Newspaper, published at Greenport, in the Town ante Program for Fiscal Year 1987,and'or alternate aggregate of Southold, County of Suffolk and State of New Proposals for years 1987, 1988, 1989. Policies and Loss Run fi- York, and that the Notice of which the annexed is gores are available at the South_ a printed copy, has been regularly published in old Town Clerk's Office, South- old Town Hall, Main Road, said Newspaper once each week for one Southold,New York- weeks successively, commencing on the 6 Ail proposals must be signed and sealed in envelopes plainly day of NOV 196 marked: "Town Insurance Prog- rani Proposal." DATED:November 3,1986. — ,JUDITH T.TERRY SOUTHOLD-TOWN CLERK 1TN6;4lo / Pr*i al Clerk Sworn to before the this day of_ / 1 19 MARY K.DEGNAN NOTARY PUBLIC,State of New York � +� sc 4�84y/8S0�� r�'7 s 4 • STATE OF NEW YORK: SS: COUNTY OF SUFFOLK: JUDITH T. TERRY, Town Clerk of the Town of Southold, New York, being duly sworn, says that she is over the age of twenty-one years; that on the 3rd day of November 19 86 , she affixed a notice of which the annexed printed notice is a true copy, in a proper and substantial manner, in a most public place in the Town of Southold, Suffolk County, New York, to wit: Town Clerk Bulletin Board, Southold Town Hall, Main Road, Southold, New York 11971. Extend date for receipt of proposals for Town Insurance Program from 11 :00 A.M. , Thursday, November 13, 1986 to 11 :00 A.M. , Friday, December 12, 1986, Southold Town Hall. Judith T. Terry Southold Town Clerk Sworn to before me this 3rd day of November 1986, Notary Public LEGAL NOTICE EXTEND RECEIPT DATE FOR REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN that the Town Board of the Town of Southold hereby extends the receipt date to 11 :_00 A.M. , Friday, December 12, 1986 for receipt of proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. All proposals must be signed and sealed in envelopes plainly marked : "Town Insurance Program Proposal." DATED: November 3, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 6, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board LEGAL NOTICE REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby seeking proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York 11971 until 11 :00 A.M. , Thursday, November 13, 1986, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in envelopes plainly marked : "Town Insurance Program Proposal." DATED: October 21, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, OCTOBER 30, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board LEGAL NOTICE EXTEND RECEIPT DATE FOR REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN that the Town Board of the Town of Southold hereby extends the receipt date to 11 :_00 A.M. , Friday, December 12, 1986 for, receipt of proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. All proposals must be signed and sealed in' envelopes plainly marked : "Town Insurance Program Proposal." DATED: November 3, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 6, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971 Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board LEGAL NOTICE EXTEND RECEIPT DATE FOR REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN that the Town Board of the Town of Southold hereby extends the receipt date to 11 :.00 A.M. , Friday, December 12, 1986 for, receipt of proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. All proposals must be signed and sealed in envelopes plainly marked "Town Insurance Program Proposal." DATED: November 3, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 6, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members 'own Clerk's Bulletin Board COUNTY OF SUFFOLK STATE OF NEW YORK ss: Patricia Wood, being duly sworn, says that she is the Editor, of THE LONG ISLAND TRAVELER-WATCHMAN, REQUEST FOR PROPOSALS a public newspaper printed at Southold, in Suffolk County; TOWN INSURANCE and that the notice of which the annexed is a printed copy, NOTICE IS HEREBY GIV- has been published in said Long Island Traveler-Watchman EN THAT the Town Board of the Town of Southold is hereby once each week for . . . . . . . . . . . . . . . . . . . /. . . . . . weeks seeking proposals for their In- surance Program for Fiscal successively, commencing on the . . . , , Year 1987,and/or alternate ag- • • • • • gregate proposals for years 1987, 1988, 1989. Policies and day of . . . . . . . . .t�: . . . . . . . 19 . . . . . Loss Run figures are available at the Southold Town Clerk'sOffice, Southold Southold Town Hall, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York Sworn to before me this . . . . . . . . . -��.. . . . . . . . . day of 11971 until 11:00 A.M.,Thurs- (' _ day, November 13, 1986, at L Wiz. which time they will be public- ly opened and read aloud. All propoasls must be signed and sealed in envelopes plainly marked: "Town Insurance Pro- o' gram Proposal." . . . . . . . . . . . . . . . . . _y21 u✓ :>. . . DATED: October 21, 1986 JUDITH T. TERRY Notary Public SOUTHOLD TOWN CLERK 1T-10/30/86(45) P."I ?iARA IQRI�Fa State c' New York C,ri'; i_l in ;;a�:uia Cou tjr Exl,i es, s 7 3119`-e --- -7I LEGAL NOTICE REQUEST FOR STATE OF NEW YORK ) PROPOSALS- ) SS: TOWN INSURANCE NOTICE IS HEREBY GIVEN COUNTY OF SUFFOLK ) THAT the Town Board of the Town of Southold is hereby seek- ing proposals for their Insurance Joan Gustayson Of Greenport, In Program for Fiscal Year 1987, and/or alternate aggregate prop- Said County, being duly sworn, says that he/she is osals for years 1987,1988,1989. Principal Clerk of THE SUFFOLK TIMES, a Weekly Policies and Loss Run figures are available at the Southold Newspaper, published at Greenport, in the Town Town Clerk's Office, Southold Town Hall, Main Road, South- of Southold, County of Suffolk and State of New old,New York. York, and that the Notice of which the annexed is Proposals will be received by the Southold Town Clerk at the a printed copy, has been regularly published in Southold Town Hall,Main Road, said Newspaper once each week for nna Southold,New York 11971 until 11:00 A.M., 'Thursday, weeks successively, commencing on the 3 0 November 13, 1986, at which day Of 0 C t 19 8 6 time they will be publicly opened and read aloud. All proposals must be signed and sealed in envelopes plainly r� marked:"Town Insurance Prog- 'ZZ V,ram Proposa " Principal Clerk DATED:Octob@r 21,1986. JUDITH T.TERRY SOUTHOLD TOWN CLERK Sworn to bere this T030-5396 --- g� 1 dayo s , s STATE OF NEW YORK: SS: COUNTY OF SUFFOLK: JUDITH T. TERRY, Town Clerk of the Town of Southold, New York, being duly sworn, says that she is over the age of twenty-one years; that on the 24th day of October 1986 , she affixed a notice of which the annexed printed notice is a true copy, in a proper and substantial manner, in a most public place in the Town of Southold, Suffolk County, New York, to wit: Town Clerk Bulletin Board, Southold Town Hall, Main Road, Southold, New York 11971. Request for proposals - Town's Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987`1988, 1989. Proposals will be opened 11 :00 A.M., Thursday, November 13, 1986, Southold Town Hall. Judith T. Terry Southold Town Clerk Sworn to before me this 24th day of October .19-U--., t� Notary Public LEGAL NOTICE REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby seeking proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York 11971 until 11 :00 A.M., Thursday November 13, 1986, at which time they will be publicly opened and read aloud All proposals must be signed and sealed in envelopes plainly marked : "Town Insurance Program Proposal." DATED: October 21, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, OCTOBER 30, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following : The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board T e IMF 17147 �.� LEGAL NOTICE REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby seeking proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York 11971 until 11 :00 A.M., Thursday, November 13, 1986, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in envelopes plainly marked : "Town Insurance Program Proposal." DATED: October 21, 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, OCTOBER 30, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board LEGAL NOTICE REQUEST FOR PROPOSALS - TOWN INSURANCE NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby seeking proposals for their Insurance Program for Fiscal Year 1987, and/or alternate aggregate proposals for years 1987, 1988, 1989. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York 11971 until 11 :00 A.M., Thursday, November 13, 1986, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in envelopes plainly marked : "Town Insurance Program Proposal." DATED: October 211 1986. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, OCTOBER 30, 1986, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler-Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board YOLK .Jnsurance BUS I NESS I NSIRAWE PROGRAM ANALYSIS PRFpARED FOR: TOWN OF SOUTHOLD MAIN ROAD 9-OuTr-am r N.Y. S jBM I T TED BY: VAL STYPE JR. PRESIDENT VAL STYPE & SONS, INC. 10/07/86 NOTE: DESCRIPTIONS OF COVERAGE IN THIS PROPOSAL HAVE BEEN SIMPLIFIED AND ARE SUBJECT TO THE COVERAGE ACCEPTED AND THE EXACT POLICY TERMS. THIS OFFER EXPIRES IN NA DAYS. Opp BSSI0 N7 rourr Main Road Mattituck, N.Y. 11952 TPIA TELEPHONE: (516) 298-8481 ipGE� 'eANCE A n SOUTHOLD SCHEDULE OF IIYSURA CE: PUBLIC OFFICIALS LIABILITY $OPE MILLION LIMIT FOR EACH LOSS $ONE MILLION LIMIT FOR ANNUAL AGGREGATE $2,500 RETENTION (AMOUNT TO BE BORNE BY TOWN FOR EACH LOSS) $9,315 ANNUAL PREMIUM Public Officials Liability is designed to cover actions or decisions of the public entity when it is claimed that actions have caused some- one (the claimant) to suffer financialiv or that certain of their rights have been violated. I HAVE PROVIDED A BRIEF DESCRIPTION OF COVERAGE, THE POLICY SHOLLD BE CONSULTED AND READ FOR SPECIFIC LIMITS, CONDITIONS, ETC. 901JTHOLD SCFEDU-E OF I NSURANCE: 1 . CLAIMS: 4/10/86- Harold & Esther Woh! Article 78 - zoning ordinance 5/21/86- Pindar Vineyards Article 78 - Building Dept. 6/18/86- Kathleen Varano Article 78 - Zoning Board e /+7/86- Lo Stack Interior, Inc. Breach of Contract 7/30/86- Ron Mor izzo Builder, Inc. Breach of Contract 2. EXTENDED DISCOVERY PERIOD: $2,329 for each 12 month period - maximum of 36 months to excercise the extension: written notice to the company not later than 30 days after the effective date of non- renewal Va� 'Strp Sena, enc. .7nsurdnce 0 OCT 2; 1 1986 October 21, 1986 TOWN OF SOUTHOLD Town of Southold Main Road Southold, NY 11971 Attention: Town Board Dear Town Board Members: In response to your request during the Town Board meeting on October 6, 1986. 1) The Loss History for the Public Officials, Police Professional, Business Automobile and Package policies are attached. 2) The Business Auto and Package policy premiums for the term January 1, 1987 to January 1, 1988 could be increase 250. The Public Officials and Police Professional premiums for the renewal term can not be determined as this time. We will advise the Town Board as soon as the renewal premiums become known to us. Very truly yours, Valentine W. Stype, Jr. President VWS/jm 4 0pE55tON� Main Road Mattituck, N.Y. 11952 -PIA hswaia /naenr TELEPHONE: (516) 298-8481 w 2 GRANGE AC's r. ,.i >?�7it--- �S" Ci4... �...+.. y� ..w+ t s� •t.s -. � t��* �1�' � -T-�.3'--.;.���r ♦ 3.-•- a�"' •! !v` > J�k a f r•'r 'p•�''ti f, S ��,►� � a .. - .:'. i -�. d'TiR•,r' .L'Y .. .. .ns:rsKc' c at .:,i<4 S.(�..; t c.'"...� '�''Y"S�ISC i' :• x�* _":"' N"`.x3"Y�...7'.. '`` "t'.s 1 :�'• y14Y'•.`Yc +..� J�a.e t 1. fy ._.n 6 •+„�""'Cy rK �1' YT `• :c "'�' _ < �•:r��a +i�. ...: -+.:�,,.. �'�` .s -:;`.�, -..,,� 1LK' _`. i-f. -� 1=�Ps **��.�.�AN+�..`.��'i�Js;+ "”'-•}� a. .: �ER�"' .. -'dR"�•"r'�`.;,t�''I�-a,`���`"�'..F` .,•,�,� -- v"•- ..+. 4� 1✓ t w �t� y .� „sr.._•� �� '7•- r-� P -„�� /••�.3�.'v �.+•.�' � y. >yA..4, , - s � • �t-- �k- -�-ts t � ��� as.. K.c £ �+e1ay�� :,r'. sr .,k��,,,r- w.�_.`srw�Ti'7""r"r""�''`w► �}'lR�^9rar•.p�'sngd°+�.►+�:+.�vwl � r. •j�.�.t �7•-�a-�a-�„�f,+�a"�.�'re.� 'r ... .. .r,,.;. y+..�e .-ya ( •. � t �`,- -y`Y Z, .M. �' i 'e -�Y � .,etrY � - +•. ' -- a T•t.•- .. ♦ �.,t"'?-Y•.r,+Ot.ZN' a.:� :,�_ - .y..) -k , HT1.`- `•�.,Js•�'�'d_�_�??t�g+`t•_ •�: ..rr,SY.�,, -y,•'. ,,,r - .. tt .. -i',.! k -�•_ --C!`-t',... .�yy,.sts::� i.+4' x s'.s w r.;eti.. -- v '?"•Y r.�.+y -•-it s-�ii3r�!fir.►"t i�s>.�Y+ --•• 'Er . . .�.� , - - - �.a:.� .it • �� .:. r•'i. , ` f- - _ POLICY TO CLAIMS ;NQUIRYf �,"` sw PWK46 =QSE ENTER 3L I CY NUME-:r R P005-Z-3503 I N_'t 1REL' SOUTHOL:D f TOWN OF, CLF It". N1�'r.LER LOSS DaATC STATUS P i T''C TrTAL PAID TOTAL RESE_P,VFS u _k)CKJO :SJ43 02/%1/86 CLOSED 008 �C0 7-8 O In .&000^;,rc^'_S4 04/-10/86 CLOSED 0 L Q_ V'f.00of . .,-000,002:5475 12/14/85 018 4--e,C-0 r-16 O/'1 .x0000028336 . __ 07 i 3�!SS - CLOSED O1 c -.0000028566-'--4 08/04/8,6 - 073, - + <. --3�•�L..1af-•'�"�a •#` A� (F trsr .,;i✓ 1 -s n.,., +..`. siL. tib- .i s*e' ;• �{ =tr�.r. ��,._ �.. _. .mss:.�. -..y - .. _ sr. .�4 yam• +�'wtr"yri',V•,,�,r`^.��•".•fA.-.r H.i-�a.....-...�..>,.,. -� .. - - � •! ..- ._ ._ -. - .. r -�_ -_ fes'• .,. . - - • �� w•. - _ - ..i ��_�.n .�+tti �•y � Wit• V. .a_ PF1 N.ISC PF2 BILLING ,., PF3 ENDORSEMENTS PF4 NAMES rIt ADDRESSES PF5 ,ITEM PF6 `DRIVERS PF7 LOSSES - PF16 EXIT _ - PF9 NEXT 15 LOSSES F' PF10 PREM 'SIDE LOSSES - 15-IN NO MORE CLAIMS FOR THIS POLICY -� _•_ - VSTE:Session active _ ♦ �- J / - A a`.`-✓ ..., �'-?E7'� 2 _'i«4'' -aysf.�.ral:..s,<, - � n a 5, .. - . • 1_ �.. _ �.yi ''t>,.v``�,:� ter'' 3,_o-' x7. '- •.� ��� 111"' -._ .. . *•" ... .- _ 15161 299.9481 �* ` VAL STYPE & SONS. INC. INSURANCE CONSULTANTS iow t .i• :t :' : r�;.l'•�.�- ,f+ M t,�cr�.�_+7r ��,+,�,•�t'ZyN ���s.��f MAIN ROAD 3��r%....%+�M-'� '..r+'+'1 w"I7.•,vi"i y-n e MATTITUCK.N.Y.11952 fY�^H'� : ;•-Sr- r 3 e� i+� .� - " k VAL w.STYPE JR. 1 e l Vit:.':t -�i•..'[: :z t •.'�} bx E�` y�.wS i.Sr'`4„"�>re�"lJ"f�•`rYt�s'tt'�"��" � <` ;w i •�-}tpR'., � � t, �'7 z• f''s`M,;.+�Y E t,:r•.�-a,�.k.,� ,�+�,�i I,y. ,,y�,4*y `f'� ��; .L '�:[,,, -�`y4•� e-v- illa POLICY TO CLAIMS INQUIRY PWK48 ?LEASE ENTER POLICY NUMBER PLO600275 INSURED SOUTHOLD, TOWN OF P. D. CLAIM NUMBER LOSS DATE STATUS ADJ TOTAL P ID TOTAL RESERVES 0000025424 05/30/86 CLOSED 018 0000026234 03/24/86 CLOSED 031 r Q e0l�& &v l� T e it 4� y S vy� i'�(•� 00 00031083 06/01/86 CLOSED 018 Pie cc ��� �� AA I,e,ka-e-1 SGL Yk-� 0 h-j PF1 MISC PF2 BILLING PF3 ENDORSEMENTS PF4 NAMES & ADDRESSES PF5 ITEM PF6 DRIVERS PF7 LOSSES PF16 EXIT PF9 NEXT 15 LOSSES PF10 PREM SIDE LOSSES 015-IN NO MORE CLAIMS FOR THIS POLICY VSTE:Session active REDUESrOR-GINA S pgC,kci-5c po\2cJi POLICY NUMBER 002394469 POLICY YEAR 1985 INSURED SOUTHOLD,TOWN CONSOLIDATED AGT. 015115 - - --- ftsNe - r!:XP -O+4Tf-EiFt flA t M Rf� --A�C��iN#-Pr'^ AlT -- --BRANC-H- ----- NEW 01-01-85 01-01-86 06-01-86 06-02-86 5931 NOT IN USE KA 15115 STYPE & SONS I 73 MELVILLE PRNT 9I LMT PD LMT AUDIT EST-RPM M W/C G/L A/L APD 1/4 PRP FIRP 0TH MD C W/C G/L A/L APO I/M 'PRP BUR OTH -.__-----__-- _.._ __- ytMN• --- -_ U540-- Q5U9 �irfrlt 090976 ---�42— -------- OAP---O*P-612 -24 --- ****** PREMIUM AND LOSS SUMMARY ****** - L jt --A/g pEP/€�ftEidl-- At3fJ + E+vt STBiE�ri2id-PRS-RET-AIDJ —T4DT#A--- TW---- - 32 * 519260 49824- 46,9436 0 344 1 4 803 134, 644 1 36,6791 294.6 3_ * 279179 29460 294639 0 310993 93 4,086 13.9 6 w-0-71 0 ' .3aJ ter----4 .996 53 A 49501 4,501 O 62 A 7,834 79834 0 • GRAND T 901VA92 29364 889528 0 49337 19896 134,644 140,877 15901 --- ------ ----------- ---*-a:**4�k--CL-AI-#�-BET•ATL--**�k�*�-- LOCN PS CLAIM NO ACC-OT CLAIMANT NAME AS ML SL * PAID LOSSES PAID EXP RESERVES TOTAL INC 8888 97 3.1-259127-00 010285 KREIGER WELL PUMP85 31 33 35 1 19012.00 1,012.00 ----- -- - TOWN MOWE41--D"AGED GATE. YALY 88813 97 31-?49558-00 011595 COCKERHILL. EDYTHE81 31 32 31 1 55000 55000 CLMT TRIPPED*FELL OVER SLAB OF CEMENT —.--8$90-47-3 l 7v5-�►I LCE�IS�r-�E$9R AH$1-3 i'32 3t 1 4-W-788 935 1 f884---- 2 r78f3r35 - CLMT ALLEGES INJURY DUE TO NEGLIGENCE OF INSD 8989 97 31-251991-00 020385 OIACHUN RONALD 81 31 32 31 1 CWP --__ {L�+FT-+4LtE�iE�-FA{=5E-+4�R€ST4#4�4Lrr,nc non61�T1t�3N*#S5A1J1=T 8838 97 31-250005-00 020685 BORRILL DAVID 85 31 33 35 1 19128.02 19128.02 8888 97 31-250005-00 020685 BORRILL DAVID 85 31 33 35 1 19534,38 53000 1 ,587.38 0W AR0- r4N INSfl •�H-CL-£-AR Ifs-SN(;NF-C���I4E$-x+11 TL-MT-VEW 8881 97 31-250927-00 031385 GOHIER VIRGINIA 81 31 32 31 1 CWP CLMT TRIPPED*FELL ON SIDEWALK �-_ 8g9fi-97-31 -z'�5?2#4-90- 0*1413x9--!LF3V9-M-APT --- 9►.00 CLMT TRIPPED OVER RAISED SIDEWALK FELL*SUSTAINED INJURY 88.99 97 31-253982-00 051185 HAINPRIDGE KEITH 81 31 32 31 1 9000 162 171000 -AttE6E5-fMaURlf--flklE-Tt} �+FE6�I�.E�FCE OF--INSD ----- ---- --- __ - 88139 97 31-253163-00 061685 KOSSMANN PATRI CIA85 31 33 35 1 3.50 3.50 8688 97 31-25316'1-00 061685 KOSSMANN PATRICIA85 31 33 35 1 36.75 36.75 8 3-88-8GiKeSSMANN P Ti"-E IV STUCK IN FLOOD AREA 8888 97 31-?54499-00 070485 POYLE ROBERT 81 31 32 31 1 759489 75,489000 8808 -97� _ 70485- }YtE-R08ERT 81-31-32-31 1 _26.2©5 - -- 25,2©S.t)O --------------- -----_ 8f188 97 31-254499-02 070485 BOYLE RICHARD 81 31 32 31 1 259205 259205.00 CLMT HAD AMPUTATION OF PART OF LEG DUE TO 81)ATING ACCID rvuC3 C3 254311 00 011905 FeSTEP CHARJ=ES at :3i 32 3; CLMT WALKED INTO CHARCOAL FIRE PIT SRR8 97 31-257750-00 092795 £R TCSfIN A C 85 31 33 35 1 CW13 r X' .¢l♦ ; r T£?- aiELLTAIG 8888 97 31-258766-00 10.0185 LEVERF_TT JACK 81 31 32 31 1 5.50 5,050 59055.50 CLMT DIED AS A RESULT OF CAR ACCICJENT AI-r-FGES 'TOWN AT F -----J�5-#-31--32--31 - -28ge 40 - CLMT ALLEGES SHE TRIPPFO ON SIDEWAL X ---- 8888 97 31-259694-00 120?95 RAYNOR DAVID 85 31 33 35 1 ifE+tFROM NEWILY !!f� • CNA INSURANCE TIME 23.27. POLICY EXPERIENCE REPORT OATF 06/20/ PAGE REOUESTOR-GINA S POLICY NUMBER 002394469 POLICY YEAR 1985 INSURED SOUTHOLD,TOWN CONSOLIDATED AGT. 015115 — - -A l M-DET*TL -------------- - LOCN PS CLAIM NO ACC-DT CLAIMANT NAME AS ML SL 4 PAID LOSSES PAID EXP RESERVES TOTAL INC TOTAL ALL 33 LOSSES 3,992.61 93.25 4,085.86 TOTAL ALL LIAR LOSSES 4.336.61 1 ,896.10 134.644 140.876.71 . -A C-Ct)"T COUNT 15 -- -- -— - 8888 97 31-750253-00 020985 SOUTHOLD TOWNSHIP20 31 fit 30 1 CWP - -Gtid T ft 4 f+f-ttaf-tfP'_L flS T-t-9id T RE3L-S Ti2ttEiE---f EME NT--tii A tt ---- ------- -____-_-- --- ------------ _ _ _ TOTAL ALL FIRE LOSSES 1000 .00 ACCIDENT COUNT 1 GRAND TOTAL ALL 16 4,336.61 1 .996. 10 134,644 140.876.71 pnLICY FYDERIFNCF REp7PT DATE 09/21/86 PAGE 2 RE0UcFSTOR-0ILFK DCLjCY NUM9EP 001>027571 P!1LTCY YEAR 19A5 TNSORE7 SnUTHnLO,T'OWN CnNSOLiDATFO AGT, 015115 PSN. nc =FF nATF FXn IAT= FVL nATF Rt1N i1ATF DOOT ACCOUNT Mn AGEVT BRANCH r �0�7573 01-01-QS_ 01-01_-_R6 0R-01 -a6 n-F-'7-aF 4011 NIT IM JSP OI115STYmF 6 S9NS 1 730 MFLViLLE DONT RI LMT On LMT A')r)f T FST-RPM V W/C G/L A/L Apr) I/M PPP R+QP OTH MD C 4/C G/L A/L APO I/M ORP 9UR OTH ANN* 0500 0500 FINAL 042508 057 058 20 ##**** nP=MIUM AND L']SS SUMMARY *#**** LTNF AIS DFO/pnrM Alin p^FM STD/FAPN Por- OF=T ADJ/DTV On PAID LnSSFS OATI RFSF_PVES TOTAL TNC L/P --- 34 # 19,Q45 127 0.?3? 0 1590n0 3:i 15,033 74.3 35 # 11)99P14 105 1t , nR9 0 19f307 165 19972 17.8 AUTI T 30.929 397 319321 0 16.907 19i 17,005 54.3 _ 16 A 6,558 49C'i59 0 �-? A R 9 ?15 R, 2 15 n 4,11 57 495 1500 '34Y 7 T I9,773 129771 0 432 57 445 3.9 -RANI T7 4397!1? 44,'194 0 17,145 255 179500 39.7 ******** CLAIM nETATL ******** LOC V p5 rLAIM Mn ACC-11 CLAIMANT NAMF AS ML SL * OATn L^SSFS OAT7 7xP RESFPVES TnTAL INC RP99 07 31-749949-00 011IRS RAP.7Ar C.FORG= 31 35 37 1 1 50.00 19371 .4A '79A I, GRr1-SAT VFH SKT O LOLL TnF7 KITH TNS7 VFH RRRR 97 31-7G1501-nl 041725 KnCH =LI7APFTH 71 35 33 1 65.00 65.00 A89R 97 31-25150t-0? 0417115 KLIDM JASON 31 34 33 1 C1/O ASAR 47 31-?51501-03 041755 KOCH ELIZARFTH 31 34 33 1 159000.00 32.50 159032. .`'10 JASnN KLVFH ? f PflssF0 IN FRnNT nF VEH 1 CAUS TNG CnLLTSI RRRR 97 11 -X51174-11 070185 LFc JnHN I1 15 37 1 a64.SR 50.00 114.52 r'HFSTFP CMT NSI VEH RACKING Up STPUCK r-LMT VEH RRQ4 97 31-:54141-nn_ PLASKO L 31 35 17 1 720.53 220.63 CLMT ALLFGFS "nCK 'FFLL OFF INSD VEH RROKF WINOSHTFLO TITAL ALL 14 LnSSFS 159000.hn 32.50 15,032.50 TOTAL ALL 35 LnSS=S 19AOf1.69 155_.00 1,971._64 T'lTAI_ ALL AUTI L 'ISS'=S 16,816069 197.x,(1 170004. 19 ACCTDENT CnONT 4 BR44 o7 31-?51501-00 04t795 Sr1UTHILD TnWN IF ';1 37 33 1 418.45 56.50 494.95 JASON KSVFH ? CRnSSFD TN FONT 9F VEH 1 CALIFTNG CnLLTSi TnTAL ALL 35 LOSSES .no 000 TOTAL ALL 17 LISSFS 438.45 56.50 494.95 TgTAL ALL PLTY n LOSSF7S 419.45 56.50 494.95 AC:CTIFNT CnUNT 1 GRAND TOTAL ALL 5 179245.14 254. 00 17.494.14 --_� "' �- •,,� !� r r~4K 9A5 [NSURFp SOUTHOLD•TOWN CONSOLTnATFn AGT• 015115 I�1 p RrN. nc FrF DATE '--'XD DATE EVL nATF RUN DATE PRPT ACCnUN F w 7077�i71 O1-ni-Rf, nt-n/-q7 nA-01 -96 07-�7-,1T NO AGENT 9PANCH 6 4011 NOT IN USF AA 015115STYPF f, SONS I 730 MrLV[L_LF PR*7T RI LMT PD LMT AU')i T EST-RPM M W/C G/L A/L Aon I/M PRP IRP OTH MO C W/C G/L A/L ADD T!M PRP BUR CMH ANNA 0500 066?4p 09 3 0S � . 9 20 ***#** OPFMT'JM ANn LPrS SUMMARY ***s** LINT A/S nFn/-R�'•M 4Un = RFA! STn/rAF7N Pt:?- "r=- Ar),),-DTVr')!) DATn� LOSSES MAII RESERVES TOTAL IN': L/P i---- ------ - ? -- A --i n= " ---- 170717 0 35 4 6d7 4UTn T 47.019 9'710 t1 1 .770 193 1 .953 20.2 ?71 .770 1Q3 1 .Q53 7.2 . 47 n - -_ ----- It A fi. n4 5 3 -,?6 0 621 691 1g.6 37 4 in. lgfi 5.44?_ oHY 7 T ! h.? �1 9.468 6?1 10.5 19312 GRANT TD 63.25^ 1 .312 13.9 - 3h.84, 0 3,7139 197 3.275 A.9 I **** ##* -LAIM DETAIL _LnrN �5 CL ATM Nn ACC-IT CLAIMANT NAME AS ML SL * PAID LOSSES PAT^J EXP RES>=RVFS TOTAL INC gRR9 Q7 31-1>S901fi-00 010�ig5 Gt1LDSMTTH 31 35 331 9 9 1.73 60.50 1 •1152.23 ANn?FW C TN57 VE'H COLLinEn WITH CLMT VFH __-.- RP9q 97 31-��000c-n0 MOSH=RS SCgTT 31 35 33 1 2 -"-- -- --- _ 29 .41 613 00 7IGMUNn HFINS'a SNflVDLnW STPUCK QAPK'ED CUNT VEH 360.40 j 94RR 97 31-26009P-00 02?5g6 TUT HILL JEFFREY 31 35 33 1 b4•Sp PAUL f=nr"'LMT STP'JCK TNSn VFH 64.50 AEtgq 97 'fl-'352541•-nO n$;10`k6 WINTER HAT)gnrz FISHF 11 3c; 71 1 243.54 I J AHCLMT VFH WiNn'ZHTELr) tIAMA.G=n 9Y PrJCK �ALLTti'G OFF 243.54 TnTAL ALL 34 LISS--S TNS O •OO •OO TOTAL ALL 3r, LnSSFS 1 ,527.67 193.00 TOTAL ALL AUTn LnSS=S 1 .720.67 I C HENT Ptltl*iT 1.527.57 193.00 1 .720.67 -.�. AS4 i gRRg R7 on--�S777-�7 032A86 TNsn 31 37 3n 1 87.50 1%gRj 97 no--29277-6q 03249E TNSD87.50 -�1 17 gin_ 1 �a�.9� 345.85 _ ni TCF IN PURS�tIT �TRt1f.K TNTFNTIOR'ALLY qV OTHER VFH Q I 988q 97 00--?5?77-73 04?196 SOUTHJLD TOWN DILTC 31 37 33 ! 197.43 IV `1T T nV 187.43 j RaRR 17 n4?4g6 S(IUTHOLn TOWN vnl [C' 31 35 33 1 5gp,7q f TV HIT 7FFR 690.79 TITAL ALL 36 LCSSFS 69 n.79 •pn TOTAL ALL 37 LOSSES 600,7q -- - TnTAL ALL PHY D LOSSES .00 6?0.78 ACC T HENT CfaUNT 3 1 .311 .57 000 1 .311 .57 97 00--25277- 9 n2?lq6 MATTTT(.)CK GLASS m 31 35 31 f 741 . 89 STONE nPr%KE WTNnrTM 241 .88 ' TnTAL ALL 14 Lr1SS=S -- 1- TOTAL ALL 35 LnSScs .00 .00 TnTAL ALL AUTOLOSSES 241.89 •O0 241 .8+1 ACCTD241.88 .O0 FNT COUNT ' 1 241 .88 P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $ 5000 _ Carrier: Policy Period: Premium Payment Plan: Comments: B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Policy Period: Premium Payment Plan: Comments : C. Comprehensive General Liability a. First dollar coverage : b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage : C. Comprehensive General Liability Rating basis: Carrier: Premium Payment Plan: Comments: D. Automobile Insurance Limits - Rate per vehicle: Carrier: Policy Period: Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate Der 100 Exposure $ 500 Carrier: Policy Period: Premium Payment Plan: Comments : F. Umbrella Liability First $ 5,000,000: Next $ 5,000,000: Rating Basis : Carrier: F. Umbrella Liability Policy Period: Premium Payment Plan: Comments : G. Yacht Insurance Physical Damage - Deductible $ 500 Premium: Carrier: Policy Period: Comments: H.- Public Employee Blanket Bond Premium: Carrier: Policy Period: Comments: PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible: _ Name of Agent/Broker Street or P.O. Box City, State, and Zip Name of Person Completing Quotation Signature Title Date: o sano, C�o YOUR Jnsurance BUSINESS INSU:ZANCE PROGRAM ANALYSIS PRFYAFED FOR: TOWN OF SOUTHOLD MAIN ROAD SOUTrQLD, N.Y SUBMI 1 TTED BY: VAL STYPE JR. PIES I DEM VAL STYPE & SONS, INC. 10/07/86 NOTE: DESCRIPTIONS OF COVERAGE IN THIS PROPOSAL HAVE BEEN SIMPLIFIED AND ARE SUBJECT TO THE COVERAGE ACCEPTED AND THE EXACT POLICY TERMS. THIS OFFER EXPIRES IN NA DAYS. 4opE55ioN TPIA Main Road Mattituck, N.Y. 11952 �^^•�^ TELEPHONE: (516) 298-8481 m = �' ORANGE Ar-. SOUTHOLD SCHEDULE OF I NSLIRANCE: PUBLIC OFFICIALS LIABILITY $ONE MILLION LIMIT FOR EACH LOSS $ONE MILLION LIMIT FOR ANNUAL_ AGGREGATE $2,500 RETENTION (AMOUNT TO BE BORNE BY TOWN FOR EACH LOSS) $9,315 ANNUAL PREMIUM Public Officials Liability is designed to cover actions or decisions of the public entity when it is claimed that actions have caused some- one (the claimant) to suffer financially or that certain of their rights have been violated. I HAVE PROVIDED A BRIEF DESCRIPTION OF COVERAGE. THE POLICY SHOULD BE CONSULTED AND READ FOR SPECIFIC LIMITS, CONDITIONS, ETC. SOUTHOLD y SCFEDLLE OF I N5LRANCE: 1 . CLAIMS: _ 4/10/86- Harold & Esther Woh! Article 78 - zoning ordinance 5121/86- Pindar Vineyards Article 78 - Building Dept. 6/18/86- !Cathleen Varano Article 78 - Zoning Board 6/17/86- Lo Stack Interior, Inc. Breach of Contract 7/30/86- Ron Morizzo Builder, Inc. Breach of Contract 2. EXTENDED DISCOVERY PERIOD: $2,329 for each 12 month period - maximum of 36 months to excercise the extension: written notice to the company not later than 30 days after the effective date of non- renewal Rnco gnsurance FT t0e . 1 91986 October 21, 1986 TOWN OF SOUTHOLD Town of Southold Main Road Southold, NY 11971 Attention: Town Board Dear Town Board Members: In response to your request during the Town Board meeting on October 6, 1986. 1) The Loss History for the Public Officials, Police Professional, Business Automobile and Package policies are attached. 2) The Business Auto and Package policy premiums for the term January 1, 1987 to January 1, 1988 could be increase 250. The Public Officials and Police Professional premiums for the renewal term can not be determined as this time. We will advise the Town Board as soon as the renewal premiums become known to us. Very truly yours, - ALL f Valentine W. Stype, Jr. President VWS/jm F0FE5510 N7 1yamrr�4 Main Road MattituckGIEW , N.Y. 11952 �� TELEPHONE: (516) 298-8481 a 2 URANCE AGE s _•� L ya. ,�Ic ,s -- -•s. •- tr ��s?M��M�11�ti _ s•' ,y'� #• 'rlI•*-�'• � �r "' '.. - �[?11:+S7i, T.sr�fSSR:. ,r � •qT' r..s.. •Sv• aR-Rd +ra?•3r' +'•A"S� .. ,'� ..=•�•1 a: �. .- - '.Z•_ �M1> t`#il saa :T�_af�'�'.::3?s.'ti>?�rxL' '.R�.. 3w� rs. _r '•,� 'ri -�" .a '���.�,�x�..H•.iA.! :•y�_,� `i?" } .. �p� r' ,� i •yam• � r .-- r? 4a::1- ..F*y bf '•1" •�fi�i�V• tr'JL' � '"4 �+R 1 x I La ri �. -.rte ;s•. ��.� _r n,r ., �o��car•,;.Ka�..vey�^�"'�`L►.'rrz:�t �, rh�s�.'�-!� � `:r F'�. s+FJ'T 1��r� •��'�� -S�.�fi�ilnMtl�+� r e� W:4- � �ajrc•� .er ) ��- ,.0 _ '9N �4. f', �'T :Y�4y�/Z{?R�� }^�+ ) �'. ,..s:►,�:4- < sir -' �+.R'' y5•t'.' Y. - t-. �.iR i..i" a. - �3r ' � `_ sw w-:t a„J”�;, v -{�^f' 1r' c 1 ..' .: -.. .. ^-r2 _=�•.� �`-fPs y-..{.��'-�,;y�,]}y��n- s'• �'--�Y �'buicl-s��sa-.. .�a..•s:_ -�8"r'. .sF."'�"'r�`•1'k�fa���i "�. .R..S _ .V'" ,yr t!� 1✓.� � "Lf Yi�S�S p' ��: !� �yi✓ *- .rte "'�.-.. r_^4 P "«� -".Jxi�.- r•� . - , .. r�. s s: ♦ w•. >R^' r � '�,s�'a �� -- -+�•ts t r? r ?Ly.:s. rs.c ',res' t +c�+� � .. w �' _ 6 .• ;Cn.•.�d K. .ice +w-- •~ 3 ,� i .r.:�'y' ..:aY .,,.���•.'''�`*� .• :. 0.•... t. �Y,�a�ai1'i^r "kt�i►yyy°y�y}'y�y ,yyw� t ' vim;4 Z t '�+r- ..ar�..�h•Y•T�� a`:- rRr w.� r i - y a'___-+��y � � .. .. ..:.» -.t•'+. i•" .tr-?':�-s\.'N'�� 'C—.. �-. .. r ..r-mss`...� J1:c+ i.Ys`G♦jJ'et=a7'?ei.,-.wr.:.4r. -r- ; - r y '•''Ta'~ ?+ CiF tJ.l+:ti yx i. 'Lj.• ,. POLICY TO CLAIMS INQUIRY' '�_�x` � PWK48. =QSE EN ER r L_ icy NUM�:E R PO 5='35113 I N�t1R�:: SOUTHOLD, TOWN OF 2-LF IP" N:,:" 1sER LCSS DATE S*TUS aC T TC:TnL PAID TOTAL RESERV-F-3 _k)0,)Uu 19 4 , 02/21!86 CLOSED 008 b^ C-0!-8 on e�JCt���:1Fc'_34 04,/•1Q/86 - CLOSED Oac te.c-o" Oh -0000025475' 1Z/14/85 CLCr`_:,ED 018 }--CC-0r--d On .,0 000028336 07 i 3 !SG CLCS4b 01 C p h " 0000028566 t;I 0E3%44.86. IrLO:yED 0:32 }-� an •r'c .T t�.a S,.rt f..,,r �t" n ..sr �._„-�P \ -s�-ss., :►4 4 r R1 rr :T :_Irl a{v::.`.. R-•.-+, - .r: • t. . � �.. I� } T i y z- t � � � - _• .. ... �_ - R-��Y}. - - � -.� f -,. �. �1...+'. �,*1•�e•y -d =may;(.`..�k'� Y�� . -,e t PF1 NISC PF2 BILLING ` ,., PF3 ENDORSEMENTS PF4 NAMES i -ADDRESSES. PF5 ,ITEM ;:'FS -DRIVERS :`_ PF7 LOSSES PF16 EXIT - PF9 NEXT 15 LOSSES `.i: - PF10 PREM SIDE LOSSES 15-IN NO MORE CLAIMS FOR THIS POLICY - .- - VSTEsSession active -• I5181 298.0461 �—�—� _ .•_ :.rpt;:� VAL STYPE & SONS. INC. '� - - •tet Y�` INSURANCE CONSULTANTS �` .r<r^t - � .c t r'4��s• u- `�..T�-'.r�`�4'Y'"�+A!' ��tRn ��a15s..r _+, MAIN ROAD s ♦T`,2�-= sLtgv+7 :.. VAl W STYPE JR. MATTITUCK. N.Y. 11952 .. + s _* 1a+rte �< .'�► ` -�'�� _" x t `'1 .l.y(`` 4\�+a{�4�•^ ,_✓ S;„-Y..`�"-�x•'.!� •fns-�S� - 'r;' "ai. '�"�. ,t�Z+/�.^�r�.'����r=L S-. zt''�`a ., :7 t- r:r �.+-8',8.71= !4'P i� u •1 t��ti taR � +I_#� i- t*+vY �.�:a •{ y 11�Mn'e S\ .:-K }J-.� �lV��+W t `..� .F"�s. f•�•><-w _; !r :��`,�-l.?^...-:..i..A�5►t_. r-)^- t'� .+.'l '��L_ 1f �•'z 7•�;a a`f't: ryR,71�i"��• J: yt -'�- "yzr.n�i..�a'{.��` ��i•�aLeie!'•�.S��C. tet..?-s-,...�r'-'{i�j- 'r ,'•�iL} �.-� r Y F'WK48 POLICY TO CLAIMS INQUIRY "LEASE ENTER INSURED SOUTHOLD, TOWN OF P. D- DOLICY NUMBER PLO600275 TOTAL TOTAL RESERVES y �`S CLA I M NUMBER LOSS DATE STATUS ADJ F' I D o d 05/30/86 CLOSED ��18 , `� T 2 1' �' S v� i���00025424 CLOSED b31 {'2� �� 0.1 0 hc� �ic�i 0026234 03/24/86 t i 18 Y`Q LO h d t,�� AA�,c�a S c�i� �UC�31083 06/01/86 CLOSED ENDORSEMENTS PF4 NAMES R ADDRESSES PF1 MISC PF6 BILLING PF`' ENDORSEMENTS LOSSES PF5 ITEM F'F6 DRIVERS PF10 PREM SIDE LOSSES PFIG EXIT PF9 NEXT 15 LOSSES 015-IN NO MORE CLAIMS FOR THIS POLICY VSTE:Session active rt� Wut_ � iUl<-b1NA S pgc,k'.-wyc pO�tW POLICY NUMBER 002394469 POLICY YEAR 1985 INSURED SOUTHOLD,TOWN CONSOLIDATED AGT. 015115 - - ------ --R ei:- --EFF-fyAT-F-FXP--"TE EVt flAfi�-RUN ATE P9PT-AC-C`0tPNT-NG--A(;F#4T -- -6ftANCH- --------NEW 01-01-A5 01-01-86 06-01-86 06-02-36 5931 NOT IN USE KA 15115 STYPE E SONS I 73 MEL.VILLE PRNT 9I LMT PO LMT AUDIT EST-PPM M W/C G/L A/L APD I/M PRP RRP 0TH MD C W/C G/L A/L APO I/M PRP BUR OTH -----___. -- -.-- -ANN* -- - -0500------0500 F itdA1 090076- -942 -- 442--{T4�-4�2 --20 ****** PREMIUM AND LOSS SUMMARY *##*** . -------L T�vf --A>S--4EP/�Ei1----Atf+J--�v�-ST-9tE�-Ri�l-#SRF--i2E-T--,kBd-lilt-V--f►c�--f>A Tf�-tt3SSE-S------P+�I-f1--R£SE�1fE5--�F'1TA} .- TI:C' --- -L/R --- - -_ 32 * 519260 4. 824- 4694361 O 344 1 ,803 134, 644 136,791 294,6 33 # 279179 2.460 29,639 0 39993 93 49086 13.8 -- -- --- --tfAB- -T--785434 --2r 364 ---76x47'- 0 -av337- —1-x-89.6--=-34.�4�---��Q.8-77-- 53 A 40501 4.501 0 62 A 7,834 7x834 0 - —-S fr----A ----f#8 GRAND T 90,892 2-P364- 884528 0 49337 19896 1 34,644 1 40,87'7 159. 1 -- ------ --------- -�-t..�*a*�4--CL-AT-M--DET-Af1--**�*�*�-- -------- --- _ LOCN PS CLAIM NO ACC-DT CLAIMANT NAME AS ML SL * PAID LOSSES PAID EXP RESERVES TOTAL THC 8888 97 3.1-259127-00 010285 KREIGER WELL PUMP85 31 33 35 t 10012.00 1, 012.00 8889 97 31-?49558-00 011595 COCKERHILL EDYTHE81 31 32 31 1 55.00 55.00 CLMT TRIPPED*FELL OVER SLAB OF CEMENT 9-E4-a785 }-s -1 88. 35 I.-09O- -2*789.35 CLMT ALLEGES INJURY DUE TO NEGLIGENCE OF INSD 8981 97 31-251991-00 020385 OTACHUN RONALD 81 31 32 31 1 CWP --CL�4T-+4L�E6ES-FALSE-AP4:4EST-*44AL-T-C-*-^" - O&E46l)-T-I0N*ASSAiJLs 8993 97 31-25000+-00 020685 BORRILL DAVID 85 31 33 35 1 1 ,128.02 19128.02 8889 97 31-250005-00 020685 90RRILL DAVID 85 31 33 35 1 19534.38 53. 00 19587,38 O-W AP � AN 1N SE) ii£tf-EL£#T T f�16-5Nf3M1-CSL-L-T 4)E$-W I-TH-FL44T-VEH - 8881 97 31-250927-00 031385 GOHIER VIRGINIA 81 31 32 31 1 CMP CLMT TRIPPED*FELL ON SIDEWALK _-�-----899f3-47-33-2i22*4-84--04}�35--��O3Y9-+�FAf�T E ,.aO-- ---- -- - -- ----------- 95.00 CLMT TRIPPED OVER RAISED SIDEWALK FELL*SUSTAIN£O INJURY 8849 97 31-253982-00 051185 SAINPRIDGE KEITH 81 31 32 31 1 9.00 162 171 .00 L-f+FT--AL.L-E-GES-INJURY---DUL=- Tf} �lE6L RENEE-9F--ItI�D 8899 97 31-253163-00 061615 KOSSMANN PATRICIASS 31 33 35 1 3.50 3.50 8889 97 31-253163-00 061685 KOSSMANN PATRICIA85 31 33 35 1 36.75 36.75 -223,21-- IV STUCK IN FLOOD AREA 8888 97 31-?54499-00 070485 POYLE ROBERT 81 31 32 31 1 75.489 75,499. 00 98'3f1-47-3t— #��t9--91-O7flr185-9QYtE-f2f3B£flT26.205- --25,205.00 -- --- - 8888 97 31-254499-02 070485 BOYLE RICHARD 81 31 32 31 1 25,205 25,205.00 CLMT HAD AMPUTATION OF PART OF LEG DUE TO BOATING ACCID 63 3�r -- CLMT WALKED INTO CHARCOAL FIRE PIT H9R8 97 31-257750-00 092785 f=R ICSgN A C 85 31 33 35 1 cwo .—..a.....►+ aw..w.�eeaem e i e e � 37 i i�Jns'�' 1�.�� --- ---_ E--tAiiSEf) TOWN Tf2EE -Tfl-�ALt-£3N-WURFS- -T{?- DWELLT#G-- ------ $1988 97 31-258766-00 100185 LEVERF_TT JACK 81 31 32 31 1 5050 50050 50055050 CLMT OtED AS A PESVLT OF CAR ACCIDENT AL._FGE5 'TOWN AT F — - - --- -- - 8aAt3 -07 31-�i-iii157-n0 -t t t4q- i -RflSr---EL f?A£U=T-4. ----- 2890 00 CLMT ALLEGFS SHE TRIPPED) ON SIDEWALK 6888 97 31-259694-00 120?95 RAYNOR DAVID 85 31 33 35 1 CWP V --iFROM NEWf=V �t�4 f3-R£3A�------ - ----------- ---- CNA INSURANCE TIME 23.27. POLICY EXPERIENCE REPORT DATF 06/20/ PAGE REQUESTOQ-GINA S POLICY NUMBER 002394469 POLICY YEAR 1995 INSURED SOUTHOLD*TOMN CONSOLIDATED AGT. 015115 �1Hr4-$ET*T�-#tM/e�hki # -------- - ------- ----- - LOCN PS CLAIM NO ACC-DT CLAIMANT NAME AS ML SL * PAID LOSSES PAID EXP RESERVES TOTAL INC -----------TOTAL—ALL-- 211 1sSE3 34 .06 ---}.-$f>2085- - -134,6411 -1-36,7900 85 TOTAL ALL 33 LOSSES 3,992. 61 93025 4.085086 TOTAL ALL LIAR LOSSES 4.336.61 1 .896*10 1340644 1400876071 -At-cf'Jt<MT-C8UN I YDS—-- - - --- --- 8888 97 31-?50253-00 020985 SOUTHOLD TOWNSHIP20 31 62 30 1 CNP -------------- -m T-R 4 C-K I t4G-MR-L OS T-C UN T ROIL­S Ti?UE-K-C EME N T-W A tt --- --- —---------- -------_ ____ TOTAL ALL FIRE LOSSES 1.00 000 ACCIDENT COUNT i ti - GRAND TOTAL ALL 16 40336061 1 .896010 134.644 140.876071 PAGE ? REOUc�STOR-0ILFK ODLI CY NUM9EO 002027573 PILTCY YEAR 1995 INSURED SnUTHILD,I'OMN CINSOLIOATF0 AGT, 015115 P=Nl nc cPF "ATF FXn JATF FVL OATS= Rt7N (1gTF POOT ACCOUNT Nn AGEVT ARANCH �OnTti73 01-01-as_ O1_ O1_-a6 OR-01_-R6 0--77-_a6 401_1 _NIT TN JSP 01 `;115STYoF G 514S_I_7_30_M_FLV[LLE_ PONT RI LMT Pn LMT A')'1T T EST-RPM V w/C G/L A/L Aon I/M PPP RRP OTH Nn C A/C G/L A/L APO I/M ORP 9UR OTH ANN 0500 0500 FINAL 042c,08 057 OF8 20 **** * nRcMIUM RNn LrJSS SUMMARY *#**** L.TNF_ AIS 7Fo/30rM ALM STn/FAPN POE OST AOJ/nIV Pn PAID LOSSES OAl PESF_PVES TOTAL INC L/P 19.04, aq7 '>0• ?320 159000 73 1 +•033 74w3 35 a 11.994 105 119 ')99 N 0 t ,907 165 11972 17.8 AUT7 T 30.429 39? 31. 321 0 16.807 109 179005 5403 _ -4 Is A 4,1c;Ci9 4,55$3 0 -47 A 9. 71 ri R,215 0 4719 57 495 5.0 ,"3HY 7 T 1 7•773 1 2,77-1 0 43A 57 445 30q RAN'1 T7 39 440 '194 0 17• 45 255 17.500 3907 ##**#**# CLAIM OFTATL ****#*** Lt1CV OS CLAN NO ACC-7T CLAIMANT NAME AS ML SL * PATn L^SSPS AAT9 cXP RESFwVFS TOTAL INC RP913 97 31-249999-00 01 71 '15 R.APZAr C:FIR G= 31 35 3? 1 1 •3''1 .49 50.00 1 9371 04A r'4AT(, GR(-1-'AT V=H RKTO COLLTnF7 WITH TNc7 VFH 9>a99 97 0417Rc; KnCH CLY749PTH 3t 35 3-4 1 65.00 65000 A89q 47 31-251501-rt2 041765 KLIDM JASON 31 34 33 1 CWP A9R9 97 31-?51501-03 04IT19 KOCH ELTZARFTH 31 34 33 1 159000000 32.SO 15.032050 JASnN KLVFH 2 7Pf)SSFn IN FPnNT nF VEH 1 CAUS TNG CnLLTST 9QR9 47 0701 15 LFF JOHN 71 35 37 1 a64.5R 50000 �14.Ci9 rHFSTFc? qNT NSI VC=H RACKING UO STPUCK CLMT V-H RRQ9 97 31 -754141-nrl_17-3g5 PLASKO l_ 31 313 77 1 X20063 227063 CLMT ALLFGFS PICK FELL OFF IVSD VEH RROKF WINDSHIELD -� TI TAL ALL 14 LnSSFS 15.000000 32.50 15.032050 TPTAL-ALL 35 LPSS Fq 11106469 155.00 1.9710_64 T'ITAI- ALL AUTI L7SS''S 1 $1.80$3.69 197050 17.004. 19 ACCTIFNT cnUNT 4 6599 47 3l-?51501-00 041795 SnIlTMIL0 TOWN IF '=1 37 33 1 4?8045 96.ri0 494095 ti JASON KSVFH 2 CRnSSFD IN FPONT 'OF VEH 1 CAUSING COLLTSI TnTAL ALL 35 L')SSFS 000 . 00 TOTAL ALL 77 LOSSES 4313045 56.50 494.95 TOTAL ALL n%4Y n LOSSES 438.45 56.50 494.95 ACCT7FNT CnIJNT 1 G9ANI TOTAL ALL 5 1792493014 254. 00 17.494.14 Pr-N� nc FCF DATE FXP DATE FVL DATE PUN DATE PRPT ACCnUNT NO AGENT 9RANCH Q"�w'� X077577 01-01 -R6 nl-nt -a7 nR-01 -96 07-->7-164011 NOT TN USE AA O15l1SSTYPF f, SONS 1730 MFLVTLLF PRAfT RI LMT PD LMT AU'lt T QST-RPM M N/C G/L A1L AD n I/M PRP IRP OTH MD C W/C G/L A/L ADD I/M DRP BUR OTH , 066240 093 059 20 i ANN• 0500 . ! fr#*#** nRFMTtJM ANn LT`--S SUMM4r>Y *#***# LINE 4/S DFn/3Pv-.4 AUD '-v9Fkq ST'1/VrAPN P4� nFT An.1/DTV nD DAIn LOSSES 0A I ) RESERVES TnTAL tN' L/p --- ?4 0 ----- --- --- i---- ----- -'�5-- A I �,��n7 -- - g.�tO 0 1 ,770 193 1 .453 20.2 i 4UTr) T 47.^19 ?_7, 4.--7 n 1 .770 1Q3 19063 7.2 A 6, n45 300;?6 0 501 691 1 Q.b --- -- 5.44?_ 0 621 671 17.5 37 A IIN, IBs, 1 ,9317 1 ,712 17.q nHtV 7 T n,46A n 3,'lti� 197 3,275 R.9 GRAN') Tn 63,2Fr' -36. 94`i ##*# *## #'L A I M DETAIL 1nr'N 0S CLATN Nn ACC-DT CLATM_ANT NAME AS ML SL * PATD LOSSES PATI EXP RESERVES TOTAL INC i gppq 97 31-7ri�Ol�,-00 3109R6 GnLDSMT TH 31 35 33 1 991.73 60.50 1 ,A52.23 AND??FW C TNS') VEH COLLTler) WTTH CLMT VFH aQ9a 97 �� G-n0 070a9� MOSH-RS SCnTT 71 75 33 1 29?.4O F9.00 360.40 ' 31- O�0 _._---- - i - 7IGMUNL� HFTN57 SNnWOLnM STDUCK PAPKED CLMT VEH 9989 97 31-26q n9R-00 02?5a6 TUTHILL JFFF4EY 31 35 13 1 64.50 64.50 i DIUL FnPLMT STUCK TNSn VFH PnnR FTSHF 31 -;F 77 1 243.54 243.54 aa99 3 97 1-?6?541--n0 n�1096 wINTEa HA . J RHCLMT VPH WIN7SHTEL') nfkMAG-f) 9Y POCK VrALLTNG n=F TNS .00 .00 -- TnTAL ALL -A4- L'ISSES 1 ,720.67 TOTAL ALL 35 L!lSSES 1 •527.67 1 43.00 1,5?7.67 193.00 1 ,720.67 TOTAL ALL AUTO` LnSS=S A r nFNT CMINT 4 i �1 37 3n 1 97.50 87.50 gRa9 17 A86 1NSD 7l 37 io 1 345.99 345.R5 98x9 q7 00--?_5.277-6a 03?4Q6 INSO _ _. onL TCF IN PURSO)IT gTRl1CK TNTFNTIOn'ALLY qY OTHER VEH 9889 Q7 00--25177-73 04?1916 SnUTHJLD TOWN DIL IC 31 't7 33 1 197.43 1A7.43 TV HIT nV 690.79 aQaq q7 On--?5��7-75 n4?496 ;OUTHOLn TOWN POLTC 31 35 33 1 500.79 TV HTT OFFP 600.70 TIT_AL ALL :36 LL'S Sa'S F.r�D.70 .On - --6?0.78 - F?0.78 .00 TOTAL ALL 37 L0'; 1 .311 .57 L TnTAL ALL PHY r) LOSSES 1 .311 .57 .00 ACCTDENT Cn0NT 3 97 00--?5277-5Q n2?lq6 M4TTTTUCK GLASS M 31 35 33 l ?41 .x9 241 .88 STONE nn^KE WTNnnM _. L .00 .00 TnTAL ALL 74 LrISSFS 241 .89 on T41 *SIR TnTAL ALL 35 Lf'SSFS 241 *S3 TnTAL ALL AUTO LOSSES 241.99 .00 ACCIOFNT COUNT 1 IANURAAIaESAar CNAA Insurance Companies ENCOMPASS SERIEO A Plaza 1 f hicago, Illinois 60685 SECTION DECLARATIONS INSURANCE IS PROVIDED BY THE COMPANY DESIGNATED BELOW (A stock insurance company, herein called the company) 1 Producer No. Branch Prefix Policy Number 015115 1, 732 IP 30 239 44 69 1-1 Continental Casualty Company NAMED INSURED&ADDRESS:(No.,Street,Town,County,State,Zip) ❑ National Fire Insurance Company of Hartford Southold Township Main Street ❑ American Casualty Company of Reading, Pa. Southold, Suffolk Co. , NY 11971 ❑ Transportation Insurance Company The Business of the Named Insured is Municipality Policy Period: AT NOON (STANDARD TIME) JINSURED IS: ❑ Individual ❑ Corporation ❑ Partnership AT THE ATION 01/01/85 To 0./01/88 PREMSESONVOLVEDFTHE ❑ Joint Venture W1 Other:Municipality 2 Insurance is provided in accordance with the following schedule of coverages. No coverage is provided for anyPart of this policy unless a limit of liability or the word "included" is shown for such Part. Schedule a. Part I Damage to Property/Business Earnings D See Separate Schedule Item Description and Location of Property Covered Limit of Liability Building(s) Contents Business Earnings see form G39226B b. %=Coinsurance Clause; %ML = Monthly Limit Clause; ❑ % ❑ % ❑ %ML AA=Agreed Amount Clause I[] AA ❑ AA ❑ AA C. Part 1 Property Deductible Amount: ❑ $100: K] $ 500.00 d. MORTGAGE CLAUSE: Subject to the provisions of the Mortgage Clause in Part I of this policy, Loss(if any) on building items under Part I shall be payable to: (insert name, address and item number) N/A e. Part 11 Comprehensive General Liability Per Occurrence Aggregate Combined Limits of Liability $ 500,000.00 $ 500,000.00 Optional Liability Extensions: Only those coverages where an ®appears are included. Except as otherwise indicated the Comprehensive General Liability limits apply. ®Medical Payments ($1,000 Per Person, unless otherwise indicated) $ - Per Person ®Fire Legal Liability ($50,000 per occurrence, unless otherwise indicated) $ - Per Occurrence ®Personal Injury (the above aggregate applies, unless otherwise indicated) $ — Aggregate ®Blanket Contractual ®Broad Form Property Damage See Part II for any other coverages and limits of liability which may be afforded. f. Part III Crime and Part IV Boiler and Machinery: See Part III and IV for Coverage and Limits 3. Forms and Endorsements made part of this policy at time of issue include: (Insert number and suffix) G39200D, G39282E99, G39224C, G39229C, (339226B,-G- A, G30454C, G53251A, G39250C, G392 8B31, G 8211A31, G392 5A, G3 B, G Provisional Premium is $ and is payable $ go.000,00 at inception, and $ 0 at each anniversary. The premium for installments subsequent to the initial installment shall be subject to adjustment on the basis of the rates in effect at each anniversary date, unless indicated by an X in the box. ❑ NOT APPLICABLE New York State Fire Insurance fee $76.17 (annual) This policy shall not be valid unless countcrsigned by a duly authorized agent of this Company. Cou.rtersigned by (IJ- 4 Chairman of the Board Corporate Secretary Authorized Age tl G-39201-C ' ENCOMPASS SERIES � civa For All the Commitments You MakO POLICY CONDITIONS THE FOLLOWING CONDITIONS APPLY TO ALL PARTS OF THE POLICY A. TIME OF INCEPTION: To the extent that coverage sured. The Company may cancel this policy at in this policy replaces coverage in other policies any time by mailing to the Insured and to any terminating at 12:01 A.M. (Standard Time) on the mortgagee designated in this policy at any time inception date of this policy, this policy shall be by mailing to the Insured and to any mortgagee effective at 12:01 A.M. (Standard Time) instead designated in this policy at the last address of at Noon (Standard Time). known to the Company-or its agent at least a 60 Special State Provisions; California, Florida, Or- day notice of cancellation. If the premium is not egon and Washington: All coverages in this pol- paid when due, the Company will mail at least a icy shall be effective at 12:01 A.M. (Standard 10 day notice of cancellation. Time). If the Insured cancels, earned premium shall be B. INSURANCE UNDER MORE THAN ONE PART: In the computed in accordance with the customary event that more than one Part of this policy cov- short rate table and procedure. If the company ers the same loss,damage or claim,the Company cancels, earned premium shall be computed pro shall not, under any circumstances, be liable for rata. Premium adjustment may be made either at more than the actual loss, damage or claim sus- the time cancellation is effective or as soon as tained by the Insured. practicable after cancellation becomes effective, C. CONFORMITY WITH STATUTE: The terms of this but payment or tender of unearned premium is policy and forms attached hereto which are in not a condition of cancellation. conflict with the statutes of the state wherein F. LIBERALIZATION CLAUSE: If during the period that this policy is issued are hereby amended to con- insurance is in force under this policy, or within form to such statutes. forty-five days prior to the inception date thereof, D. PREMIUM: All premiums for this insurance shall on behalf of this Company there be adopted, or Cbe computed in accordance with the Company's filed with and approved or accepted by the In- rules, rates and rating pians, applicable to the surance Supervisory Authorities, all in confor- insurance afforded. mity with the law, any changes in the form at- tached to this policy by which this form of in- If this policy is issued for a period in excess of surance could be extended or broadened without one year with a specified expiration date and a increased premium charge by endorsement or premium is payable at each anniversary, such substitution of form, then such extended or premium shall be determined annually on the broadened insurance shall inure to the benefit of basis of the rates in effect at the anniversary the Insured as though such endorsement or sub- date. stitution of form had been made. Premium designated in this policy as "provi- G. CONCEALMENT—FRAUD: This entire policy shall sional premium" is a deposit premium only which be void if, whether before or after a loss, the shall be credited to the amount of the earned Insured has willfully concealed or misrepre- premium due at the end of the policy period. At sented any material fact or circumstance con- the close of each annual period, or part thereof cerning this insurance or the subject thereof or terminating with the end of the policy period, the the interest of the Insured therein, or in the case I earned premium shall be computed for such pe- of any fraud or false swearing by the Insured I riod and, upon notice thereof to the Named In- relating thereto. sured, shall become due and payable. If the total H. INSPECTION AND AUDIT: The Company shall be earned premium for the policy period is less than Permitted but not obligated to inspect the Named the premium previously paid, the Company shall rInsured's property and operations at any time. return to the Named Insured the unearned por- Neither the Company's right to make inspections tion. nor the making thereof nor any report thereon The Named Insured shall maintain records of shall constitute an undertaking, on behalf of or such information as is necessary for premium for the benefit of the Named Insured or others, computation, and shall send copies of such rec- to determine or warrant that property or opera- ords to the Company at the end of the policy tions are safe or healthful, or are in compliance period and at such times during the policy period with any law, rule or regulation. as the Company may direct. The Company may examine and audit the Named E. CANCELLATION OF POLICY: This policy may be Insured's books and records at any time during cancelled at any time at the request of the In- the policy period and extensions thereof and G-39200-D Page 1 of 11 Pages • • 1` within three years after the final termination of guards as are set forth by endorsement hereto. this policy, as far as they relate to the subject Failure to maintain such protective safeguards matter of this insurance. shall suspend this insurance, only as respects 1. DECLARATIONS: By acceptance of this policy,the the location or situation affected, for the time of Named Insured agreesthatthe statements in the such discontinuance. Declarations are his agreements and represen- M. NOTICE TO INSURED: If more than one Insured is tations,that this policy is issued in reliance upon named in the Declarations, the Insured first the truth of such representations and that this named shall act for itself and for every other policy embodies all agreements existing be- Insured for all purposes of this policy. Knowl- tween himself and the Company or any of its edge possessed by an Insured shall, for the pur- agents relating to this insurance. poses of this policy, constitute knowledge pos- J. CHANGES: Notice to any agent or knowledge pos- sessed by every Insured. Cancellation of this sessed by any agent or by any other person shall policy by, or through notice to, the Insured first not effect a waiver or a change in any Part of this named shall be cancellation of this policy with policy or estop the Company from asserting any respect to every Insured. right under the terms of this policy; nor shall the terms of this policy be waived or changed,except N. FAILURE TO RENEW: If the Company has offered by endorsement: issued to form a part of this to renew this policy and the Named Insured has policy. accepted the offer of renewal, but the renewal K. SPECIAL DEFINITIONS, has not been issued to the Named Insured prior 1. Wherever in any form attached the word "pol- to the expiration date, then this policy shall con- icy" appears it shall mean the Part of this tinue in full force and effect as though renewed policy to which such form applies. from the date of expiration until replaced by a renewal certificate or policy but in no event to 2. Wherever in any form attached the words"ad- exceed 12 months from the date of expiration vance premium" appear, they shall mean stated in the Declarations or in a renewal en- "provisional premium" as set forth in item D. dlorsement attached to this policy. Premium for Premium above. this extension shall be computed in accordance L. PROTECTIVE SAFEGUARDS: It is a condition of with the rules and rates contained in the Com- this insurance that the Insured shall maintain so pany's manual at the date of such expiration of far as is within This control such protective safe- this policy. THE FOLLOWING CONDITIONS APPLY TO PART I A. WAR RISK EXCLUSION: This Part shall not apply reaction or nuclear radiation or radioactive Ion- to loss caused, directly or indirectly, by or due tamination, all whether controlled or uncon- to any act or condition incident to the following: trolled. Loss by nuclear reaction or nuclear ra- t. Hostile or vvarlikE� action in time of peace or diation or radioactive contamination is not war, including action in hindering, combating intended to be and is not insured against by this or defending against an actual, impending or Part, whether such loss be direct or indirect, expected attack, (a) by any government or proximate or remote, or be in whole or in part sovereign power (de jure or de facto), or by caused by,contributed to,or aggravated by"fire" any authority maintaining, or using military„ or any other perils insured against by this Part. naval or air forces; or (b) by military, naval or Subject to the foregoing and all provisions of this air forces; or (c) by an agent of any such policy,direct loss by fire resulting from nuclear government, power, authority or forces, 'it reaction or nuclear radiation or radioactive con- being understood that any discharge, explo- lamination is insured against by this Part. sion or use of any weapon of war employing C. (NUCLEAR EXCLUSION: Loss by nuclear reaction nuclear fission or fusion shall be conclusively or nuclear radiation or radioactive contamination, presumed to be such a hostile or warlike ac- all whether controlled or uncontrolled, or due to tion by such a government, power, authority any act or condition incident to any of the fore- or forces; going is not insured against by this Part, whether 2. Insurrection, rebellion, revolution, civil war, such loss be direct or indirect, proximate or re- usurped power, or action taken by govern- mote, or be in whole or in part caused by, con- ment authority in hindering, combating or de- tributed to, or aggravated by any of the perils fending against such an occurrence; seizure insured against by this Part; and nuclear reaction or destruction under quarantine or customs' or nuclear radiation or radioactive contamination, regulations, confiscation by order of any gov- all whether controlled or uncontrolled, is not "ex- • ernment or public authority, or risks of con- plosion" or "smoke." This clapse applies to all traband or illegal transportation or trade. perils insured against hereunder except the per- B. NUCLEAR CLAUSE: The word "fire" in this Part is ils of fire and lightning, which are otherwise pro- not intended to and does not embrace nuclear vided for in the Nuclear Clause above. Page 2 of l l Pages D. NO BENEFIT TO BAILEE: This insurance shall in the limit of liability for all contributing insurance no way inure directly or indirectly to the benefit applicable to the property involved at the time ® of any carrier or other bailee for hire. such loss occurs, no special inventory or ap- o. ASSIGNMENT: This policy shall be void if as- praisement of the undamaged property shall be signed or transferred without the written consent required providing that nothing herein shall be of the Company. construed to waive the application of the first F. CONDITIONS: paragraph of this clause. 1. In the event of loss, permission is granted for If insurance under Part I of this policy is divided the Insured to make reasonable repairs, tem- into separate limits of liability,the foregoing shall porary or permanent, provided such repairs apply separately to the property covered under are confined solely to the protection of the each such limit of liability. property from further damage, and provided If this insurance is written on a reporting basis, further that the Insured shall keep an accu- the foregoing Coinsurance Clause does not apply rate record of such repair expenditures. The and is replaced by the applicable reporting form " cost of any such repairs directly attributable provisions. to damage by any peril insured hereunder As respects the State of Florida, the rate charged shall be included in determining the amount in this policy is based upon the use of this Coin- of loss. Nothing herein contained is intended surance Clause, with the consent of the Insured. to modify the policy requirements applicable J. AGREED AMOUNT CONDITIONS: If the Declara- in case loss occurs, and the Insured shall tions Part I Damage to Property/Business Earn- protect the property from further damage. ings Schedule specify "agreed amount," the fol- 2. Permission is hereby granted for such un- lowing conditions apply: occupancy as is usual or incidental to the Subject to all the conditions and stipulations oth- described occupancy. erwise applicable to Part I, the "Coinsurance 3. Permission is hereby granted for such use of Clause" in this policy is suspended and replaced the premises as is usual and incidental to the by the following: occupancy and to keep and use all materials 1. With respect only to the items specified in in such quantities as are usual and incidental the Declarations Part I Damage to Property/ to such occupancy. Business Earnings Schedule, as being sub- G. NO CONTROL: This insurance shall not be prej- ject to these "agreed amount" provisions, it i� udiced: is made a condition of this insurance that the 1. By any act or neglect of the owner of any application of the "Coinsurance Clause" is building if the Insured is not the owner suspended in determination of loss caused thereof, or by any act or neglect of any oc- by the perils insured against occurring after cupant (other than the Insured) of any build- the inception date of this policy or endorse- ing, when such act or neglect of the owner ment attaching these "agreed amount" Con- or occupant is not within the control of the ditions. Insured, or 2. If this policy is renewed by endorsement, 2. By failure of the Insured to comply with any these "agreed amount" conditions shall not warranty or condition contained in any form apply unless "agreed amount" is shown on or endorsement attached to this policy with the renewal endorsement as applying to the regard to any portion of the premises over renewal. which the Insured has no control. K. LIMITS OF LIABILITY AND DEDUCTIBLE: This Com- H. POLICY PERIOD, TERRITORY: This Part applies pany shall not be liable: only to loss to property during the policy period 1. for more than the limits shown on the Dec- while such property is within the 50 states of the larations Part I Damage to Property/Business United States of America, the District of Colum- Earnings Schedule; nor bia or the Commonwealth of Puerto Rico. 2. for the amount of any deductible shown in I. COINSURANCE CLAUSE: The Company shall not Section 2 of the Declarations Part I Property/ be liable for a greater proportion of any loss to Business Earnings Schedule, applying sepa- the property covered than the limit of liability rately to each occurrence. Windstorm or hail under this Part for such property bears to the losses occurring at separate locations in the amount produced by multiplying the coinsurance course of a single storm shall be considered percentage stated in the Declarations by the total a single occurrence. value of the insured property determined by the L. WHAT TO DO WHEN LOSS OCCURS: same method of valuation used to establish the amount of the loss. 1. The Insured shall as soon as practicable re- port to this Company or its agent every loss In the event that the aggregate claim for any loss or damage which may become a claim here is both less than $10,000 and less than 5% of Page 3 of 11 Pages under and also report such loss or damage to and loss at the office of this Company. No the police if such is a result of violation of the loss shall be paid hereunder if the Insured law and shall also file with the Company or has collected the same from others; its agent within 90 days from the date of loss 9. If the Insured and the Company fail to agree ` a detailed sworn proof of loss. Failure by the as to the amount of loss, each shall, on the Insured to report the loss or damage and to written demand of either, made within 60 days file such sworn proof of loss as required shall after receipt of proof of loss by the Company, invalidate any claim hereunder for such loss; select a competent and disinterested ap- 2. It shall be necessaryfor the Insured to use praiser, and the appraisal shall be made at a all lawful and proper efforts for the safeguard- reasonable time and place. The appraisers ing and recovery of the property covered or shall first select a competent and disinter- its value without prejudice to this insurance, ested umpire, and failing for 15 days to agree and this Company will contribute to the just upon such umpire, then, on the request of and reasonable charges thereof in such pro- the Insured or the Company, such umpire portion as the amount of insurance hereun- shall be selected by a judge of a court of der bears to the whole value of the property record in the state in which such appraisal is involved in the disaster at the time such loss pending. The appraisers shall then set the shall occur. The acts of each party or, their amount of loss, stating separately the actual agents in saving, preserving or recovering the cash value at the time of loss and the amountfr property shall not be considered or held to of loss and failing to agree shall submit their be either a waiver or an acceptance of aban- differences to the umpire.An award in writing #. donment; of any two shall determine the amount of 3. The Insured and every claimant hereunder loss.The Insured and the Company shall each shall submit: to examination by the Company, pay his or its chosen appraiser and shall bear subscribe the :same, under oath, if required, equally the other expenses of the appraisal and produce for the Company's examination and umpire. The Company shall not be held all pertinent: records, all at such reasonable to have waived any of its rights by any act times and places as the Company shall des- relating to appraisal; ignate and shall cooperate with the Company 10. If the Insured shall sustain any loss covered in all matters pertaining to loss or claims with by this policy which exceeds the applicable respect thereto; amount of insurance hereunder, the Insured t 4. No action shall lie against the Company un- shall be entitled to all recoveries(except from ` less, as a condition precedent thereto, there suretyship insurance, reinsurance, security shall have been full compliance with all the or indemnity taken by or for the benefit of the terms of this policy nor until 30 days after the Company) by whomsoever made, on account required proofs of loss have been filed with of such loss under this policy until fully reim- the Company, nor at all unless commenced bursed, less the actual cost of effecting the within 2 years Brom the date when the Insured same; and any remainder shall be applied to first has knowledge of the loss; the reimbursement of the Company. 5. The insured property may be owned by the M. IMPAIRMENT OF RECOVERY: Except as noted be- Insured or held by him in any capacity or may low, the Company shall not be bound to pay any be property for which the Insured is legally loss if the Insured shall have impaired any right liable; provided, the insurance applies only of recovery for loss to the property insured. It is to the iinterest of the Insured in such property, agreed that: including the Insured's liability to others, and does not apply to the interest of any other 1. As respects property while on the premises In- person or organization in any of said property of the Insured, permission is given the In- unless included in the Insured's proof of loss; sured to release others in writing from liabil- ity for loss prior to loss, and such release 6. It shall always be the option of this Company shall not affect the right of the Insured to to take all or any part of the articles at the recover hereunder, and ascertained or appraised value or to repair or 2. As respects property in transit, the Insured replace any property lost or damaged with may, without prejudice to his insurance, ac- other of like kind and quality within a reason- cept such bills of lading, receipts or con- able time of giving notice,within 30 days after tracts of transportation as are ordinarily is- receipt of the proof herein required, of its sued by carriers containing a limitation as to intention to do so; the value of such goods or merchandise. 7. There can be no abandonment to this Com- pany of the property insured unless specifi- N. OTHER INSURANCE: Cally agreed to by the Company; 1. Loss by fire or other perils not provided for It 8. All adjiusted claims shall be paid or made in 2 below: If at the time of the loss, there is good within 30 days after presentation and other insurance available to the Insured or acceptance of satisfactory proofs of interest any other interested party covering such loss Page 4 of 11 Pages or which would have covered such loss ex- notice of sale relating to the property, nor by any cept for the existence of this insurance, then change in the title or ownership of the property, the Company shall be liable as follows: nor by the occupation of the premises for pur- (a) If such insurance is Contributing Insur- poses more hazardous than are permitted by this ance, defined as any insurance written in policy; provided, that in case the mortgagor or the name of the Insured, upon the same owner shall neglect to pay any premium due un- plan, terms, conditions and provisions as der this policy, the mortgagee (or trustee) shall, contained in this policy whether collec- on demand, pay the same. tible or not, the Company shall be liable Provided also, that the mortgagee (or trustee) for no greater proportion of any loss than shall notify this Company of any.change of own- the limit of liability under this policy bears ership or occupancy or increase the hazard which to the whole amount of insurance cover- shall come to the knowledge of said mortgagee ing such loss. (or trustee) and, unless permitted by this policy, (b) If such insurance is Specific Insurance, it shall be noted thereon and the mortgagee (or y defined as any insurance other than that trustee) shall, on demand, pay the premium for described as Contributing Insurance in(a) such increased hazard for the term of the use above, the Company shall not be liable thereof; otherwise this policy shall be null and for any loss hereunder until the liability void. of such Specific Insurance has been ex- This Company reserves the right to cancel this hausted, and then shall cover only such policy at any time as provided by its terms, but amount as may exceed the amount due in such case this policy shall continue in force from Specific Insurance (whether collec- for the benefit only of the mortgagee (or trustee) tible or not) after application of any con- for 10 days after notice to the mortgagee (or tribution, coinsurance, average or distri- trustee) of such cancellation and shall then bution or other clauses contained in cease, and this Company shall have the right, on policies of such Specific Insurance af- like notice, to cancel this agreement. fecting the amount collectible there- Whenever this Company shall pay the mortgagee under, not exceeding however, the appli- (or trustee) any sum for loss or damage under this cable limit of liability under this policy. policy and shall claim that, as to the mortgagor 2. Loss by burglary, robbery or theft or loss of or owner, no liability therefor existed, this Com- personal property covered on an unspecified pany shall, to the extent of such payment, be peril basis: insurance under this policy shall thereupon legally subrogated to all the rights of apply as excess insurance over any other valid the party to whom such payment shall be made, and collectible insurance which would apply under all securities held as collater.l to the mort- in the absence of this policy. gage debt, or may at its option, pay to the mort- 3. When loss under this policy is subject to a gagee (or trustee) the whole principal due or to deductible, the Company shall not be liable grow due on the mortgage with interest, and shall for more than its pro rata share of such loss thereupon receive a full assignment and transfer in excess of the deductible amount. of the mortgage and of all such other securities; O. LOSS CLAUSE: Unless otherwise provided any but no subrogation shall impair the right of the loss hereunder shall not reduce the amount of mortgagee (or trustee) to recover the full amount this policy. of said mortgagee's (or trustee's) claim. P. LOSS PAYABLE CLAUSE: Loss, if any, shall be Loss or damage, if any, under this policy shall adjusted with the Named Insured and shall be be payable to the aforesaid mortgagee(or trustee) payable to him unless other payee is specifically as interest may appear under all present or future named hereunder; provided, at the option of the mortgages, in order of precedence of such mort- Company any loss to property of others may be gages, in accordance with the terms of this adjusted with and paid to the owner of such prop- Standard Mortgagee Clause, it being understood erty. that no notice of increase or decrease in any mortgagee's interest is required. O. MORTGAGE CLAUSE: (Applies only to buildings). R. BRANDS OR LABELS: If branded or labeled mer- This entire clause is void unless name of most- chandise is damaged and the Company elects to gagee(s) or trustee(s) is inserted in the Declara- tions Part I Damage to Property/Business Earn take all or any part of the property at the agreed ings Schedule. Loss or damage, if any, on or appraised value, the Insured may at his own buildings under this policy, shall be payable to expense stamp "salvage" on the merchandise or the aforesaid as mortgagee (or trustee) as inter- its containers or may remove the brands or la- est may appear. This insurance, as to the interest bels, if such stamp or removal will not physically of the mortgagee (or trustee) only therein, shall damage the merchandise. not be invalidated by any act or neglect of the S. VALUATION: Subject to all other provisions and mortgagor or owner of the described property. conditions, the following valuations are estab- nor by any foreclosure or other proceedings or lished for property insured under Part I: Page 5 of 11 Pages w ! 4 1. Insured's buildings, as defined (but in no time and place of loss, less all customary event to include rugs or carpeting, curtains discounts and unincurred expenses. or draperies, upholstery, cloth awnings, unit 5. Patterns, molds, models, dies: At actual cash air conditioners. domestic appliances and value with proper deduction for depreciation outdoor equipment), at the full cost to repair or obsolescence, however caused, and shall or replace the property(without deduction for in no event exceed what it would then cost depreciation) if repaired or replaced with due to repair or replace the same with material of diligence and dispatch and within a reason- like kind and quality. able time after loss, but not to exceed: 6. Tenant's Improvements and Betterments: (a) The cost to replace the property covered (a) If repaired or replaced within a reasonable on the same site in a condition equal to, time after loss at the expense of the In- but not superior to or more extensive than, sured, the actual cash value of the dam- the condition when new. aged or destroyed property, (b) The amount actually and necessarily ex (b) If not repaired or replaced within a rea proper' in repairing or replacing such sonable time after loss, that proportion property or any part thereof. of the original cost at time of installation (c) If the damaged property is not repaired or of the damaged or destroyed property replaced within a reasonable time after which the unexpired term of the lease or loss, or if the Insured shall so elect, the rental agreement, whether written or oral, actual cash value (with deduction for de- in effect at the time of loss bears to the preciation) of the damaged or destroyed period(s) from the date(s) such improve- property. If the Insured shall elect follow- ments and betterments were made to the ing loss to make claim on the basis of expiration date of the lease; actual cash value he shall have the right (c) Property replaced by another for the ben- to make further claim for additional liabil- efit of and at no cost to the Insured tenant ity on the basis of additional cost of repair shall not be covered hereunder. or replacement, provided the Company is notified in writing within a reasonable time 7• All other Insured property: At actual cash after loss of the Insured's intent to make value. further claim. T. SUBROGATION: In the event of any payment un- In no event shall aggregate payment for this der this policy, the Company shall be subrogated and any other property insured under any item 'to all the Insured's rights of recovery therefor of the Declarations Part I Damage to Property/ against any person or organization and the In- Business E=arnings Schedule exceed the limit sured shall execute and deliver instruments and of liability shown for such term. papers and do whatever else is necessary to se- 2. Property of others at the amount for which cure such rights. The Insured shall do nothing the Insured is liable but in no event to exceed after loss to prejudice such rights. actual cash value. Loss shall be adjusted with U. VACANCY AND UNOCCUPANCY CLAUSE: This the Insured for the account of the owner(s) Company shall not be liable for loss caused by of said property, except that the right to ad vandalism or malicious mischief occurring after just such loss with said owner(s) is reserved a described building (whether intended for oc to the Company and the receipts of the cupancy by owner or tenant) has been vacant or owner(s) in satisfaction thereof shall be in unoccupied for a period of 30 consecutive days, full satisfaction of any claim by the Insured nor for loss caused by any other insured peril for which such payments have been made. after it has been vacant for a period of 60 con- 3. Property sold but riot delivered at the actual secutive days, regardless of the date coverage is selling price of the Insured less all discounts effective. and unincurred expenses. This condition shall not apply to one and two 4. Finished stock, manufactured by the Insured family dwellings nor to buildings in due course 1 at the selling price of such property at the of construction. i THE FOLLOWING COIVDITIOIVS APPLY TO PART II 1. SUPPLEMENTARY PAYMENTS: and before the Company has paid or tendered The Company will pay, in addition to the appli or deposited in court that part of the judg j cable limit of liability; ment which does not exceed the limit of the I (a) all expenses incurred by the Company, all Company's liability thereon; costs taxed against the Insured in any suit (b) premiums on appeal bonds required in any defended by thE� Company and all interest on such suit. premiums on bonds to release at- the entire amount of any judgment therein tachments in any such suit for an amount not which accrues after entry of the judgmentin excess of the applicable limit of liability of Page 6 of 11 Pages 1 this policy, and the cost of bail bonds re- in excess of one year, any limit of the Company's quired of the Insured because of accident or liability stated in this policy as "aggregate" shall traffic law violation arising out of the use of apply separately to each consecutive annual pe- any vehicle to which this policy applies, not riod. to exceed $250 per bail bond, but the Com- 5. SUBROGATION: In the event of any payment un- pany shall have no obligation to apply for or der this Part, the Company shall be subrogated furnish any such bonds; to all the Insured's rights of recovery therefor (c) expenses incurred by the Insured for first aid against any person or organization and the In- to others at the time of an accident, for Bodily sured shall execute and deliver instruments and Injury to which this policy applies; papers and do whatever else is necessary to se- (d) reasonable expenses incurred by the Insured cure such rights. The Insured shall do nothing at the Company's request in assisting the after loss to prejudice such rights. �! Company in the investigation or defense of 6. ACTION AGAINST COMPANY: No action shall lie a any claim or suit, including actual loss of against the Company unless, as a condition pre- earnings not to exceed $25 per day. cedent thereto, there shall have been full compli- 2. FINANCIAL RESPONSIBILITY LAWS: When this ance with all of the terms of this policy, nor until policy is certified as proof of financial respon- the amount of the Insured's obligation to pay shall sibility for the future under the provisions of any have been finally determined either by judgment motor vehicle financial responsibility law, such against the Insured after actual trial or by written insurance as is afforded by this policy for Bodily agreement of the Insured, the claimant and the Injury liability or for Property Damage liability Company. shall comply with the provisions of such law to Any person or organization or the legal represen- the extent of the coverage and limits of liability tative thereof who has secured such judgment or required by such law.The Insured agrees to reim- written agreement shall thereafter be entitled to burse the Company for any payment made by the recover under this policy to the extent of the in- Company which it would not have been obligated surance afforded by this policy. No person or or- to make under the terms of this policy except for ganization shall have any right under this policy the agreement contained in this paragraph. to join the Company as a party to any action 3. INSURED'S DUTIES IN THE EVENT OF OCCUR- against the Insured to determine the Insured's ® RENCE, CLAIM OR SUIT: liability, nor shall the Company be impleaded by (a) In the event of an Occurrence. written notice thelnsured or his legal representative. Bankruptcy containing particulars sufficient to identify or insolvency of thelnsured orthelnsured's estate the Insured and also reasonably obtainable shall not relieve the Company of any of its obli- information with respect to the time, place gations hereunder. and circumstances thereof, and the names 7 OTHER INSURANCE:The insurance afforded by this and addresses of the injured and of available Part is primary insurance, except when stated to witnesses,shall be given by or for the Insured apply in excess of or contingent upon the absence to the Company or any of its authorized of other insurance.When this insurance is primary agents as soon as practicable. and the Insured has other insurance which is (b) If claim is made or suit is brought against the stated to be applicable to the loss on an excess Insured, the Insured shall immediately for- or contingent basis,the amount of the Company's ward to the Company every demand, notice, liability under this policy shall not be reduced by summons or other process received by him the existence of such other insurance. or his representative. With respect to any insurance afforded by this (c) The Insured shall cooperate with the Com- policy for Bodily Injury or Property Damage arising pany and, upon the Company's request, as- from watercraft where the Insured is, irrespective a sist in making settlements, in the conduct of of this insurance, covered or protected against suits and in enforcing any right of contribu- any loss or claim which would otherwise have tion or indemnity against any person or or- been paid by the Company, there shall be no con- ganization who may be liable to the Insured tribution or participation by this Company on the because of injury or damage with respect to basis of excess, contributing, deficiency, concur- which insurance is afforded under this policy; rent, or double insurance or otherwise. and the Insured shall attend hearings and When both this insurance and other insurance trials and assist in securing and giving evi e and obtaining the attendance of wit- apply to the loss on the same basis, whether dencences. The Insured shall not. except at his Primary, excess or contingent, the Company shall own cost, voluntarily make any payment, as- not be liable under this policy for a greater pro- . sume any obligation or incur any expense Portion of the loss than that stated in the appli- �""� other than for first aid to others at the time cable contribution provision below: of accident. (a) Contribution by Equal Shares: If all of such 4. AGGREGATE: If this policy is in effect for a period other valid and collectible insurance provides Page 7 of 11 Pages for contribution by equal shares, the Com- (2) the nuclear material is contained in spent pany shall not be liable for a greater propor- fuel or waste at any time possessed, han tion of such loss than would be payable if dled, used, processed, stored, trans- each insurer equals the lowest applicable ported or disposed of by or on behalf of limit of liability under any one policy or the an Insured; or full amount of the loss is paid, and with re- (3) the damage arises out of the furnishing spect to any amount of loss not so paid the by an Insured of services, materials, parts 1 remaining insurers then continue to contrib- or equipment in connection with the plan- ute equal shares of the remaining amount of ning, construction, maintenance, opera the loss until each such insurer has paid its tion or use of any nuclear facility, but if limit in full or thE! full amount of the loss is such facility is located within the United paid. States of America, its territories or pos- (b) Contribution by Limits: If any of such other sessions or Canada, this exclusion (3) ap- insurance does not provide for contribution plies only to Property Damage to such by equal shares, the Company shall not be nuclear facility and any property thereat. liable for a greater proportion of such loss II. As used in this exclusion than the applicable limit of liability under this "hazardous properties" include radioactive,toxic policy for such loss bears to the total appli- or explosive properties; cable limit of liability of all valid and collec- "nuclear material" means source material, spe- tible insurance against such loss. cial nuclear material or byproduct material; 8. NUCLEAR EXCLUSION: "source material," "special nuclear material," It is agreed that: and "byproduct material" have the meanings L This policy does not apply: given them in the Atomic Energy Act of 1954 or A. Under any Liability Coverage, to damage in any law amendatory thereof; (1) with respect to which an Insured under "spent fuel" means any fuel element or fuel com- this policy is also an Insured under a nu- ponent, solid or liquid, which has been used or clear energy liability policy issued by Nu- exposed to radiation in a nuclear reactor; clear Energy Liability Insurance Associ- "waste" means any waste material (1) containing ation, Mutual Atomic Energy Liability by-product material other than the tailings or Underwriters or Nuclear Insurance Asso- wastes produced by the extraction or concentra- ciation of Canada, or would be an Insured tion of uranium or thorium from any ore processed under any such policy but for its termi- primarily for its source material content, and (2) nation upon exhaustion of its limit of li-. resulting from the operation by any person or or- ability; or ganization of any nuclear facility included within (2) resulting from the hazardous properties the definition of nuclear facility under paragraph of nuclear material and with respect to (a) or (b) thereof; which (a) any person or organization is "nuclear facility" means required to maintain financial protection (a) any nuclear reactor, pursuant to the Atomic Energy Act of (b) any equipment or device designed or used 1954, or any law amendatory thereof, or for(1) separating the isotopes of uranium (b) the Insured is, or had this policy not: or plutonium, (2) processing or utilizing been issued would be, entitled to in- spent fuel, or (3) handling, processing or demnity from the United States of Amer- packaging waste, ica, or any agency thereof, under any essing, fabricating or alloying of special (c) any equipment or device used for the proc- agreement entered into by the United States of America, or any agency thereof, with any person or organization. nuclear material if at any time the total amount of such material in the custody of B. Under any Medical Payments Coverage, or the Insured at the premises where such under any Supplementary Payments provi- equipment or device is located consists sion relating to first aid,to expenses incurred of or contains more than 25 grams of plu- with respect to damage resulting from the tonium or uranium 233 or any combination hazardous properties of nuclear material and thereof, or more than 250 grams of ura- arising out of the operation of a nuclear fa- nium 235, cility by any person or organization. (d) any structure, basin, excavation, prem- C. Under any Liability Coverage to damage re- ises or place prepared or used for the sulting from the hazardous properties of nu- storage or disposal of waste, clear material, if and includes the site on which any of the fore- (1) the nuclear material (a) is at any nuclear going is located, all operations conducted on facility owned by or operated by or on such site and all premises used for such opera- behalf of an Insured or (b) has been dis- tions; charged or dispersed therefrom; Page 8 of 11 Pages "nuclear reactor" means any apparatus designed Insured shall die, such insurance as is afforded or used to sustain nuclear fission in a self-sup- by this policy shall apply (1) to the Named In- porting chain reaction or to contain a critical sured's legal representative, as the Named In- mass of fissionable material; sured, but only while acting within the scope of "property damage" includes all forms of radio- his duties as such, and (2) with respect to the active contamination of property. property of the Named Insured to the person hav- 9. ASSIGNMENT: Assignment of interest under this ing proper temporary custody thereof, as Insured, policy shall not bind the Company until its con- but only until the appointment and qualification sent is endorsed hereon. If, however, the Named of the legal representative. DEFINITIONS APPLICABLE TO PART II When used in the provisions applicable to Part II of tion other than another contractor or subcon- this policy (including endorsements forming a part tractor engaged in performing operations for hereof): a principal as a part of the same project. Automobile means a land motor vehicle, trailer or Operations which may require further service or semitrailer designed to travel on public roads (in- maintenance work, or correction, repair or replace- cluding any machinery or apparatus attached ment because of any defect or deficiency, but which thereto), but does not include mobile equipment. are otherwise complete, shall be deemed completed. Bodily Injury means bodily injury, sickness or disease The Completed Operations Hazard does not include sustained by any person which occurs during the pol- Bodily Injury or Property Damage arising out of icy period, including death at any time resulting there- (1) operations in connection with the transpor- from or Incidental Medical Malpractice Injury. tation of property, unless the Bodily Injury or Collapse Hazard includes "structural property dam- Property Damage arises out :)f a condition in age" as defined herein and Property Damage to any or on a vehicle loading thereof,created by the loading or un- other property at any time resulting therefrom. "Struc tural property damage"means the collapse of or struc- (2) the existence of tools, uninstalled equipment tural injury to any building or structure due to (1) or abandoned or unused materials, or grading of land, excavating, burrowing, filling, back- (3) operations for which the classification stated filling,tunnelling, pile driving, cofferdam work or cais- in the policy or in the Company's manual spec- son work or(2) moving, shoring, underpinning, raising ifies including Completed Operations. or demolition of any building or structure or removal Elevator means any hoisting or lowering device to or rebuilding of any structural support thereof. The connect floors or landings, whether or not in service, collapse hazard does not include Property Damage (1) and all appliances thereof including any car, platform, arising out of operations performed for the Named shaft, hoistway, stairway, runway, power equipment Insured by independent contractors, or (2) included within the Completed Operations Hazard or the Un and machinery; but does not include an automobile servicing hoist, or a hoist without a platform outside derground Property Damage Hazard or (3) for which a building if without mechanical power or if not at- liability is assumed by the Insured under an Incidental Contract. tached to building walls, or a hod or material hoist used in alteration, construction or demolition opera- Completed Operations Hazard includes Bodily Injury tions, or an inclined conveyor used exclusively for and Property Damage arising out of operations or carrying property or a dumbwaiter used exclusively i reliance upon a representation or warranty made at for carrying property and having a compartment height any time with respect thereto, but only if the Bodily not exceeding four feet. Injury or Property Damage occurs after such opera Explosion Hazard includes Property Damage arising tions have been completed or abandoned and occurs out of blasting or explosion. The explosion hazard away from premises owned by or rented to the Named does not include Property Damage (1) arising out of Insured. "Operations" include materials, parts or the explosion of air or steam vessels, piping under equipment furnished in connection therewith. Oper- pressure, prime movers, machinery or power trans- ations shall be deemed completed at the earliest of mitting equipment, or (2) arising out of operations the following times: performed for the Named Insured by independent (1) when all operations to be performed by or on contractors, or (3) included within the Completed behalf of the Named Insured under the con- Operations Hazard or the Underground Property tract have been completed, Damage Hazard or (4) for which liability has been assumed by the Insured under an Incidental Con- (2) when all operations to be performed by or on tract. behalf of the Named Insured at the site of the Incidental Contract means an written (1) lease of operations have been completed, or Y premises. (2) easement agreement, except in con- (3) when the portion of the work out of which nection with construction or demolition operations the injury or damage arises has been put to on or adjacent to a railroad, (3) undertaking to indem- its intended use by any person or organiza- nify a municipality required by municipal ordinance. Page 9 of 11 Pages except in connection with work for the municipality, Named Insured and over which the Named Insured (4) sidetrack agreement, or (5) elevator maintenance maintains ownership or majority interest, other than - agreement. a joint venture, provided this insurance does not Incidental Medical Malpractice Injury means injury apply to Bodily Injury, and Property Damage, Per- �. arising out of the rendering of or failure to render, sonal Injury and Advertising Injury with respect to during the policy period, the following services: which such new organization under this policy is also (A) medical,surgical,dental,x-ray or nursing serv- an Insured under any other similar liability or in- ice or treatment or the furnishing of food or demnity policy or would be an Insured under any beverages in connection therewith; or such policy but for exhaustion of its limits of liability. The insurance afforded hereby shall terminate 90 (B) the furnishing or dispensing of drugs or med- days from the date any such organization is acquired ical, dental or surgical supplies or appliances. or formed by the Named Insured. IncidentalttMedical Malpractice Injury does not Named Insured's Products means goods or products apply yomanufactured, sold, handled or distributed by the (1) expenses incurred by the Insured for first Named Insured or by others trading under his name aid to others at the time of an accident including any container thereof(other than a vehicle), and the "Supplementary Payments" pro- but Named Insured's Products shall not include a vision and the "Insured's Duties in the vending machine or any property other than such con- Event of Occurrence, Claim or Suit" Con- tainer, rented to or located for use of others but not dition are amended accordingly; or sold. (2) any Insured engaged in the business or Occurrence means an accident, including continu- occupation of providing any of these serv- ous or repeated exposure to conditions, which re- a ices described under (A) and (B) above; sults in Bodily Injury or Property Damage neither (3) injury caused by any indemnitee if such expected nor intended from the standpoint of the i indemnitee is engaged in the business or Insured. occupation of providing any of the serv- This includes any intentional act by or at the direction ices described under (A) and (B) above. of the Insured which results in Bodily Injury, if such Insured means any person or organization qualifying injury arises solely from the use of reasonable force as an Insured in the "PE!rsons Insured" provision of for the purpose of protecting persons or property. the applicable insurance coverage. The insurance af- forded applies separately 'to each Insured against Policy Territory means: whom claim is made or suit is brought, except with (1) the United States of America, its territories respect to the limits of the Company's liability. or possessions, or Canada, or Loading or Unloading, with respect to an Automobile„ (2) international waters or air space,provided the means the handling of property after it is moved from Bodily Injury or Property Damage does not the place where it its accepted for movement into or occur in the course of travel or transportation onto an Automobile or while it is in or on an Auto• to or from any other country, state or nation, mobile or while it is being moved from an Automobile, or to the place where it is finally delivered, but Loading, (3) anywhere in the world with respect to dam- or Unloading does riot include the movement of prop.- ages because of Bodily Injury or Property erty by means of a mechanical device (other than a Damage arising out of a product which was hand truck) not attached to the Automobile. sold for use or consumption within the ter- Mobile Equipment nneans a land vehicle(including any ritory described in paragraph (1) above, pro- machinery or apparatus attached thereto), whether or vided the original suit for such damages is not self-propelled, (1) not subject to motor vehicle brought within such territory. registration, or (2) maintained for use exclusively on (4) Anywhere in the world with respect to Bodily premises owned by or rented to the Named Insured, Injury, or Property Damage, and when such including the ways immE.,diately adjoining, or (3) de.. coverage is provided, Personal Injury or Ad- signed for use principally off public roads, or (4) de- vertising Injury arising out of the activities of signed or maintained for the sole purpose of affording any Insured permanently domiciled in the mobility to equipment of the following types forming United States of America though temporarily an integral part of or permanently attached to such outside the United States of America its ter- vehicle: power cranes, shovels, loaders, diggers and ritories and possessions or Canada, provided drills; concrete mixers (other than the mix-in-transit the original suit for damages because of any type); graders, scrapers, rollers and other road con- such injury or damage is brought within the struction or repair equipment;air-compressors, pumps United States of America, its territories or and generators, including spraying,welding and build- possessions or Canada. ing cleaning equipment; and geophysical exploration • and well servicing equipment. Such insurance as is afforded by paragraph (4) above Named Insured means the person or organization shall not apply: named in Section 1. of the Declarations of this policy. (a) to Bodily Injury or Property Damage in- Any organization which is acquired or formed by the cluded within the Completed Operations Page 10 of 11 Pages Hazard or the Products Hazard; Underground Property Damage Hazard includes un- (b) to premises medical payments coverage. derground Property Damage as defined herein and Products Hazard includes Bodily Injury and Property Property Damage to any other property at any time C Damage arising out of the Named Insured's Products resulting therefrom. Underground Property Damage or reliance upon a representation or warranty made means Property Damage to wires, conduits, pipes, at any time with respect thereto, but only if the Bodily mains, sewers, tanks, tunnels, any similar property, Injury or Property Damage occurs away from prem- and any apparatus in connection therewith, beneath ises owned by or rented to the Named Insured and the surface of the ground or water, caused by and after physical possession of such products has been occurring during the use of mechanical equipment for relinquished to others. the purpose of grading land, paving, excavating, drill- ing, burrowing, filling, back-filling or pile driving. The Property Damage means (1) physical injury to or de- Underground Property Damage Hazard does not in- struction of tangible property which occurs during elude Property Damage (1) arising out of operations the policy period, including the loss-of use thereof performed for the Named Insured by independent con- at any time resulting therefrom, or (2) loss of use of tractors, or(2) included within the Completed Opera- tangible property which has not been physically in- tions Hazard or (3) for which liability is assumed by jured or destroyed provided such loss of use is the Insured under an Incidental Contract. caused by an Occurrence during the policy period. I t s Page 11 of 11 Pages ENCOMPASS SERIES CNA For All the commitments You Make' ALL RISK PROPERTY FORM A. PROPERTY COVERED Insurance under this extension is excess over any other existing insurance covering This Coverage Part insures only those build- this same property. ing(s) and contents as defined below, described in the Declarations Part I Damage to Property/ 3. Furs and Fur Garments: For the peril of theft, Business Earnings Schedule for which a limit furs and fur garments are covered for but not of liability is shown. exceeding loss in the aggregate of $1,000 in Building(s): Buildings(s) or structure(s) shall in- any one occurrence for all contributing in- clude attached additions and extensions; fix- surance. tures, machinery and equipment constituting a 4. Jewelry and Precious Items: For the peril of permanent part of and pertaining to the service theft, jewelry and watches, watch move- of the building(s); materials and supplies in- ments, jewels, pearls, precious stones, bul- tended for use in construction, alteration or re- lion, gold, silver, platinum and other precious pair of the building(s) or structure(s); yard fix- alloys or items consisting primarily of gold, tures; personal property of the Insured used for silver, or other precious metals are covered maintenance or service of the building(s), includ- for but not exceeding loss in the aggregate ing fire extinguishing apparatus, outdoor furni- of $1,000 in any one occurrence for all ture, floor coverings and appliances for refriger- contributing insurance. This limitation shall ating, ventilating, cooking, dishwashing and not apply to jewelry and watches valued at laundering (but not including other personal $25 or less per item. property in apartments or rooms furnished by the Insured or landlord); all while at the described C. PROPERTY NOT COVERED location(s). Contents: Personal property of the Insured usual In addition to the kinds of property which are C or incidental to the business and not otherwise otherwise excluded or limited under this Cov- insured under any other policy, and in addition erage Part, the following are also excluded: the Insured's interest in similar personal property 1. Growing crops, lawns, trees, shrubs and owned by others in the Insured's care, custody plants, except as otherwise provided in this or control, and the Insured's interest in improve- Coverage Part; ments and betterments to buildings not owned by the Insured; all while at the described loca- 2. Foundations of building(s) which are below tion(s) or within 100 feet thereof if in the open. the under surface of the lowest basement floor, or where there is no basement, which B. PROPERTY SUBJECT TO LIMITATIONS are below the surface of the ground: foun- dations of machinery or boilers or engines The following kinds of property are subject to which are below the surface of the ground: limitations as below: underground flues, pipes, wiring and drains; sidewalks or driveways; piling for building(s) 1. Signs: Signs, including neon tubing, at a or wharf property below the low water mark: described location for an amount not ex- including cost of excavations, grading or fill- ceeding $2,000 against loss by an insured ing; peril. 3. Property which is more specifically insured 2. Personal Property of Others: Personal prop- in whole or in part under this or any other erty of others at a described location for an contract of insurance; amount not to exceed $10,000 against loss 4. Animals, pets, aircraft, watercraft including by an insured peril, loss to be adjusted with motors, equipment and accessories (except the Named Insured for the account of the rowboats and canoes while out of the water owners of the property, except that the right and on the described premises) and auto- to adjust any loss with the owners is re- mobiles including motor trucks, trailers, served to the Company and the receipts of semi-trailers, self-propelled vehicles and the owners in satisfaction thereof shall be machines, except motorized and non-motor- in full satisfaction of any claim by the ized equipment not licensed for use on pub- Named Insured for which payments have lic thoroughfares and operated principally been made. As respects personal property on the premises of the Insured; belonging to others, this provision shall re- place any loss payable provision of this policy. G-39224-C Page 1 of 4 5. Currency, money, bullion, notes and secu- unless loss by fire or explosion ensues, and rities except as otherwise provided in this this Company shall then be liable only for such Coverage Part; ensuing loss. 6. Valuable papers and business records, in- 7. Explosion (other than explosion of accu- cluding books of account, manuscripts, ab- mulated gases or unconsumed fuel within stracts, dra'Nings, card index systems, film, the firebox or combustion chamber or flues tape and disc drum, cell and other magnetic or passages which conduct combustion recording or storage media for electronic;data gases therefrom), rupture, bursting, crack- processing; except as otherwise provided in ing, burning out or bulging of steam boilers, this Coverage fart; steam pipes, steam turbines, or steam en- s. Import shipments gines if owned by, or leased by, or operated P r priors either discharge under the control of the Insured, unless loss from import conveyances or termination of the risk assumed by marine underwriters; by fire ensues and this Company shall then export shipments after either being laden be liable only for such ensuing loss; on board Export conveyances or having 8. Rain, snow or sleet with respect to personal come under the protection of marine insur- property in the open, but this exclusion shall ance; shipments by mail, except parcel post; not apply to property in the custody of 8. Property sold by the Insured under condi- carriers or bailees for hire; tional sale, trust agreement, installment pay- 9. Windstorm, hail, rain, sleet or snow with re- ment or other deferred payment plan after spect to exterior radio and television towers, delivery to customers; antennas, masts and lead-in wiring, unless 9. Personal effects belonging to officers, such property is specifically scheduled in the part P Hers or employees of the Insured except as art I Damage to Property/Business Earnings otherwise provided in this Coverage Part. Schedule; 10. Inherent vice, wear and tear, gradual dete- rioration, insects, vermin, delay, loss of use or , wet orThis Coverage Pant insures against all direct peril anott excluded r nroless this loss Coverage Pat physical loss to the property covered under this ensues and then this Company shall be Coverage Part. liable for only such ensuing loss. Loss from interruption of business is also excluded E. EXCLUSIONS unless and to the extent otherwise covered This Coverage Part does not insure against loss by this policy; caused by, resulting from, contributed to or 11. Latent defect or mechanical breakdown, and aggravated by any of the following: with respect to glass breakage, errors and omissions in design, manufacture or instal- l. Any electrical injury or disturbance to elec- lation, other than loss or damage caused by trical appliances, devices, fixtures or wiring or resulting from ensuing fire, explosion, caused by electrical arcing; smoke, elevator collision or leakage of fire 2. Volcanic explosion or eruption including re Protection equipment, or water damage not otherwise excluded; sulting ash or dust; Earthquake or other earth movement, including but not limited to land- 12. Dishonest acts or omissions of the Insured slide, muciflow, earth sinking, earth rising or or of any associate, servant or employee of shifting, subsidence, frost heaving; the Insured whether acting alone or in col- 3. Flood, surfacE? water, waves, tidal water or lusion with others; tidal wave, o'ver'flow of streams or other 13. Theft of any property from a building in bodies of water or spray from any of the process of construction; foregoing, all whether driven by wind or not; 14. Freezing of plumbing or heating systems or 4. Backup of severs or drains; their appliances, or by leakage or overflow 5. Water below the surface of the ground whiich from such systems or appliances while the damages the building or which seeps or described building(s) is vacant or unoccu- leaks into the building, caused by natural Pied, unless the Insured shall have exercised sources; due diligence with respect to maintaining heat in the building(s) or unless such sys- 6. Enforcement of any local or state ordinance tems and appliances had been drained and or law regulating the construction repair or the water supply shut off during such va - C: demolition of building(s) or structure(s); cancy or unoccupancy; Page 2 of 4 t 15. Mysterious disappearance; loss, the proof 4. Trees, Plants, Lawns and Shrubs: This Cover- of which, is dependent upon an inventory age Part covers for an amount not exceeding computation or a profit and loss computa- $2,500 in total, nor more than $500 for any C tion; one tree, plant, lawn or shrub not being grown for commercial purposes, in any one occur- 16. Insured's voluntarily parting with title or rence against the following perils only: fire possession of any property if induced to do and lightning, windstorm and hail, explosion, so by any fraudulent scheme, trick, device smoke,vehicles or aircraft, riot and civil com- or false pretense; motion, sprinkler leakage, vandalism and ma- 17. Actual work upon the property insured, ex- licious mischief, sonic boom, leakage, falling cept with respect to ensuing loss caused objects, elevator collision and collapse of an by or resulting from fire, explosion, water insured building but excluding loss to such damage or smoke not otherwise excluded; property outside of buildings by perils of windstorm and hail, damage by vehicles and 18. Atmospheric conditions or changes in tem- vandalism and malicious mischief. perature, rust or corrosion, shrinkage, evap- 5. Off Premises:This Coverage Part covers prop- oration or loss of weight of any personal 9 property; smog and gas or smoke from ag erty in and in transit anywhere within and ricultural or industrial operations; unless between Continental United States of Amer- directly caused by or resulting from physical ica and Canada (but excluding inter-coastal damage to the property covered, or to the shipments via the Panama Canal and coast- premises or conveyances containing such wise shipments to or from Alaska), and in property by a peril not otherwise excluded. transit anywhere within the State of Hawaii and territories or possessions of the United 19. Any legal proceeding, except General Av- States of America, including General Average erage and Salvage Charges. and Salvage Charges, is insured against the perils of this Coverage Part,and the following F. EXTENSIONS OF COVERAGE additional perils: flood, meaning the rising of rivers and streams; earthquake; collision, de- The Insured may elect to apply the following railment or overturn of transporting vehicles; Extensions of Coverage. Each of the limits of collapse of bridges, culverts, docks, or Cliability specified apply as an additional amount wharves. of insurance. The Coinsurance Clause does not apply to loss under the Extensions of Coverage. This extension shall be limited to the follow- 1. Extra Expense: This Coverage Part covers for ing amounts per occurrence: an amount not exceeding $1,000 in any one a) $10,000 for property while in transit (other occurrence for the extra expense necessarily than while in the custody of outside incurred by the Insured to continue normal salespeople); or services and operations which are inter- b) $1,000 for property in the custody of out- rupted as a result of loss by an insured peril side salespeople; and to the property covered hereunder while on the premises, or to the building containing c) $10,000 for all other property off prem- such property.The Insured shall exercise due ises: diligence and dispatch to restore normal serv- ices and operations. subject to the following LOCKED VEHICLES 2. Removal of Debris: This Coverage Part covers WARRANTIES: expenses incurred in the removal of all debris As to items a) and b), the Insured warrants of the property covered hereunder which may that the load-carrying body or bodies of the be occasioned by toss caused by any of the vehicle(s) owned, leased or operated by the insured perils of this Coverage Part. The total Insured are fully enclosed and of sound con- amount recoverable under this Coverage Part, struction, equipped with suitable locks and including this extension, shall not exceed the this Company shall be liable for loss by theft limit of liability for each item insured under only as a direct result of violent or forcible this Coverage Part. entry (of which there shall be visible evi- dence), except while the vehicle is in actual . Fire Extinguisher Recharge: This Coverage course of loading or unloading; Part covers for an amount not exceeding $1,000 in any one occurrence for the cost of As to item b), the Insured warrants that ve- recharging the Insured's Underwriters Labo- hicles will not be left outside overnight, that ratories listed or Factory Mutual approved vehicles will be properly locked when ga- type ABC (multipurpose) fire extinguishers raged in either a public or private garage (the after being used in fighting a fire on the In- doors of private garage also to be locked)and sured's premises or on adjoining premises. that vehicle doors, ignition and/or transmis- Page � of 4 sion will be locked and keys removed, and This extension covers (a) the value of blank windows and windshield properly closed papers or records, (b) costs or expenses in- whenever left unattended with insured mer- curred in reproduction of valuable papers or chandise therein. records. Failure of the Insured to comply with the 9. Accounts Receivable: This Coverage Part cov- above warranties shall render the coverage ers for an amount not exceeding $1,000 in null and void, except as respects carriers for anyone occurrence for the following loss and hire. expenses which are the direct result of loss 6. Automatic Coverage: Such insurance as is af- of or damage to accounts receivable records forded under this Coverage Part shall apply by an insured peril: to new or newly acquired buildings, struc- (a) All sums due the Insured from customers, tures, additions and contents within the Part provided the Insured is unable to effect territorial limits. This additional coverage collection thereof as the direct result of shall cease 90 clays from the date of acqui- such loss or damage; sition or start of construction, on the date the new location is reported to the Company, (b) Interest charges on any loan to offset im- or the expiration date of this policy, which- paired collections pending repayment of ever first occurs. Additional premium for such such sums made uncollectible by such new locations shall be due and payable for loss or damage; values reported, computed from the date of the acquisition. (c) Collection expense in excess of normal collection cost made necessary because This extension does not apply to any loss of such loss or damage; against which the Named Insured has other (d) Other expenses, when reasonably in- valid and collectible insurance. curred by the Insured in re-establishing The limit of this Company's liability under records of accounts receivable following this extension shall be the highest limit of such loss or damage. liability applicable to similar property at any location scheduled in the Declarations or 10. Currency, Money and Stamps: This Coverage $100,000, whichever is less. Part covers for an amount not exeeding$1,000 in any one occurrence for loss by an insured 7. Personal Effects: This Coverage Part covers peril to currency, money and stamps on the for an amount not exceeding $5,000 for loss insured premises, or while being conveyed in any one occurrence by an insured peril to outside the premises by the Insured, or by an personal effects while located on the de- employee of the Insured. scribed premises, belonging to officers, part- ners or employees of the Insured,and limited 11. Fire Department Service Charge: This Cover- to $500 on personal effects owned by any undergroundage Part covers for an amount one individual. This Extension of Coverage not exceeding $500 for liability assumed by does not apply if the loss is covered by any contract or agreement, or required by local other insurance, whether collectible or not, ordinance for fire department service charges or which would have been covered by :such incurred when the fire department is called other insurance in the absence of this policy. to save or protect covered property from a At the option of the Company, loss under this peril insured against. Extension of Coverage may be adjusted with and payable 1:o the Insured. 12. Damage To Property: This Coverage Part cov- ers damage to the building and the exterior 8. Valuable Papers and Records: This Coverage thereof, and to the insured property within Part covers for an amount not exceeding the building by such burglary,theft or robbery $1,000 in any one occurrence for loss to val- or attempt thereat, provided with respect to uable papers and business records, including damage to the building and the exterior books of account, manuscripts, abstracts, thereof the Named Insured is the owner of drawings, card index systems, film, tape and the building or is liable for such damage. disc,drum,cE;ll and other magnetic recording or storage media for electronic data process- ing, but: excluding currency, money, securi- ties and stamps; which are the property of the Insured, when such property is damaged _ by an insured) peril Page 4 of 4 ENCOMPASS SERIES INSURANCE FROM CNA COMMERCIAL APPRECIATION PROTECTION ENDORSEMENT $ Included Additional Premium 2.0 %Quarterly Increase In consideration of the additional premium specified, it is agreed that the amount of insurance applying to building(s) under this policy shall be increased every 3 months after the inception date of this policy by the quarterly increase specified above. If the endorsement is effective after the inception date, the amount of insurance shall be increased by the specified percentage every 3 months beginning with the end of the quarter period during which the endorsement is added. If the amount of insurance applying to building(s)is changed during the policy term,the new amount of insurance shall be increased by the specified percentage every 3 months beginning with the end of the quarter period during which the change is made.The percentage increase indicated above shall apply separately to each insured building. G-39229-C ' ENCOMPASS SERIES CNA For All the Commitments You Make C COMPREHENSIVE GENERAL LIABILITY INSURANCE (Combined Limits of Liability) I. COVERAGE A—BODILY INJURY LIABILITY while being used in any prearranged or organized COVERAGE B—PROPERTY DAMAGE LIABILITY racing, speed or demolition contest or in any stunt- ing activity or in practice or preparation for any The Company will pay on behalf of the Insured all such contest or activity or (2) the operation or use sumswhichthe Insured shalIbecomeleg aIlyobIigated of any snowmobile ox trailer designed for use to pay as damages because of therewith; A. Bodily Injury or (d) to Bodily Injury or Property Damage arising out of B. Property Damage and in the course of the transportation of Mobile Equipment by an Automobile owned or operated to which this insurance applies, caused by an Occur- by or rented or loaned to any Insured; rence, and the Company shall have the right and duty (e) to Bodily Injury or Property Damage arising out of to defend any suit against the Insured seeking dam- the ownership, maintenance, operation, use, load- ages on account of such Bodily Injury or Property ing or unloading of Damage, even if any of the allegations of the suit are groundless, false or fraudulent, and may make such (1) any watercraft owned or operated by or rented investigation and settlement of any claim or suit as it or loaned to any Insured, or deems expedient, but the Company shall not be obli- (2) any other watercraft operated by any person in gated to pay any claim or judgment or to defend any the course of his employment by any Insured; suit after the applicable limit of the Company's liability has been exhausted by payment of judgments or but this exclusion does not apply to watercraft settlements. while ashore on premises owned by, rented to or C Exclusions controlled by the Named Insured nor to watercraft under 26 feet in length which are neither owned by This insurance does not apply: Named Insured nor used to carry persons or prop- (a) to liability assumed by the Insured under any con- erty for a charge. tract or agreement except an Incidental Contract; (f) to Bodily Injury or Property Damage arising out of but this exclusion does not apply to a warranty of the discharge, dispersal, release or escape of fitness or quality of the Named Insured's Products smoke, vapors, soot, fumes, acids, alkalis, toxic or a warranty that work performed by or on behalf chemicals, liquids or gases, waste materials or of the Named Insured will be done in a workman- other irritants, contaminants or pollutants into or like manner; upon land, the atmosphere or any water course or (b) to Bodily Injury or Property Damage arising out of body of water; but this exclusion does not apply ifsuch discharge, dispersal, release or escape is ing or unloading of the ownership, maintenance, operation, use, load- sudden and accidental; (1) any Automobile or aircraft owned or operated (g) to Bodily Injury or Property Damage due to war, by or rented or loaned to any Insured, or whether or not declared, civil war, insurrection, rebellion or revolution or to any act or condition (2) any other Automobile or aircraft operated by incident to any of the foregoing, with respect to any person in the course of his employment by any Insured; (1) liability assumed by the Insured under an Inci- dental Contract, or but this exclusion does not apply to the parking of a (2) expenses for first aid under the Supplementary n Automobile on premises owned by, rented to or controlled by the Named Insured or the ways Payments provision; immediately adjoining, if such Automobile is not (h) to Bodily Injury or Property Damage for which the owned by or rented or loaned to any Insured; Insured or his indemnitee may be held liable: (c) to Bodily Injury or Property Damage arising out of (1) as a person or organization engaged in the (1) the ownership, maintenance, operation, use, business of manufacturing, distributing, sell- loading or unloading of any Mobile Equipment ing or serving alcoholic beverages, or G-39250-C Page 1 of 8 (2) if not so engaged, as an owner or lessor of (m)to loss of use of tangible property which has not premises used for such purposes. been physically injured ordestroyed resulting from if such liability is imposed (1) a delay in or lack of performance by or on (i) by, or because of the violation of, any stat- behalf of the Named Insured of any contract or ute, ordinance or regulation pertaining to agreement, or the sale, gift, distribution or use of any (2) the failure of the Named Insured's Products or alcoholic beverage, or work performed by or on behalf of the Named (ii) by reason of the selling, serving or giving Insured to meet the level of performance,qual- of any alcoholic beverage to a minor or to ity, fitness or durability warranted or repre- a person under the influence of alcohol or sented by the Named Insured; which causes or contributes to the intoxi- but this exclusion does not apply to loss of use of cation of any person except with respect Ito other tangible property from the sudden and acci- liability of the Insured or his indemnitee as dental physical injury to or destruction of the an owner or lessor described in (2)above; Named Insured's Products or work performed by But part (i) and (ii) of this exclusion does not apply or on behalf of the Named Insured after such prod- with respect to liability arising out of the giving or ucts or work have been put to use by any person or serving of alcoholic beverages at functions inc:i- organization other than an Insured; dental to the Named Insured's business provided (n) to Property Damage to the Named Insured's Prod- the Named Insured is not engaged in the business ucts arising out of such products or any part of of manufacturing, distributing, selling or serving such products; of alcoholic beverages and part (ii) of this exclu- (o) to Property Damage to work performed by or on sion does not apply with respect to the liability of behalf of the Named Insured arising out of the the insured or his indemnity as an owner or lessor work or any portion thereof, or out of materials, described in (2)above. parts or equipment furnished in connection (i) to any obligation for which the Insured or any car- therewith; rier as his insurer may be held liable under any (p) to damages claimed for the withdrawal, inspec- workmen's compensation, unemployment com- tion, repair, replacement, or loss of use of the pensation or disability benefits law, or under any Named Insured's Products or work completed by similar law; or for the Named Insured or of any property of (j) to Bodily Injury to any employee of the Insured which such products or work form a part, if such arising out of and in the course of his employment products,work or property are withdrawn from the by the Insured or to any obligation of the Insured market or from use because of any known or sus- to indemnify another because of damages arising pected defect ordeficiencytherein: out of such injury; but this exclusion does not (q) to Property Damage included within: apply to liability assumed by the Insured under an Incidental Contract; (1) the Explosion Hazard in connection with oper- (k) to Property Damage 1:0 ations identified in this policy by a classifica- tion code number which includes the symbol (1) property owned or occupied by or rented to "x," the Insured, (2) the Collapse Hazard in connection with (2) property used by the Insured, or operations identified in this policy by a clas- (3) property in the care, custody or control of the sification code number which includes the Insured or as to which the Insured is for any symbol "c," purpose exercising physical control. (3) the Underground Property Damage Hazard in but parts (2) and (3) of this exclusion do not apply connection with operations identified in this with respect to liability under a written sidetrack policy by a classification code number which includes the symbol "u." agreement and part (3) of this exclusion does not apply with respect to Property Damage(other than II. PERSONS INSURED to Elevators)arising out of the use of an Elevator at Each of the following is an Insured under this insur- premises owned by, rented to or controlled by the ance to the extent set forth below: Named Insured; (a) if the Named Insured is designated in the Declara- Named Insured arising out of such premises or any (I) to Property Damage to premises alienated by this tions as an individual, the person so designated part thereof; but only with respect to the conduct of a business Page 2 of 8 • • of which he is the sole proprietor, and the spouse ture, any partner, member or spouse of any of of the Named Insured with respect to the conduct the foregoing. of such a business; This insurance does not apply to Bodily Injury or (b) if the Named Insured is designated in the Declara- Property Damage arising out of the conduct of any tions as a partnership or joint venture,the partner- partnership or joint venture of which the Insured is a ship or joint venture so designated and any partner partner or member and which is not designated in this or member thereof but only with respect to his Iia- policy as a Named Insured. bility as such; Spouse—Partnership—If the Named Insured is a III. LIMITS OF LIABILITY partnership, the spouse of a partner but only with Regardless of the number(1)Insured under this pol- respect to the conduct of the business of the Named Insured; icy, (2) persons or organizations who sustain Bodily Injury or Property Damage, (3) claims made or suits (c) if the Named Insured is designated in the Declara- brought on account of Bodily Injury or Property Dam- tions as other than an individual, partnership or age to which this insurance applies, the Company's joint venture, the organization so designated and liability is limited as follows: • any executive officer, director or stockholder Coverages A and B Combined—The limit of liability thereof while acting within the scope of his duties stated in the Declarations Page as applicable to"each . as such; Occurrence" is the total limit of the Company's Iia- (d) any person (other than an employee of the Named bility under Coverages A and B combined for all Insured or organization while acting as real estate damages as the result of any one Occurrence pro- manager for the Named Insured; and vided that with respect to any Occurrence for which notice of this poicy is given in lieu of security or (e) with respect to the operation, for the purpose of when this policy is certified as proof of financial locomotion upon a public highway, of Mobile responsibility under the provisions of the motor ve- Equipment registered under any motor vehicle reg- hicle financial responsibility law of any state or prov- istration law, any person while operating with the ince, such limit of liability shall be applied to provide permission of the Named Insured any such equip- the separate limits required by such law for Bodily ment registered in the name of the Named Insured Injury liability and Property Damage liability to the and any person or organization legally responsible extent of the coverage required by such law, but the for such operation, but only if there is no other separate application of such limit shall not increase valid and collectible insurance available, either on the total limit of the Company's liability. a primary or excess basis to such person or orga- nization; provided that no person or organization Subject to the above provision respecting "each shall be an Insured under this paragraph (e) with Occurrence," the total liability of the Company for respect to: Property Damage to property owned all damages because of all Bodily Injury and Property by, rented to, in charge of or occupied by the Damage to which this coverage applies and de- Named Insured or the employee of any person scribed in any of the numbered subparagraphs below described in Paragraph II, Persons Insured. shall not exceed the limit of liability stated in the Declarations Page as "aggregate". (f) other than executive officers, any employee, of the (1) all Property Damage arising out of premises Named Insured while acting within the scope of or operations rated on a remuneration basis, their duties as such; but the insurance afforded to or Contractor's Equipment rated on a receipts such employees does not apply to: basis, including Property Damage for which (1) Bodily Injury to another employee of the liability is assumed under the Incidental Con- Named Insured arising out of or in the course tract relating to such premises or operations, of his employment, or but excluding Property Damage included in subparagraph (2) below: (2) Bodily Injury to the Named Insured, or if the (2) all Property Damage arising out of and occur- Named Insured is a partnership or joint ven- ring in the course of operations performed for ture, any partner or member thereof, or the the Named Insured by independent contrac- spouse of any of the foregoing, tors and general supervision thereof by the (3) To Property Damage to property owned, occu- Named Insured, including any such Property pied or used by, rented to, in the care, custody Damage for which liability is assumed under or control of or over which physical control is any Incidental Contract relating to such oper- being exercised for any purpose by another ations, but this subparagraph (2) does not employee of the Named Insured or if the include Property Damage arising out of main- Named Insured is a partnership or joint ven- tenance or repairs at premises owned by or Pags3of8 • • 4 e , rented to the Named Insured or structural engineer or surveyor, to the liability of the alterations at such premises which do not indemnitee, his agents or employees, arising involve changing the size of or moving build- out of ings or other structures; (1) the preparation or approval or the failure to (3) all Bodily Injury and Property Damage prepare or approve maps, drawings, opin- included within the Completed Operations ions, reports, surveys, change orders, Hazard and al Bodily Injury and Property Dam- designs or specifications,or age included within the Products Hazard. (2) the giving of or the failure to give directions Such aggregate limit shall apply separately (i)to the or instructions by the indemnitee, his Property Damage described in subparagraphs (1) and agents or employees, provided such giving (2),(ii)with respect to each project away from premises or failure to give is the primary cause of the owned by or rented to the Named Insured in subpara- Bodily Injury or Property Damage. graphs (1) and (2) and (iii) to the sum of the damages (d) to any obligation for which the Insured may be for all Bodily Injury and all Property Damage described held liable in an action on a contract by a third in subparagraph (3). party beneficiary for Bodily Injury or Property Coverages A and B--For the purpose of determin- Damage arising out of a project for a public ing the limit of the Company's liability, all Bodily Injury authority; but this exclusion does not apply to and Property Damage arising out of continuous or an action by the public authority or any other repeated exposure to substantially the same general person or organization engaged in the project. conditions shall be considered as arising out of one (e) to Bodily Injury or Property Damage arising Occurrence. out of operations,within 50 feet of any railroad IV. POLICY TER RIITORY property, affecting any railroad bridge or tres- This insurance applies only to Bodily Injury or Prop- tle, tracks, road beds, tunnel, underpass or erty Damage which occurs within the Policy Territory: crossing; but this exclusion does not apply to sidetrack agreements. V. OPTIONAL LIABILITY EXTENSIONS (3) The following exclusions applicable to Coverages The following coverages are optional and coverage A (Bodily Injury) and B (Property Damage) do not is afforded only when indicated in the Declarations apply to this Contractual Liability Coverage:(b), (c) C page as included. (2), (d) and (e). A.CONTRACTUAL LIABILITY COVERAGE (4) The following additional condition applies: (1) The definition of Incidental Contract is extended Arbitration.The Company shall be entitled to exer- to include any contract or agreement relating to cise all of the Insured's rights in the choice of arbi- the conduct of the Named Insured's business. trators and in the conduct of any a,titration (2) The insurance afforded with respect to liability proceeding. assumed under an ,Incidental Contract is subject B. PERSONAL INJURY AND ADVERTISING INJURY to the following additional exclusions: LIABILITY COVERAGE (a) to Bodily Injury or Property Damage for which (1) The Company will pay on behalf of the Insured all the Insured has assumed liability under any sums which the Insured shall become legally obli- Incidental Contract, if such injury or damage gated to pay as damages because of Personal occurred prior to the execution of the Inciden- Injury or Advertising Injury to which this insurance tal Contract. applies, sustained by any person or organization and arising out of the conduct of the Named (b) if the Insured is an architect, engineer or sur- Insured's business, within the Policy Territory, and veyor, to .Bodily Injury or Property Damage the Company shall have the right and duty to arising out:of the rendering or failure to render defend any suit against the Insured seeking dam- professional services by such Insured, ages on account of such injury, even if any of the including allegationsare groundless,false orfraudulent,and (1) the preparation or approval of maps, draw- may make such investigation and settlement of any ings, opinions, reports, surveys, change claim or suit as it deems expedient, but the Com- orders,designs or specifications,and pany shall not be obligated to pay any claim or judgment or to defend any suit after the applicable (2) supervisory, inspection or engineering limit of the Company's liability has been exhausted service's; by payment of judgments or settlements. (c) if the indemnitee of the Insured is an architect, (2) This insurance does not apply: Page 4 of 8 (a) to liability assumed by the Insured under any under, (2) persons or organizations who sustain contract or agreement; injury or damage, or (3) claims made or suits (b) to Personal Injury or Advertising Injury arising brought on account of Personal Injury or Adver- out of the willful violation of a penal statute or tising Injury the total limit of the Company's li- ordinance committed by or with the knowl- ability under this coverage for all damages shall edge or consent of the Insured; not exceed the Bodily Injury limit of liability (c) to Personal Injury or Advertising Injury arising stated in the Declarations Page as aggregate. out of a publication or utterance of a libel or (4) Additional Definitions slander, or a publication or utterance in viola- Advertising Injury means injury arising out of an tion of an individual's right of privacy, if the first offense committed during the policy period occur- injurious publication or utterance of the same ring in the course of the Named Insured's advertis- or similar material by or on behalf of the ing activities, if sucks injury arises out of libel, Named Insured was made prior to the effective slander, defamation, violation of right of privacy, date of this insurance; piracy, unfair competition,or infringement of copy- (d) to Personal Injury or Advertising Injury arising right, title or slogan. out of libel or slander or the publication or Personal Injury means injury arising out of one or utterance of defamatory or disparaging mate- more of the following offenses committed during rial concerning any person or organization or the policy period.- goods, eriod:goods, products or services, or in violation of (a) false arrest, detention, imprisonment, or mali- an individual's right of privacy, made by or at the direction of the Insured with knowledge of cious prosecution; the falsity thereof; (b) wrongful entry or eviction or other invasion of (e) to Personal Injury or Advertising Injury arising the right of private occupancy; out of the conduct of any partnership or joint (c) a publication or utterance venture of which the Insured is a partner or member and which is not designated in the (1) of a libel or slander or other defamatory or Declarations of the policy as a Named Insured; disparaging material, or C (f) to Advertising Injury arising out of (2) in violation of an individual's right of (1) failure of performance of contract, but this privacy; exclusion does not apply to the unautho- except publications or utterances in the rized appropriation of ideas based upon course of or related to advertising, broadcast- alleged breach of implied contract, or ing, publishing or telecasting activities con- ducted by or on behalf of the Named Insured (2) infringement of trademark, service mark or shall not be deemed Personal Injury trade name, other than titles or slogans, by C. PREMISES MEDICAL PAYMENTS COVERAGE use thereof on or in connection with goods, products or services sold, offered for sale The Company will pay to or for each person who sus- or advertised; tains Bodily Injury caused by accident all reasonable (3) incorrect description or mistake in adver- Medical Expense incurred within one year from the tised price of goods, products or services date of the accident on account of such Bodily Injury, sold, offered for sale or advertised; provided such Bodily Injury arises out of (a) a condi- tion in the Insured Premises or (b) operations with (g) with respect to Advertising Injury respect to which the Named Insured is afforded cov- (a) to any Insured in the business of adver- erage for Bodily Injury liability under the policy. tising, broadcasting, publishing or tele- This insurance does not apply: / casting, or (1) to Bodily Injury ,j (b) to any injury arising out of any act commit- ted by the Insured with actual malice. (a) arising out of the ownership, maintenance, (h) to Persona/ Injury to another employee of the operation, use, loading or unloading of Named Insured arising out of or in the course (1) any Automobile or aircraft owned or oper- of his employment. ated by or rented or loaned to any Insured, (3) Limits of Liability or (2) any other Automobile or aircraft operated Regardless of the number of (1) Insureds here- by any person in the course of his employ- Page 5 of 8 ment by any Insured; (4) which causes or contributes to the intoxi- but this exclusion does not apply to the park- cation of any person, ing of an Automobile on the Insured Premises, if the Named Insured is a person or organi- if such Automobiie is not owned by or rented zation engaged in the business of manufac- or loaned to any Insured; turing, distributing, selling or serving (b) arising out of alcoholic beverages, or if not so engaged, (1) the ownership, maintenance, operation, is an owner or lessor of premises used for use, loading or unloading of any Mobile such purposes, but only part (1) of this Equipment while being used in any prear- exclusion (2) (C) applies when the Named ranged or organized racing, speed or dem- Insured is such an owner or lessor; olition contest or in any stunting activity or (d) due to war, whether or not declared, civil in practice or preparation for any such con- war, insurrection, rebellion or revolution, or to test or activity, or any act or condition incident to any of the (2) the operation or use of any snowmobile or foregoing; trailer designed for use therewith; (3) to Bodily Injury (c) arising out of the ownership, maintenance, (a) to the Named Insured, any partner therein, any operation, use, loading or unloading of tenant or other person regularly residing on (1) any watercraft owned or operated by or the Insured Premises or any employee of any rented or loaned to any Insured, or of the foregoing if the Bodily Injury arises out of and in the course of his employment (2) any other watercraft operated by any per- therewith; son in the course of his employment by any (b) to any other tenant if the Bodily Injury occurs Insured; on that part of the Insured Premises rented but this exclusion does not apply to watercraft from the Named Insured or to any employee of while ashore on the Insured Premises; such a tenant if the Bodily Injury occurs on the (d) arising out of and in the course of the transpor- tenant's part of the Insured Premises and tation of Mobile Equipment by an Automobile arises out of and in the course of his employ- r owned or operated by or rented or loaned to ment for the tenant; the Named InsurE?d; (c) to any person while engaged in maintenance (2) to Bodily Injury and repair of the Insured Premises or altera- tion, demolition or new construction at such (a) included within the Completed Operations premises; Hazard or the Products Hazard; (d) to any person if any benefits for such Bodily (b) arising out of operations performed for the Injury are payable or required to be provided Named Insured by independent contractors under any workmen's compensation, unem- other than ployment compensation or disability benefits (1) maintenance and repair of the Insured law, or under any similar law; Premises, or (e) to any person practicing, instructing or partic- ipating in any physical training, sport, athletic (2) structural alterations at such premises activity,or contest whether on a formal or infor- which do not involve changing the size of or moving buildings or other structures; mal basis; (c) resulting from the selling, serving or giving of (f) if the Named Insured is a club, to any memberof the Named Insured; any alcoholic beverage (1) in violation of any statute, ordinance or (g) if the Named Insured is a hotel, motel, or tour- regulation, ist court, to any guest of the Named Insured. (2) to a minor, (4) to any Medical Expense for services by the Named Insured, any employee thereof or any person or (3) to a person under the influence of alcohol, organization under contract to the Named Insured or to provide such services. Page 6 of 8 LIMITS OF LIABILITY are deleted and replaced by the following: The limit of liability for Premises Medical Payments This insurance does not apply to liability Coverage is $1,000 each person unless otherwise stated in the Declarations Page. The limit of liabilityassumed . the Insured under any contractor applicable to "each person" is the limit of the Com- pany's agreement.liability for all Medica/ Expense for Bodily (2) The limit of Property Damage liability as respects Injury to any one person as the result of any one this Fire Legal Liability Coverage—Real Property accident; but subject to the above provision respect- is $50,000 each Occurrence unless otherwise ing "each person," the total liability of the Company stated in the Declarations Page. under Premises Medical Payments Coverage for all (3) The Fire Legal Liability Coverage—Real Property Medical Expense for Bodily Injury to two or more persons as the result of any one accident shall not shall be excess insurance over any valid and col- exceed the limit of Bodily Injury liability stated in the lectible property insurance (including any deduct- ible portion thereof), available to the Insured, such policy as applicable to "each Occurrence." as, but not limited to, Fire, Extended Coverage or When more than one Medical Payments coverage Installation Risk Coverage, and the Other Insur- afforded by the policy applies to the loss,the Company ance Condition of the policy is amended shall not be liable for more than the amount of the accordingly. highest applicable limit of liability. E. BROAD FORM PROPERTY DAMAGE LIABILITY - ADDITIONAL DEFINITIONS COVERAGE(Including Completed Operations) When used herein: The insurance for Property Damage liability applies, Insured Premises means all premises owned by or subject to the following additional provisions: rented to the Named Insured with respect to which the (1) Exclusions (k) and (o) are replaced by the Named Insured is afforded coverage for Bodily Injury following: liability under this policy, and includes the ways imme- (a) to property owned or occupied by or rented to diately adjoining on land; the Insured, or, except with respect to the use Medical Expense means expenses for necessary med- of Elevators, to property held by the Insured ical, surgical,x-ray and dental services including pros- for sale or entrusted to the Insured for storage thetic devices and necessary ambulance, hospital, or safekeeping, professional nursing and funeral services. (b) except with respect to liability under a written ADDITIONAL CONDITION sidetrack agreement or the use of Elevators, i Medical Reports; Proof and Payment of Claim (1) to property while on premises owned by or rented to the Insured for the purpose of As soon as practicable the injured person or someone having operations performed on such on his behalf shall give to the Company written proof property by or on behalf of the Insured, of claim, under oath if required, and shall, after each i request from the Company, execute authorization to (2) to tools or equipment while being used by enable the Company to obtain medical reports and the Insured in performing his operations, copies of records. The injured person shall submit to (3) to property in the custody of the Insured I physical examination by physicians selected by the which is to be installed, erected or used in Company when and as often as the Company may rea- construction by the Insured, sonably require. The Company may pay the injured person or any person, or organization rendering the (4) to that particular part of any property, not services and the payment shall reduce the amount pay- on the premises owned by or rented to the t able hereunder for such injury. Payment hereunder Insured shall not constitute an admission of liability of any per- (i) upon which operations are being per- son or,except hereunder, of the Company. formed by or on behalf of the Insured D. FIRE LEGAL LIABILITY COVERAGE—REAL at the time of the Property Damage PROPERTY arising out of such operations, or With respect to Property Damage to structures or por- (ii) out of which any Property Damage tions thereof rented to or leased to the Named Insured, arises, or including fixtures permanently attached thereto, if (iii) the restoration, repair or replacement such Property Damage arises out of fire; of which has been made or is neces- (1) All of the exclusions of the policy, other than the sary by reason of faulty workmanship Nuclear Energy Liability Exclusion (Broad Form), thereon by or on behalf of the I,7sured; Page 7 of 8 4 y (5) with respect to the Completed Operations (2) The Broad Form Property Damage Liability Cover- Hazard and with respect to any classifica- age shall be excess insurance over any valid and tion stated in the policy or in the Company's collectible property insurance (including any manual as "including completed opera- deductible portion thereof) available to the tions," to Property Damage to work per- Insured, such as, but not limited to, Fire, Extended formed by the Named Insured arising out of Coverage, Builder's Risk Coverage or Installation such work or any portion thereof, or out of Risk Coverage, and the Other Insurance Condition such materials, parts or equipment fur- of the policy is amended accordingly. nished in connection therewith. Page 8 of 8 ENCOMPASS SERIFS . IP 30 239 44 69 • 1AWRAN"PAW DECLARATIONS EXTENSION SNA DAMAGE TO PROPERTY/BUSINESS EARNINGS SCHEDULE SECTION 2a (Continued) C Limit of Liability Item Description and Location of Property Covered Building(s) Contents Bus. Earnings 2a. 1 On a frame building occupied as $800,000.00 $75,000.00 town ahll situated at: Main Street Southold, Suffolk Co. , NY i 2 On a brick building occupied as beach $10,000.00 _ - house toilets situated in New Suffolk, Suffolk Co. 3 On a brick building occupied as 35,000.00 - - animal shelter situated at: NIS Main Road, Peconic, Suffolk Co. , NY i 4 On a brick building occupied as 10,000.00 - - I animal shelter rear of NIS Main Road, Peconic, Suffolk Co. , NY 5 On a non-combustible building 220,000. $10,000.00 occupied as land fill storage building situated at: NIS Rt. 48 Cutchogue, Suffolk Co. , NY f 6 On a brick building occupied for 25,000.00 - - *� equipment test building situated at: NIS Rt. 48, Cutchogue, Suffolk Co. , NY 7 On a frame building occupied as 200,000.00 35,000.00 - main garage and office situated at: W/S Peconic Lane, Peconic, Suffolk Co. 8 On a frame building occgied for 25,000.00 15,000.00 - storage barn and garage situated at: W/S Peconic Lane, Peconic, Suffolk Co. 9 On a frame building occ#ed for 60,000.00 25,000.00 - garage and equipment situated at: W/S Peconic Lane, Peconic, Suffolk Co. , NY b. Conditions applicable: (See Declarations 100 % NE] 100 % ❑ % ML Section 2b for definitions of symbols used) ❑ AA ❑ AA ❑ AA Name of Form and Form Number Applicable: Part 1 Schedule Page of Schedule Pages • IP 30 239 44 69 • ENCOMPASS SERIES INWRA "FJV" DECLARATIONS EXTENSION SNA DAMAGE TO PROPERTYIBUSINESS EARNINGS SCHEDULE SECTION 2a (Continued) Limit of Liability Item Description and Location of Property Covered Building(s) Contents Bus. Earnings 2a. 10 On a frame building occupied as lawn $18,000.00 $7,000.00 - mower repair situated at: W/S Peconic. Lane, Peconic, Suffolk Co. , NY 11 On a frame building occupied as salt 15,000.00 5,000.00 storage building situated at: W/S _ Peconic Lane, Peconic, Suffolk Co. , NY 12 On a brick building occupied as police 180,000.00 50,000.00 - headquarters situated at: N/S Route 25 , Peconic, Suffolk Co. , NY 13 On a fire resistive building 4,000.00 - - occupied as steel radio tower situated at: Rear of N/S Rt. 25 Peconic, Suffolk Co. , NY 14 On a non-combustible building 200,000.00 15,000.00 - occupied as senior citizen & youth center situated at: E/S Peconic Lane, Peconic, Suffolk Co. , NY b. Conditions applicable: (See Declarations X-� 100 % ❑ 100 % ❑ _ % ML Section 2b for definitions of symbols used) ❑ AA ❑ AA ❑ AA Name of Form and Form Number Applicable: Part 1 Schedule Page of Schedule Pages ENCOMPASS SERIES • • INSURANCE FROM CNA IP 30 239 44 69 C ACCOUNTS RECEIVABLE AND VALUABLE PAPERS AND RECORDS EXTENSION All conditions applicable to Part I (except any Coinsurance Clause, Deductible, or Conditions of any other Coverage Part) shall also apply to this Coverage Part. Coverage on Accounts Receivable and Valuable Papers and Records insured under this Coverage Part supersedes and replaces any contents of Part I of this policy which would otherwise cover the same property. This Coverage Part covers the property indicated by an X and scheduled below: ❑ Accounts Receivable—Non Reporting Form ❑ Accounts Receivable—Reporting Form – ® Valuable Papers and Records ACCOUNTS RECEIVABLE COVERAGE 1. The following loss and expenses which are the direct result of loss of or damage to accounts receivable records at locations listed in the Schedule are covered: a. All Sums due the Insured from customers,provided the Insured is unable to effect collection thereof as the direct result of such loss or damage; b. Interest charges on any loan to offset impaired collections pending repayment to such sums made uncollect- ible by such loss or damage; c. Collection expense in excess of normal collection cost made necessary because of such loss or damage; d. Other expenses,when reasonably incurred by the Insured in re-establishing records of accounts receivable following such loss or damage. VALUABLE PAPERS AND RECORDS COVERAGE 2. The following Valuable Papers and Records are covered: Ca. All Valuable Papers and Records, not specified in b. below,at locations listed in the schedule. b. Specified articles(show location,description and value of each) Location Article Value(each) 3. a.ACCOUNTS RECEIVABLE SCHEDULE Location Kind of Name of Maker "Class"or Limit of Liability Item No. Receptacle "Hour Exposure" of Label b.VALUABLE PAPERS AND RECORDS SCHEDULE Location Kind of Name of Maker "Class"or Limit of Liability Item No. Receptacle "Hour Exposure" of Label Contained in a metal cabinet $50,000.00 G-53251-A • 1 4. Protection of.Accounts and Valuable Papers and Records. Insurance under this Coverage Part shall apply only while the records are contained in the premises described., it being a condition precedent to any right of recovery hereunder that such records shall be kept in the receptacles, described in the schedule above, at all times when the premises are not open for business,except while such records are in actual use or as stated in paragraphs 5 and 6 below. 5. Automatic Extension. Such insurance as is afforded by this Coverage Part applies while the records are being conveyed outside the premises and while temporarily within other premises,except for storage, provided the Company's liability for _ Loss shall not:exceed 10%of the combined limits of liability stated in paragraph 1, nor$5,000,whichever is less. 6. Removal.Such insurance as is afforded by this Coverage Part applies while the records are being removed to and while at a place of safety because of imminent danger of loss and while being returned from such place,provided the Insured gives written notice to the Company of such removal within ten days thereafter. This extension insures against: All risks of loss of or damage to the property described except as hereunder provided. AS RESPECTS ACCOUNTS RECEIVABLE AND VALUABLE PAPERS AND RECORDS THIS EXTENSION DOES NOT INSURE AGAINST LOSS: a. due to any fraudulent, dishonest or criminal act by any b. due to electrical or magnetic injury,disturbance or erasure Insured, a partner therein,or an officer,director or trustee of electronic recordings,except by lightning. thereof, while working or otherwise and whether acting alone or in collusion with others; AS RESPECTS ACCOUNTS RECEIVABLE RECORD:) THIS EXTENSION DOES NOT INSURE AGAINST LOSS: a. due to bookkeeping, accounting or billing errors or c. due to alteration,falsification,manipulation,concealment, omissions; destruction or disposal of records of accounts receivable b. the proof of which as to factual existence, is dependent committed to conceal the wrongful giving, taking, obtain- upon an audit of records or an inventory computation;but ing or withholding of money, securities or other property this shall not preclude the use of such procedures in sup- but only to the extent of such wrongful giving, taking, port of claim for loss which the Insured can prove,through obtaining or withholding. evidence wholly apart therefrom, is due solely to a risk of loss to records of accounts receivable not otherwise excluded hereunder; AS RESPECTS VALUABLE PAPERS AND RECORDS THIS EXTENSION DOES NOT INSURE AGAINST LOSS: ` a. directly resulting from errors or omissions in processing or c. of property not specifically declared and described in sec- copying unless fire or explosion ensues and then only for tion b. of schedule paragraph 1 of this extension, if such direct loss caused by such ensuing fire or explosion; property cannot be replaced with other of like kind and b. due to wear and tear, gradual deterioration, vermin or quality; inherent vice; d. of property held as samples or for sale or for delivery after sale. AS RESPECTS ACCOUNTS RECEIVABLE AND VALUABLE PAPERS AND RECORDS, THESE ADDITIONAL CONDITIONS APPLY TO THIS EXTENSION ONLY: 1. Definitions: l/aluable Papers and Records means written, Securities means all negotiable and non-negotiable instru- printed or otherwise inscribed documents and records, ments or contracts representing either Money or other prop- including books, maps,films,drawings,abstracts,deeds, erty and includes revenue and other stamps in current use, mortgages and manuscripts, but does not mean Money tokens and tickets,but does not include Money. or Securities. Loss means total or partial loss or damage. Money means currency, coins, bank notes and bullion; Premises means the interior of that portion of the building(s) and travelers checks, register checks and money orders at the location(s)designated in the Schedule of locations and held for sale to the public. limits of liability which is occupied by the Insured. AS RESPECTS VALUABLE PAPERS AND RECORDS,ONLY,THESE ADDITIONAL CONDITIONS APPLY TO THIS EXTENSION ONLY: 1. Ownership of Property; Interests Covered: The insured 2. Limits of Liability;Valuation;Settlement Options:The limit property may be owned by the Insured or held by him iin of the company's liability for Loss shall not exceed the any capacity; provided, the insurance applies only to the actual cash value of the property at time of Loss nor what interest of the Insured in such property, including the it would then cost to repair or replace the property with Insured's liability to others,and does not apply to the inter- other of like kind and quality, nor the applicable limit of est of any other person or organization in any of said insurance stated in this Coverage Part; provided, as property unless included in the Insured's proof of Loss. respects property specifically described in section b. of IN.'JORANCE FROM • • CNA i schedule paragraph 1 of this extension, the amount per the Company.The Insured or the Company,upon recovery of article specified therein is the agreed value thereof for the any such property, shall give notice thereof as soon as prac- purpose of this insurance. ticable to the other and the Insured shall be entitled to the The Company may pay for the Loss in Money or may repair property upon reimbursing the Company for the amount so or replace the property and may settle any claim for Loss of paid or the cost of replacement. the property either with the Insured or the owner thereof.Any Application of the insurance to property of more than one property so paid for or replaced shall become the property of person shall not operate to increase the applicable limit of insurance. AS RESPECTS ACCOUNTS RECEIVABLE RECORDS,NON-REPORTING FORM,ONLY, THESE ADDITIONAL CONDITIONS APPLY TO THIS EXTENSION ONLY. 1. Recoveries:After payment of loss, all amounts recovered (b)The monthly amount of accounts receivable thus by the Insured on accounts receivable for which the established shall be further adjusted in accordance Insured has been indemnified shall belong and be paid to with any demonstrable variance from that average for the Company by the Insured up to the total amount of loss the particular month in which the loss occurred, due paid by the Company;but all recoveries in excess of such consideration also being given to the normal fluctua- amounts shall belong to the Insured. tions in the amount of accounts receivable within the 2. The Determination of Receivables; Deductions: When fiscal month involved; there is proof that a loss covered by this policy has but in no event shall this Company be liable for more than the occurred but the Insured cannot more accurately estab- maximum monthly amount of accounts receivable repre- lish the total amount of accounts receivable outstanding sented by the Insured after adjustment to correspond with the as of the date of such loss, such amount shall be com- trend in average monthly gross sales and services, nor for puted as follows: more than the limit of insurance provided herein. (a)The monthly average of accounts receivable repre- There shall be deducted from the total amount of accounts sented by the Insured shall be adjusted in accordance receivable, however established, (a) the amount of such C with the percentage increase or decrease in the twelve accounts evidenced by records not lost or damaged, or oth- months average of monthly gross sales of goods and erwise established or collected by the Insured, and (b) an services which may have occurred in the interim; amount to allow for probable bad debts which would normally have been uncollectible by the Insured,(c)all unearned inter- est and service charges shall be deducted. AS RESPECTS ACCOUNTS RECEIVABLE RECORDS, REPORTING FORM, ONLY THESE ADDITIONAL CONDITIONS APPLY TO THIS EXTENSION ONLY: 1. Premium: The Insured shall, within twenty days after the amounts shall belong to the Insured. end of each fiscal month during the policy period, furnish the Company with a written statement of the total amount 3. Determination of Receivables;Deductions:When there is of accounts receivable, with deferred payments and proof that a loss covered by this extension has Occurred charge accounts segregated, as of the last day of each but the Insured cannot accurately establish the total month. amount of accounts receivable outstanding as of the date The premium stated in this extension is provisional only. of such loss,such amount shall be based on the Insured's Upon each anniversary and upon termination of this monthly statements and shall be computed as follows: extension, the sum of the monthly amounts of accounts (a.) determine the amount of all outstanding accounts receivable for the preceding twelve months shall be aver- receivable at the end of the same fiscal month in the aged and the earned premium shall be computed on such year immediately preceding the month in which the average at the rate(s)stated in this extension, whether or loss occurs; not such average exceeds the applicable limit of insur- (b) calculate the percentage of increase or decrease in ance under this policy. If the earned premium thus com- the average monthly total of accounts receivable for puted exceeds the provisional premium paid, the Insured the twelve months immediately preceding the month shall pay the excess to the Compariy;if less,the Company in which the loss occurs,or such part thereof for which shall return to the Insured the linearned portion paid by the Insured has furnished monthly statements to the the Insured, but such premium shall not be less than any Company, as compared with such average for the minimum premium stated in this policy. same months of the preceding year; 2. Recoveries:After payment of loss, all amounts recovered (c) the amount determined under(a)above, increased or by the Insured on accounts receivable for which the decreased by the percentage calculated under (b) Insured has been indemnified shall belong and be paid to above, shall be the agreed total amount of accounts the Company by the Insured up to the total amount of loss receivable as of the last day of the fiscal month in paid by the Company;but all recoveries in excess of such which said loss occurs; INSURANCE FROM CNA (d)the amount determined under (c) above shall be There shall be deducted from the total amount of accounts - increased or decreased in conformity with the normal) receivable, however established, the amount of suct� fluctuations in the amount of accounts receivable dur- accounts evidenced by records not lost or damaged, or oth- ing the fiscal month involved,due consideration being erwise established or collected by the Insured, and an given to the experience of the business since the Iasi; amount to allow for probable bad debts which would normally day of the last fiscal month for which it has been have been uncollectible by the Insured.All unearned interest rendered. and service charges shall be deducted. 00.000, ENCOMPASS SItRIES ' • INSVRI NCE FROM CNA MANDATORY ENDORSEMENT - NEW YORK It is agreed that the definition of Occurrence, Definitions Applicable to Part II of the Policy Conditions, is deleted and replaced by the following: Occurrence means an accident, including continuous or repeated exposure to conditions, which results in Bodily Injury or Property Damage neither expected nor intended from the standpoint of the Insured. G-39288-631 'ENCOMPASS SERIES • .ru 4mmA w CNA MANDATORY ENDORSEMENT - NEW YORK C Policy definition for Loading and Unloading (Policy Conditions G-39200, Definitions applicable to Part II) is deleted. C G-88211-A31 ENCOMPASS SERIES PART II — GENERAL LIABILITY CNA This endorsement modifies such insurance as is afforded by the provisions of the COMPREHENSIVE GENERAL LIABILITY INSURANCE COMPLETED OPERATIONS HAZARD AND PRODUCTS HAZARD EXCLUSION It is agreed that such insurance as is afforded by the Bodily Injury Liability Coverage and the Property Damage Liability Coverage does not apply to Bodily Injury or Property Damage included within the Com- pleted Operations Hazard or the Products Hazard. G-39265-A (ISO G-304) ENCOMPASS SERIES 0 IP 30 239 44 69 CNA The Additional Declarations and Additional Schedule Below Are For Completion Of: COMPREHENSIVE GENERAL LIABILITY INSURANCE (Combined Limits of Liability) ADDITIONAL DECLARATIONS Interest of Named Insured in such premises(check below), Location of all premises owned by,rented to or controlled by the Named Downer ❑General Lessee ❑Tenant ❑Other Insured.(Enter"same"if same locations as address shown in Item 1 of Part occupied by Named Insured(enter) Declarations) entire ADDITIONAL SCHEDULE see form G39226B RATES PROVISIONAL PREM DESCRIPTION OF HAZARDS CODE NO. PREMIUM BODILY PROPERTY BODILY PROPERTY BASIS INJURY [ DAMAGE INJURY DAMAGE Premises—Operations—Escalators (a) Area(sq ft) (a) Per 100 sq.ft.of Area (Numbers at Premises) (b)Frontage (b) Per linear ft. (c) Remunera- (c) Per$100 of Remuneration bon (e) Per landing Municipalities-borough, cities, (e) Number F (j) Per$1000 of Remuneration towns, townships, villages, etc. Insuredexp 016-91252xcu ) 6,726,533 incl. incl. incl. incl. Streets, roads or highways- with or without sidewalks-includ- ing bridges and culverts but excluding toll roads, toll bridges and draw bridges-existence only 016-92151xcu )179 incl. incl. incl. incl. Independent Contractors (g) cost (g) Per$100 of Cost (h) Number (h) Per Contract ane at inception Completed Operations—Products (d) Receipts (d) Per$1,000 of Receipts (f) Sales (f) Per$1,000 of Sales Not covered Optional Liability Extensions Medical Payments incl. Fire Legal Liability incl. Personal Injury incl. Blanket Contractual incl. incl. Broad Form Property Damage incl. Endorsement Provisional Premiums - - Total Provisional Premium incl, incl. G-39251-B (OVER) When used as a premium basis: "cost" means the total cost to the Named Insured with respect to operations performed for the Named Insured during the policy period by independent contractors of all work let or sub-let in connection with each specific project,including the cost of all labor,materials and equipment furnished,used or delivered for use in the execution of such work,whether furnished by the owner,contractor of subcontractor, including all fees, allowances, bonuses or commissions made, paid or due. "remuneration" means the entire remuneration earned during the policy period by proprietors and by all employees of the Named Insured, other than chauffeurs(except operators of Mobile Equipment and aircraft pilots and co-pilots, subject to any overtime earnings or limitation of remuneration rule applicable in accordance with the manuals in use by the Company. "receipts" means the gross amount of money charged by the Named Insured for such operations by the Named Insured or by others during the policy period as are rated on a receipts basis other than receipts from telecasting, broadcasting or motion pictures, and includes taxes,other than taxes which the Named Insured collects as a separate item and remits directly to a governmental division. "sales" means -the gross amount of money charged by the Named Insured or by others trading under his name for all goods and products sold or distributed during the policy period and charged during the policy period for installation, servicing or repair, and includes taxes,other than taxes which the Named Insured and such others collect as a separate item and remit directly to a governmental division. • IP 30 239 44 69 • ' INSURANCE FROM CNA CONTRACTORS' EQUIPMENT ENDORSEMENT Broad Form C1. Property Insured.This policy covers contractors'equipment described below or in schedule attached,which is the property of the Insured or the property of others leased, rented or borrowed by the Insured and for which the Insured is liable. Item No. Description Limits of Liability as per schedule on file with company $682,889.00 Catastrophe Limit $ 682,889.00 Deductible $ 250.00 2. Property Excluded. This policy does not cover: (a) animals, motor vehicles designed for highway use, aircraft or watercraft; (b) property while waterborne except while on ferries operating in connection with railroads or public ferries on scheduled routes; (c) property while in cofferdams or while below the ground surface in mining, tunneling or similar operations, unless specifically endorsed hereon; (d) property leased, rented or loaned :o others; (e) accounts, bills, jewelry, precious stones, currency,deeds, evidences of debt, money, notes,securities, plans, blueprints, designs or specifications; 3. Limits of Liability. The Company shall not be liable for more than the catastrophe limit indicated in the above schedule in any one loss or disaster either in case of partial or total loss or salvage charges or any other expenses or all combined. C 4. Deductible Clause. Each claim for loss or damage shall be adjusted separately and from the amount of each adjusted loss the deductible amount indicated in the above schedule shall be deducted. 5. Where Covered. This policy covers the property insured only while it is within the states of the United States, the District of Columbia (excluding Alaska and Hawaii) and the Dominion of Canada. 6. Perils Insured.This policy insures against all risks of direct physical loss of or damage to the insured property from any external cause (including general average and salvage charges) except as hereinafter excluded. 7. Perils Excluded. This policy does not insure against: (a) Delay, loss of market or use; (b) Wear and tear, gradual deterioration, inherent vice, latent defect, freezing or overheating, depreciation or obsolescence, rust, or corrosion; (c) Loss or damage caused by any repairing or restoration or remodeling process, structural or mechanical or electrical breakdown unless fire ensues and then only for the loss or damage by such ensuing fire; (d) Loss due to mysterious disappearance, or loss or shortage disclosed on taking inventory; (e) Loss, damage or expense caused by or resulting from misappropriation, secretion, conversion, infidelity or any dishonest act on the part of the Insured or other party of interest, his or their employees or agents, or any person or persons to whom the property may be entrusted (carriers for hire excepted); (f) Loss or damage occasioned by the weight of a load exceeding the registered lifting capacity of any machine under the operating conditions at the time of loss; (g) Loss by nuclear reaction or nuclear radiation or radioactive contamination, all whether controlled or uncontrolled,and whether such loss be director indirectproximate or remote,or be in whole or in part caused by, contributed to, or aggravated by the peril(s) insured against in this policy; however, subject to the foregoing and all provisions of this policy, direct loss by fire resulting from nuclear reaction or nuclear radiation or radioactive contamination is insured against by this policy; (h) Loss or damage caused by or resulting from: (1) hostile or warlike action in time of peace or war, including action in hindering, combating or defending against an actual, impending or expected attack, (a) by any government or sovereign power(de jure orde facto),or by any authority maintaining or using military,naval or airforces;or (b) by military, naval or air forces; or (c) by an agent of any such government,power,authority or forces; (2)any weapon of waremploying atomic fission or radioactive force whether in time of peace orwar; (3) insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating or defending against such an occurrence, seizure or destruction under quarantine or customs regulations, confiscation by order of any government or public authority, or risks of contraband or illegal transportation or trade. Form G-30454-C 8. Acquisition Clause. This policy is extended to cover additional items of a similar nature to those scheduled herein, the Property Insured, which items have been acquired subsequent to the attachment date and during the term of this policy. In consideration of this extension the Insured agrees to report such additions within forty-five (45) days from the date acquired and to pay premium thereon from the date acquired at pro rata of the policy rate. It is specifically understood and agreed, however, that this policy shall cease to cover such additional items if they are not reported to the Company within the said forty- five (45) day period. The Company shall not be liable under the provisions of this clause for more than the actual cash value of such property, and in no event for more than 25% of the total limit of liability under this policy on Contractors' Equipment exclusive of the provisions of this clause. 9. Coinsurance Clause. The Company shall be liable for no greater proportion of any loss or damage than the amount hereby insured bears to 100% of the actual value of the property insured hereunder at the time when such loss or damage occurs. If this policy covers two or more items, this condition shall apply to each item separately. 10. Other Insurance This insurance shall not apply to any loss except as excess insurance where any other valid and collectible insurance exists at the time of loss or damage whether prior or subsequent hereto as to date and whether fire or inland marine or casualty or any other kind of insurance in the name of the Insured or others on any property hereby insured, and this insurance shall not apply or contribute to the payment of any loss until the amount due from all such other insurance shall have been exhausted; it being understood and agreed that under this policy the Insured is to be reimbursed to the extent of the difference between the amount due from such other insurance and the amount of actual loss sustained by the Insured after applying any and all contribution, coinsurance, average or distribution clauses contained in such other policies of insurance not exceeding, however, the applicable limit or limits as specified in this policy. 11. Assignment of Policy. This Policy shall be void if assigned or transferred without the written consent of the Company. 12. Impairment of Recovery Rights Against Carriers. Any act or agreement by the Insured, prior or subsequent hereto, whereby any right of the Insured in the event of loss or damage to recover the full value of or amount of damage to any property insured hereunder against any carrier, is released, impaired or lost, shall render this policy null and void as to such loss but the Company's right to retain or recover the premium shall not be affected. It shall, however, be permissible for the Insured, without prejudice to this insurance, to accept the ordinary bills of lading issued by common carriers. The Company is not liable for any loses or damage which, without its consent has been settled or compromised by the Insured. 13. The amount of insurance provided by this policy shall not be reduced by any loss hereunder except that insurance on any scheduled item of property shall be canceled by a total loss thereto and pro rata return premium shall be payable thereon. The terms and conditions of this form wherein they conflict are to be regarded as additional to those of the policy to which it is attached and so far as they are inconsistent therewith are to supersede the same. INSURANCE FROM IP 30 23.9 44 69 CNA COMMERCIAL INLAND MARINE PROPERTY FLOATER BROAD FORM 1. Property Insured. This policy covers property of the Insured or property of others for which the Insured is legally liable all as described below or in attached endorsements. (a) Unscheduled property consisting of (but not exceeding $250 per article) (DESCRIBE PROPERTY IN FULL) Limits of Liability (b) Scheduled Property as described below or in attached endorsements. Item No. Description Limits of Give makers name, model, serial no. where applicable Liability Privateer Boat— in length with . equipment 36,000.00 2 1966 Boston Whaler 13' in length with equipment 2 000.00 3 196 Boston Whaler 13' in length 2 4 1969 Well Craft r in length with equipment Catastrophe Limit $ 42,500.00 Deductible $ 5A0 00 2. Property excluded. This policy does not cover: (a) Accounts, bills,jewelry, precious stones, currency, deeds, evidences of debt, money, notes, securities, plans, blueprints, designs, specifications; (b) Animals, vehicles licensed for highway use, aircraft, watercraft. 3. Limits of Liability. The Company shall not be liable for more than the catastrophe limit indicated in the above schedule in any one loss or disaster either in case of partial or total loss or salvage charges or any other expenses or all combined. 4. Deductible Clause. Each claim for loss or damage shall be adjusted separately and from the amount of each adjusted loss the deductible amount in the above schedule shall be deducted. 5. Where Covered. This policy covers the property in and in transit anywhere within and between Continental United States of America and Canada (but excluding inter-coastal shipments via the Panama Canal and coastwise shipments to or from Alaska), and in, and in transit anywhere within the States of Hawaii, Alaska and territories or possessions of the United States of America. 6. Perils Insured. This policy insures against all risks of direct physical loss of or damage to the property insured from any external cause, including general average and salvage charges, except as hereinafter excluded. 7. Perils Excluded. This policy does not insure against loss or damage caused by or resulting from: (a) Delay, loss of market or use,wearand tear,gradual deterioration,depreciation, insects,vermin, inherent vice, mechanical or structural breakdown or failure. (b) Misappropriation, secretion, conversion, infidelity or any dishonest act on part of the Insured or other party of interest, his or their employees or agents, or others to whom the property may be entrusted (carriers for hire excepted). (c) Mysterious disappearance or loss or shortage disclosed on taking inventory. (d) Leakage, breakage, marring, scratching, dampness of atmosphere, dryness of atmosphere, extremes or changes of temperature, shrinkage, evaporation, loss of weight, rust, contamination, change in color, flavor, texture or finish, unless such loss or damage is caused directly by fire, lightning, windstorm, hail, explosion, riot or civil commotion, aircraft, vehicles other than the conveyances actually transporting the property insured, bursting of pipes or apparatus, vandalism, malicious mis- chief, theft, attempted theft, collision, derailment, upset or overturn of the transporting conveyances. G-30421-D • (e) Flood, except while in transit or custody of common carrier, but this exclusion shall not apply to loss or damage caused by ensuing fire, theft or explosion not otherwise excluded by this policy. The term flood will include inundation, surface waters, waves, tide or tidal waters, the rising, overflowing or breakage of boundaries of lakes, ponds, reservoirs, rivers, harbors, streams, and similar bodies ofr water, including the backing up of sewers and drains resulting from any of the foregoing, all whether wind driven or not, and water below the surface of the ground which damages the building or which seeps or leaks into the building, caused by natural sources. (f) Earthquake, or earth movement, including but not limitpd to landslide, mudflow, earth sinking, earth rising or shifting, subsidence or frost heaving; Volcanic explosion or eruption including resulting ash or dust; except while in transit or custody of a common carrier. (g) Any process or loss or damage which arises while the property insured is actually being worked upon and results therefrom unless fire or explosion ensues and then only for the loss or damage caused by the ensuing fire or explosion. — (h) Short circuit or electrical disturbance of any kind (exclusive of lightning) within any electrically equipped unit unless fire ensues and then only for the loss or damage caused by the ensuing fire. (i) Nuclear reaction or nuclear radiation or radioactive contamination, all whether controlled or uncon- trolled, and whether such loss be direct or indirect, proximate or remote, or be in whole or in part caused by, contributed to, or aggravated by the peril(s) insured against in this policy; however, subject to the foregoing and all provisions of this policy, direct loss by fire resulting from nuclear reaction or nuclear radiation or radioactive contamination is insured against by this policy. (j) Hostile or warlike action in time of peace or war, including action in hindering, combating or defending against an actual, impending or expected attack, (A) by any government or sovereign power (de jure or de facto), or by any authority maintaining or using military, naval or air forces, or (B) by military, naval or air forces; or (C) by an agent of any such government, power, authority or forces; (2) any weapon of war employing atomic fission or radioactive force whether in time of peace or war; (3) insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating or defending against such an occurrence, seizure or destruction under quar- antine or Customs regulations, confiscation by order of any governmental or public authority, or risks of contraband or illegal transportation or trade. 8. Coinsurance Clause. This Company shall be liable for no greater proportion of any loss or damage than the amount hereby insured bears to 100% of the actual value of the property insured hereunder at the time when such loss or damage occurs. If this policy covers two or more items, this condition shall apply to each item separately. 9. Other Insurance. This insurance shall not apply to any loss except as excess insurance where any other valid and collectible insurance exists at the time of loss or damage whether prior or subsequent hereto as to date and whether fire or inland marine or casualty or any other kind of insurance in the name of the Insured or others on any property hereby insured, and this insurance shall not apply or contribute to the payment of any loss until the amount due from all such other insurance shall have been exhausted; it being understood and agreed that under this Policy the Insured is to be reimbursed to the extent of the difference between the amount due from such other insurance and the amount of actual loss sustained by the Insured after applying any and all contribution, coinsurance, average or distribution clauses contained in such other policies of insurance not exceeding, however, the applicable limit or limits as specified in this Policy. 10. Assignment of Policy. This Policy shall be void if assigned or transferred without the written consent of the Company. 11. Impairment of Recovery Rights Against Carriers. The Company shall not be bound to pay any loss if the Insured shall have impaired any right of recovery for loss to the property insured. However, it is agreed that the Insured may release others, in writing, from liability for loss prior to loss. Such release shall not affect the right of recovery of the insured under this policy. As respects property in transit, if covered under this policy, the Insured may, without prejudice to this insurance, accept: such bills of loading, receipts or contracts of transportation as are ordinarily issued by carriers containing a limitation as to the value of such goods or merchandise. This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: Comprehensive General Liability Insurance. Exclusion (Firemen Operations) It is agreed that this policy does not apply to the personal injury, bodily injury or property damage arising out of Firemen Operations conducted by the named inured. This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec- tive date is shown below. Complete Only When This Endorsement Is Not Prepared with the Policy Must Be Completed Or Is Not to be Effective with the Policy ENDT.NO. POLICY NO. ISSUED TO EFFECTIVE DATE OF 1 IP 30 239 44 69 THIS ENDORSEMENT INSURANCE FROM CNA Countersigned by Authorized Representative G-39543-A EXCLUSION (LAW ENFORCEMENT OPERATIONS) It is agreed that this policy does not apply to personal injury, bodily injury or property damage arising out of (1) the acts or omissions of the police officers, sheriffs or their deputies, bailiffs or — any other law enforcement personnel or (2) the ownership, maintenance, use or operation of any incarceration or detention facility, but this exclusion does not apply to bodily injury or property damage arising out of injury to a person or his property because of defects in, or operation on, premises used for law enforcement, incarceration or detention purposes if such person is not incarcerated or detained at the time injury or damage occurs, or is not in the process of being detained or incarcerated. This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec- tive date is shown below. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to he Effective with the Policy ENOT.NO. POLICY NO. ISSUED TO EFFECTIVE DATE OF 2 IP 30 239 44 69 THIS ENDORSEMENT WSURANCF FROM CNA Countersigned by Authorized Representative G-39543-A ENCOMPASS SERIES IP 30 239 44 69 COVERAGE PART IM C , ,~CNA INLAND MARINE All conditions in Policy Conditions G-39200 which apply exclusively to Part I are deleted, as respects this Coverage Part. The conditions which follow, including conditions contained in any form or endorsement designated below, apply. Coverage on the described property under this Coverage Part supersedes and replaces any other coverage under Part I which would otherwise apply. With respect to any form or endorsement attached to this Coverage Part, the term "policy" shall mean "Coverage Part." Coverage is provided as described below or in the schedule attached. DESCRIPTION OF PROPERTY: Contractors Equipment and Property Floater Forms and endorsements applicable to this Coverage Part: G30454 and G30421 CONDITIONS 1. Notice of Loss. The Insured shall as soon as beyond the actual cash value of the property practicable report in writing to the Company at the time any loss or damage occurs and the or its agent every loss, damage or occurrence loss or damage shall be ascertained or esti- which may give rise to a claim under this mated according to such actual cash value Coverage Part and shall also file with the Com- with proper deduction for depreciation, how- pany or its agent within ninety (90) days from ever caused, and shall in no event exceed date of such loss, damage or occurrence, a what it would then cost to repair or replace the detailed sworn proof of loss. same with material of like kind and quality. 2. Examination Under Oath. The Insured shall, 4. Settlement of Loss. All adjusted claims shall and insofar as is within his power the Insured be paid or made good to the Insured within shall cause his employees, members of the thirty (30) days after presentation and accep- household or others to: tance of satisfactory proof of interest and loss a. submit to examinations under oath; at the office of the Company. No loss shall be paid or made good if the Insured has collected b. exhibit all that remains of damaged the same from others. property; 5. No Benefit to Bailee. This insurance shall in c. produce for examination all writings, no wise inure directly or indirectly to the bene- books of accounts, bills, invoices and fit of any carrier or other bailee. other vouchers. 6. Subrogation or Loan. If in the event of loss or Such examinations shall be conducted by the damage the Insured shall acquire any right of Company or its authorized representative at such action against any individual, firm or corpora- reasonable time and place designated by the Com- tion for loss of or damage to, property covered pany or its representative. No examination or other hereunder,the Insured will, if requested by the act of the Company or its representative in the Company, assign and transfer such claim or investigation of any loss or claim shall be deemed right of action to the Company or, at the Com- a waiver of the Company's rights of defense or pany's option, execute and deliver to the recovery. Company the customary form of loan receipt upon receiving an advance of funds in respect 3. Valuation. The Company shall not be liable of the loss or damage; and will subrogate the G-41099-A Company to, or will hold in trust for the Com- the Company shall not be considered or held pany, all such rights of action to the extent of to be either a waiver or an acceptance of the amount paid or advanced, and will permit abandonment. suit to be brought in the Insured's name under 10.. Suit. No suit, action or proceeding for the the direction of and at the expense of the recovery of any claim under this Coverage Company. Part shall be sustainable in any court of law 7. Loss Clause. Any loss hereunder shall not or equity unless the same be commenced reduce the amount of this Coverage Part, within twenty-four (24) months next after dis- except in the event of payment of claim for covery by the Insured of the occurrence which total loss of an item specifically scheduled gives rise to the claim, provided however, that hereon. If claim is paid for total loss of one or if by the laws of the State within which this more scheduled items, the unearned premium Coverage Part is issued such limitation is applicable to such items will be refunded to invalid, then any such claims shall be void the Insured or applied to the premium due on unless such action,suit or proceeding be com- item(s) replacing those on which the claim menced within the shortest limit of time per- was paid. mitted by the laws of such State. 8. Pair, Set or Parts. In the event of loss or dam- 111. Appraisal. If the Insured and the Company age to: fail to agree as to the amount of loss, each shall, on the written demand of either, made a. any article or articles which are a part of within sixty (60) days after receipt of proof of a pair or set, the measure of loss or dam- loss by the Company, select a competent and age to such article or articles shall be a disinterested appraiser, and the appraisal reasonable and fair proportion of the total shall be made at a reasonable time and place. value of the pair or set, giving considera- The appraisers shall first select a competent tion to the importance of said article or and disinterested umpire,and failing for fifteen articles, but in no event shall such loss or (15) days to agree upon such urripire,then, on damage be construed to mean total loss of the request of the Insured or the Company, the pair or set; or such umpire shall be selected by a judge of a b. any part of property covered consisting, court of record in the State in which such when complete for use, of several parts, appraisal is pending.The appraisers shall then the Company shall only be liable for the appraise the loss stating separately the actual value of the part lost or damaged. cash value at the time of loss and the amount of loss, and failing to agree shall submit their 9. Protection of Property. In case of loss,the differences to the umpire. An award in writing Insured shall use all lawful and proper efforts of any two shall determine the amount of loss. for the defense, safeguard and recovery of the The Insured and the Company shall each pay property covered, without prejudice to this his or its chosen appraiser and shall bear insurance. The expense so incurred shall be equally the other expenses of the appraisal borne by the Insured and the Company pro- and umpire. The Company shalt not be held portionately to the extent of their respective to have waived any of its rights by any act interests. The acts of either the Insured or relating to appraisal. Val Stype & Sons Inc. 015115 732 do Policy premium of $90,000.00 for period 01/01/85 to 01/01/86 is payable as follows: 01/01/85 $22,500.00 _ 04/01/85 22,500.00 07/01/85 22,500.00 10/01/85 22,500.00 t This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec- tive date is shown below. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to he Effective with the Policy ENDT.NO. POLICY NO. ISSUED TO EFFECTIVE DATE OF THIS ENDORSEMENT 3 IP 30 239 44 69 Southold Township 014/01/85 01/01/88 CNA LFor All the Commitments You Make" Countersigned by Authorized Representative G-39543-A WSUAW""E'"(W CNA INSURANCE COMPANIES CNA Me ill,, L oflow Road Melville, Long Island, New York 11747 Dear Policyholder: According to the General Municipal Law of the State of New York, Section 168-1 and Section 209-u, you must report the presence of hazardous materials on your premises to your local fire department. The attached form is supplied by CNA through the Office of Fire Prevention and Control for the State of New York. You must utilize this form to report these hazardous materials. Please real the instructions on page 1 carefully. Table 1 gives examples of which materials must be reported. These forms must be completed annually by all insureds who have a fire insurance policy and who conduct business in the State of New York. If you should have any questions regarding this procedure, please contact your agent who will have received similar information from our Loss Control Department. This information is not for use by the insurer. Do not return these forms to the company or to your agent. Instead, please submit these forms to your local fire department authority as specified in the instructions. Thank you for your cooperation. ��of NEiG NEW YORK STATE DEPARTMENT OF STATE 0 %: OFFICE OF FIRE PREVENTION AND CONTROL `* *` HAZARDOUS MATERIALS REPORT FORM (General Municipal Law, §209•u) 7,pr�EN. OF S,C* The information entered herein is essential to your local fire chief for the protection of your employees, the fire- fighters and citizens in the immediate area, and to reduce damage to your property in the event of a fire or an emergency. Every fire insurance policyholder, engaged in commerce in this state, is required by law to report the presence of hazardous materials at their business address. Failure to file in accordance with the provisions of section 209-u of the General Municipal Law could result in a fine. A separate report is required annually for each business address. WHEN COMPLETED,THIS FORM MUST BE SENT TO YOUR LOCAL FIRE DEPARTMENT. Hazardous Materials Location' Firm Name Street Add.Only Bus.Add. Bldg.Name or No. City,State,Zip City,State,Zip Tel.No. Policy Anniv.Date Name of Emergency Contact Bus.Tel. Home Tel. (Signature and Title of Person Completing Form) 'It is suggested that a separate form be filled out for each building that contains hazardous materials. EXEMPTIONS Requests for exemptions from this law must be made in writing, attached to this form, and filed annually with your local fire department not later than the anniversary date of your policy. All exemptions approved shall expire on the next policy anniversary date. Exemptions denied shall require that the insured file a completed hazardous materials report form within 15 days of denial. FOR FIRE DEPARTMENT USE ONLY Exemptions: Approved Denied Additional Information Needed (Date) (Signature of Fire Chief) (Fire Department Name and Address) (Print Name of Fire Chief) F100965-001(4/82) New York State Department of State,Office of Fire Prevention and Control V Hazardous Material Listing (attach01tional sheets if necessary) Note: Definitions of symbols are on the second page of the instruction sheet. Identifying Total Identifying Total Symbol Material Description&Proper Shipping Name Amount Symbol Material Description&Proper Shipping Name Amount ,E XPLOSIVE' <BLASTIN \AGENT/ POISON GAS OXIDIZER — POISON 0IGNIC PEROXIDE >1 4r FLAMMABLE 7RADIOACTIVE LIQUID Y � COMBUSTIBLE I. LIQUID FLAMMABLE DANGEROUS SOLID WHEN WET FLAMMABLE ETIOLOGIC AGENTS OMEAL MATERIA GAS 0 N CASE OF DAMAGEL OR LEAKAGE NOTIFY DIRECTOR CDC ATLANTA,GEORGIA 404/633-5313 VI Special Considerations/Remarks: NEW YORE;STATE DEPARTMENT OF STATE n °a :_ OFFICE OF FIRE PREVENTION AND CONTROL HAZARDOUS MATERIALS REPORT FORM t. (General Municipal Law, §209-u) The information entered herein is essential to your local fire chief for the protection of your employees, the fire- fighters and citizens in the immediate area, and to reduce damage to your property in the event of a fire or an emergency. Every fire insurance policyholder, engaged in commerce in this state, is required by law to report the presence of hazardous materials at their business address. Failure to file in accordance with the provisions of section 209-u of the General Municipal Law could result in a fine. A separate report is required annually for each business address. WHEN COMPLETED,THIS FORM MUST BE SENT TO YOUR LOCAL FIRE DEPARTMENT. (Hazardous Materials Location' Firm Name _ Street Add.Only Bus.Add. _ _ ___ _ Bldg.Name or No. City,State,Zip _ _ . City,State,Zip Tel.No. _ . Policy Anniv.Date Name of Emergency Contact Bus.Tel. _Home Tel. (Signature and Title of Person Completing Form) 'It is suggested that a separate form be filled out for each building that contains hazardous materials. EXEMPTIONS Requests for exemptions from this law must be made in writing, attached to this form, and filed annually with your local fire department not later than the anniversary date of your policy. All exemptions approved shall expire on the next policy anniversary date. Exemptions denied shall require that the insured file a completed hazardous materials report form within 15 days of denial. FOR FIRE DEPARTMENT USE ONLY Exemptions: Approved _ Denied ,Additional Information Needed (Date) (Signature of Fire Chief) (Fire Department Name and Address) (Print Name of Fire Chief) F100965-001(4182) New York State Department c State,Office of Fire Prevention and Control •Instructions for Hazardous Material Listil# Identifying Symbol: This area identifies different classes of hazardous material. Most material will fall within one of these classes. If a particular material falls within two or more classes,it should be listed in each applicable class. Two additional boxes are provided for material that does not fall within any class.These boxes may also be used if addi- tional space is needed to further identify previously listed categories. Amounts to be reported are shown in Table 1 below. NOTE: SHIPPING AND PACKAGING LABELS MAY BE OF ASSISTANCE IN IDENTIFYING THE CLASS OF MATERIAL. Hazardous Material Description and Proper Shipping Name This area is reserved for the description and name of any hazardous material within a given class. If there is more than one material within a certain class, at a given location, then the most prevalent or most common should be used (indicate "most common"). — Total Amount List the total amount of reportable material within the given class. If the amounts vary from day to day,then the average amount should be listed. Identifying Hazardous Material Description Total Symbol and Proper Shipping Name Amount 0\ Ethyl Chloride 60 gals. most common FLAMMABLE LIQUID Special Considerations/Remarks This area is reserved for the policyholder and the fire chief for making any notes or comments they feel are pertinent. Several examples are listed below: 1. Building has a sprinkler system. 2. Adjacent building is a school. 3. Guard dogs are on the premises from 6:00 p.m.to 6:00 a.m. 4. Hazardous material amounts may vary greatly from day to day. 5. Poor water supply. 6. Access to the building is poor. 7. Flammable liquid is stored in the same building as oxidizer. Table 1 Amounts to be Reported 1. Explosives and Blasting Agents-any amount 8. Oxidizer-over 50 pounds 2. Poison Gas-any amount 9. Organic Peroxide-over 10 pounds 3. Poison and Irritant-any amount 10. Combustible Liquid - over 25 gallons inside a 4. Flammable Liquid -over 5 gallons inside a building building and over 60 gal- and over 10 gallons outside a Ions outside a building building 11. Radioactive Material-any amount 5. Flammable Solid-any amount 12. Corrosive Material -over 55 gallons 6. Flammable Gas-over 2,000 cubic feet at normal 13. Dangerous When Wet Material- any amount temperature 14. Etiologic Material- any amount 7. Nonflammable Gas-over 6,000 cubic feet at normal temperature (OVER) F100965.001(4182) New York State Department of State,Office of Fire Prevention and Control • Hazardous Material Definitions • The following definitions have been abstracted from the Code of Federal Regulations,Title 49-Transportation,Parts 100 to 199.Refer to the referenced sections for complete details. NOTE: Rulemaking proposals are outstanding or are contemplated concerning some of these definitions. Hazardous Material - Means a substance or material which has been determined by the Secretary of Transportation to be capable of posing an unreasonable risk to health,safety and property,when transported in commerce,and which has been so designated.(Sec.171.8) Multiple Hazards-A material meeting the definitions of more than one hazard class is classed according to the sequence given in Sec. 173.:2. HAZARD CLASS DEFINITIONS EXPLOSIVES An Explosive - Any chemical compound, mixture or device, the primary or common purpose of which is to function by explosion,i.e.,with substantially instantaneous release of gas and heat,unless such compound,mixture or device is otherwise specifically classified in Parts 170-189. (Sec. 173.50) CLASS A Detonating or otherwise of maximum hazard.The nine types of Class A explosives are defined in Sec. EXPLOSIVE 173.53. CLASS B In general,function by rapid combustion rather than detonation and include some explosive devices EXPLOSIVE such as special fireworks,flash powders,etc.Flammable hazard. (Sec.173.88) CLASS C Certain types of manufactured articles containing Class A or Class B explosives,or both, as compo- EXPLOSIVE nents but in restricted quantities,and certain types of fireworks.Minimum hazard. (Sec.173.100) BLASTING A material designed for blasting which has been tested in accordance with Sec. 173.114a(b) and AGENTS found to be so insensitive that there is very little probability of accidental initiation to explosion or of transition from deflagration to detonation.(Sec.173.114a(a)) COMBUSTIBLE Any liquid having a flash point above 100°F. and below 200°F. as determined by tests listed in Sec. LIQUID 173.115(d).Exceptions to this are found in Sec.173.115(b). CORROSIVE Any liquid or solid that causes visible destruction of human skin tissue or a liquid that has a severe MATERIAL corrosion rate on steel.See Sec.173.240(a)and(b)for details. FLAMMABLE Any liquid having a flash point below 100°F.as determined by tests listed in Sec.173.115(d).Excep- LIQUID tions are listed in Sec.173.115(a). COMPRESSED Compressed Gas - Any material or mixture having in the container a pressure exceeding 40 psia at GAS 70°F., or a pressure exceeding 104 psia at 130°F.;or any liquid flammable material having a vapor pressure exceeding 40 psia at 100°F.(Sec.173.300(a)) FLAMMABLE Any compressed gas meeting the requirements for lower flammability limit,flammability limit range, GAS flame projection,or flame propagation criteria as specified in Sec. 173.300(b). NONFLAMMABLE Any compressed gas other than a flammable compressed gas. GAS FLAMMABLE Any solid material,other than an explosive,which is liable to cause fires through friction, retained SOLID heat from manufacturing or processing, or which can be ignited readily and when ignited burns so vigorously and persistently as to create a serious transportation hazard. (Sec. 173.150) ORGANIC An organic compound containing the bivalent-0-0 structure and which may be considered a deriva- PEROXIDE tive of hydrogen peroxide where one or more of the hydrogen atoms have been replaced by organic radicals must be classed as an organic peroxide unless...(See Sec.173.151(a)for details) OXIDIZER A substance such as chlorate,permanganate,inorganic peroxide,or a nitrate,that yields oxygen readi- ly to stimulate the combustion of organic matter.(See Sec.173.151) POISON A Extremely Dangerous Poisons- Poisonous gases or liquids of such nature that a very small amount of (Poison Gas) the gas,or vapor of the liquid,mixed with air is dangerous to life. (Sec. 173.326) POISON B Less Dangerous Poisons Substances, liquids, or solids (including pastes and semi-solids),other than (Poison) Class A or Irritating materials,which are known to be so toxic to man as to afford a hazard to health during transportation;or which, in the absence of adequate data on human toxicity,are presumed to be toxic to man.(Sec. 173.343) IRRITATING A liquid or solid substance which upon contact with fire or when exposed to air gives off dangerous MATERIAL, or intensely irritating fumes,but not including any poisonous material,Class A. (Sec. 173.381) ETIOLOGIC An "etiologic agent"means a viable micro-organism,or its toxin which causes or may cause human AGENT disease. (Sec.173.386) (Refer to the Department of Health,Education and Welfare Regulations,Title 42,CFR,Sec.72.25(c)for details.)- RADIOACTIVE Any material, or combination of materials,that spontaneously emits ionizing radiation,and having a MATERIAL. specific activity greater than 0.00:2 microcuries per gram. (Sec.173.389)NOTE:See Sec. 173.389(a) through(1)for details. WATER REACTIVE Means any solid substance(including sludges and pastes)which,by interaction with water,is likely to MATERIAL. become spontaneously flammable or to give off flammable or toxic gases in dangerous quantities. (SOLID) * Val Stype & Sons Inc. 015115 732 dhm • It is agreed that as respects to Part One the limits have been amended as follows: Location #1 increase building to $1,100,000.00 #2 11 1 15,000.00 #3 11 150,000.00 #4 120,000.00 #5 1310,000.00 #5 itcontents " 30,000.00 #6 building 35,000.00 #7 11375,000.00 - #7 contents 100,000.00 #8 building 40,000.00 #9 150,000.00 #10 " 21,000.00 411 " " 20,000.00 411 " contents " 10,000.00 #12 " building " 275,000.00 #14 " 325,000.00 Total additional New York State Fire Insurance Fee - $58.81 annually 45,88 prorate This endorsement is a part of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. PoLICY N0. I ISSUED TO 15 '10 39 44 6 The Town of Southold etal EFFECTIVE DATE OF CHANGE 03/26/86-01/01/88 X ADDITIONAL OR 0RETURN $ 4799.00 SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT rX ADDITIONAL OR ❑RETURN REVISED INSTALLMENT(S) 2 $ $ $ 3 $ 181,109-00 $ 6228.00 $ CNA - For All the Commitments You Make"' Countersigned by Authorized Agent G-41332-A s,Val Stype & Sons Inc. 015115 7.30 do h CNA INSURANCE COMPANIES ANNUAL RERATE ENDORSEMENT It is hereby agreed that the premium adjustment shown below is for the policy period effective 01/01/86 to 01/01/88 The total premium for the period 01/01/86 to 01/01/87 is $181,109. , subject to rerate for the period 01/01/87 to 01/01/88. New York State Fire Insurance fee $127.14 Forms SR6056, SR6057 & SR5957 are deleted. Premium payable as follows: 01/01/86 $45,278.00 04/01/86 45,277.00 07%01/86 45,277.00 10/0,1/86 45,277.00 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. CONTD. ENDORSEMENT N0. POLICY N0. ISSUED TO 13 IP 30 239 44 69 T EFFECTIVE DATE OF CHANGE ADDITIONAL OR LJ RETURN 01/01/86 - 01/01/88 $ 89,341.00 SUBSEQUENT ANNIV. DATES PREV. INST. x ADD'L OR RETURN REVISED INST. 2 $ s- $ 3 01/01/87 $ 91,768.00[ $ 89 341.00 $ Countersigned by 4_t4/) �,(, Authorized-Agerfe G-41332-A CNA For All the Commitments You Make* *(office) — Ha2 Grade 1 • Loc. #1 - Town Hall-Frame-0701-PC7-9 15996 sq. ft. $864,000.00 Contents 75,000.00 (recreational) Ha2 Gr. 5 Loc. #2 - Beach House Toilets - 0844 - Brick - PC-7-9 11,000.00 (dog kennel) Ha2 Gr. 4 Loc. #3 - Animal Shelter (Lessors Risk) 0570-Brick PC7-9 38,000.00 Ha Gr. 4 Loc. #4 - Animal Shelter (Lessors Risk) 0570 brick PC7-9 11,000.00 (storage) Ha2 Gr. 3 10,000 sq. ft. Loc. #5 - Land fill storage bldg. -1211-non-comb. PC7-9 238,000.00 Contents 10,000.00 (laboratories) Ha2 Gr. 3 Loc. #6 - Equipment testing bldg. - 0922-brick PC9 27,000.00 Ha2 Gr. 3 11,207 sq. ft. Loc. #7 - Garage & office-0933-brick PC7-9 216,000.00 25,000.00 Contents Ha2 Gr. 3 Loc. X68 - Storage & Garage-0933-frame PC7-9 27,000.00 Contents 15,000.00 Ha2 Gr. 3 5307 sq. ft. Loc. #9 - Garage-0933-brick PC7-9 65,000.00 25,000.00 Contents Ha2 Gr. 3 Loc.#10 - Lawn mower repair 0933-frame PC7-9 19,000.00 Contents 7,000.00 Ha2 Gr. 4 Loc.#ll - Salt storage-1211-frame PC7-9 1 5,000.00 Contents 5,000.00 Loc.#12 - Police station-brick 0701 PC7-9 4000 sq. ft. 194,000.00 50,000.00 Contents Loc.#13 - Radio tower special class item #27 1190 PC7-9 4,000.00 Loc. #14 - Senior Citizen 0844 non-comb. PC7-9 Ha2 Gr. 5 6950 sq. ft. 216,000.00 15,000.00 Contents This endorsement is apart of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. POLICY NO. ISSUED TO Town of -- EFFECTIVE DATE OF CHANGE ❑ADDITIONAL OR ❑RETURN 01/01/86 s SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT ;ADDITIONAL OR ;RETURN REVISED INSTALLMENT(S) 2 $ $ $ 3 ; $ $ C/1/A Countersigned by -- -- For All the Commitments YOU Make"' Ruthonzed nt G-41332-A INSURANCE FROM .� `1 CONTINENTAL CA Y COMPANY 5 CNA CASUALTY OF CALIFORO 8 AMERICAN CASUALTY CO. OF READING. F 2 TRANSPORTATION INS. CO. 6 NATIONAL FIRE INS. CO. OF HARTFORD 9 VALLEY FORV INS. CO. 4 COLUMBIA CASUALTY CO. 7 TRANSCONTINLNTAL ISIS. CO. 5 CNA CASUALTY OF PUERTO RICO I The Town of Southold POLICY NUMBER: IP 30 239 44 69 Main Street POLICY PERIOD: 1/l/85 TO 1/1/88 I Southold, NY 11971 AUDIT PERIOD: 1/1/85 TO 1/1/86 LOPS __j PRODUCER NUMBER: 015115PRODUCER NAME: e & Sons Inc. rrKIT= Stype INTER- S/R I P/R PR RESP I POL TYP I BR.CODE I FINAL INT EXP PART RETRO CO.NO. 3 YR F/R STATE 59 31 730 X 1 1 RISK RATE PAGE STATE CLASS CODE CLASSIFICATION DESCRIPTION EXPOSURE WC or BI PROP/PD WC/BI PREM PROP/PD PRI NY Part II 31 OL & T 91252 Municipalities 7355482 5.33 3.40 39205 25009 92151 Streets, Roads or Hwys. 179 1138 716 Products 58259 Restaurant 7000 .659 .044 MP 36 MP 48 GLEE 15% 40379. 25773. 6057 3866 Total 46436 29639 Balance of Coverages as written and endorsed Prev. Chg. Total includes Part II only i I DATE AUDITED LINE ADDITIONAL RETURN EARNED 2/14/86 SJP PREMUM 76075 DATE REVIEWED PREVIOUSLY 2/27/86 PAS CHARGED 78439 DATE TD 2364 ADDITIONAL 3/10V6DJP PREMIUM CH KE BYA E ' RETURN �� PREMIUM 2364 In consideration of the additional premium the following is hereby added to contractors equipment: Komatsu W120-3 SIN 50212 with: Komatsu SA6D110 turbo charged after cooled direct injection 6 cylinder diesel engine with 200 HP, 24 volt starting system, 35 amp alternator. Powershift trnasmission with 3 speeds forward and reverse. Tour wheel drive full floating front axel. Fenders. 23. 5x25 XRAT Michelin Radial tires. 4 Wheel brakes, parking brake and emergency brakes. Air dryer. ROPS cab with wiper, heater, defroster. Backup alarm. Front and rear work lights, mirrors, front and rear wipers and washers. Seat belt. 4.3 cubic yard general prpose bucket with bolt-on edge, automatic bucket positioner and lift kick out. t 3 year 5000 hour Komatsu warrenty. Actual Cash Value 1 year parts and labor warranty. $110,000.00 This endorsement is a part of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. 12 of Y 30 239 44 69 ISTheTTown of Southold etal EFFECTIVE DATE OF CHANGE X ADDITIONAL OR L7 RETURN 10/17/85 - 01/01/88 S 229 SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT X ADDITIONAL OR L';RETURN REVISED INSTALLMENT(S) 2 01/01/86 $ 91 506.00 $ 1.100.00 $ 92,606-00 3 01/01/87 $ 91,506.00s s ��A /� For All the Commitments You Make', Countersigned by K Authorized ent G-41332-A t In consideration of the additional premium contractors equipment — computerized fuel recorder, #C24 1000TMP1 costing $16,250.00 and located in item X67 on the west side of Peconic Lane, Peconic, NY is added. This endorsement is apart of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. 11 IpCY3o 239 44 69 IThe Town of_South o J-dtal EFFECTIVE DATE OF CHANGE ]ADDITIONAL OR ❑RETURN 08/30/85 - 01/01/88 $ 55.00 SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT XADDITIONAL OR RETURN REVISED INSTALLMENT(S) 2 01/01/86 $ 91 .343,OO_ $ $ 91506 s 0 $ $ .00 $ 91 ,506.00 For All the Commitments You Make" Countersigned by Auu t4,eent G-41332-A It is hereby agreed the following additional insured is added to Section I property only. County of Suffolk as additional insured with respects to Property Coverage only at Location #6 N/S Route 48 Cutchogue, NY This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec- tive date is shown below. Complete Only When This Endorsement Is Aot Prepared with the Poliev Must Be Completed Or Is Not to be Effective with the Policy ENDT.NO. POLICY NO. ISSUED TO EFFECTIVE DATE OF THIS ENDORSEMENT 10 IP 30 239 44 69 The Town of Southold etal 04/04/85 01/01/88 INSURANCE FROM CNA Countersigned by Authorized Rdpfesentative G-39543-A r • 0 Val Stype & 5ons Inc. 01517-. 730 do It is hereby agreed Boat Coverage on Property Floater G30421D is deleted. This endorsement is a part of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. POLICY NO. ISSUED TO 9 lip '10 939 44 9 ha Town of EFFECTIVE DATE OF CHANGE ❑ADDITIONAL OR fX RETURN 01/22/85 - 01/01/88 $ SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT El ADDITIONAL OR CXRETURN REVISED INSTALLMENT(S) 2 ; $ $ 91 -343-00 3 $ 91.768.00 $ $ Cera For All the Commitments You Make`"' Countersigned by Authorized A ent G-41332-A Val Stype & Sons Inc. 015115 730 do As respects to Part I - Inland Marine _ Item #5 is added as follows: W.H.O. Tub Grinder S#601 with engine caterpillar diesel #67410619 value $112,000.00 This endorsement is a part of your policy and takes effect on the effective date of your policy,unless another effective date is shown below. ENDORSEMENT NO. POLICY NO. ISSUED TO 8 IP 30 239 44 69 EFFECTIVE DATE OF CHANGE 07 17 8 S ADDITIONAL OR ❑RETURN 01/01/88 SUBSEQUENT ANNIVERSARY DATES PREVIOUS INSTALLMENT X ADDITIONAL OR []RETURN REVISEDINSTALLMENT(S) 2 $ $ 1120.00 $ 91.768.00 3 �37 s $ E INSURANCE FROM ��A Countersigned by _ Au horiz ent g G-41332-A PAGE I . t £IEC RA t'I ONS 111111F,�1111= cmomlkl BUSINESS, AUTO POLICY . .IINnoN fal�b .. : ; Fur the Coma ftmemt9 Yon Mabe' �s �► 'AM ENDED 6ECLA'RATI��;' � �; RENEWAL OF`POL. CY ITER ,'UNE- Y 0202757' € F-ASON FSI t`m AkEkDAEN` CHANGED,COVERAGE ERAG1 POLICY NUMBER rFl POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY i 0242T5? ' fBTa ,,.:Ol.f'tl1*FIT CONTINENTAL CASUALCO OI��IS?$( Ak NAMED INSURED AND ADDRESS AGENT TOWN OF SOOT' VAL STYPE SONS 3NC MAIN S =. MAIN .ROAD SOUTHOLD LJF 1 NY >t 1.911 MATT I I'UCK NY 11952 POLICY PERIOD— 12:01 AM STANDARD TIME AT THE NAMED INSUREDS ADDRESS STATED ABOVE. FORM OF NAMED INSUREDS 9USINESS — OTHER ITEM TWO— SCHEDULE OF CCIVERAGES AND COVEREO AUTOS FACH OF THESE COVERAGES WILL AMPLY ONLY TO THOSE AUlT0S HOWN AS COVERED AUTOS. AUTOS ARE SHLWN AS CCV!=RED AUTOS FOR A PARTICULAR CCV=RAGt= 9Y THE ENTRY OF ONE OR MURE OF THE SYN9CLS FRI;)M :ITEM THREE NEXT TO THE NAME OF THE: COV'ERACEo COVERAGES COVE-RED LIMIT— THE MOST WE WILL PAY FOR PREMIU AUT 13 SYMBOL ANY ONE ACCIDENT OR LOSS LIABILITY INSURANCE 01 '8500s 000 $50939 PE.k.S. 1,HJURY :YIP9T U s SEPARATELY STATED IN EACH PIP F110 RSEAENT $3934 STATUTC'rY UN INS J`2FO 02 r 1 Os 00:1 / 3,0n0 I NC' MOTORISTS SUPPL_MH_NTARY 02 '1;'.O+ 000 $34 UNINSUPF-D MOTORISTS SUPPLEMENTARY 02 -$209 040 INC= UNDERINSURED MIOTORIST PHYSICAL DAMAGi= INS. ACV OR C13ST OF REPAIR WHICHEV_R IS LEESS9 MINUS ]EDUCT I 3LE SHOWN COMPREHENSIVE J7 ACV OR COST OF REPAIR -WHICHEVER IS LESS $5956 ! MINUS STATI"D IN ITEM F=OUP.9 F(;P EACH CCVEREI0 AUTO OR ALL LOSSES F--XC"---PT I=Ii=ii= QP LIGHTNING COLLI` It",,) ;:) ACV O.fi} C�CST t -�EPA:IR wHICHEVEP IS L'=SS $995r s)EDUCTIEILF STAT``'? IN :ITEi�i CURT t._1'+f._H CI"'VFRF.0 AUTO AND N ? I S='s.=VT`; C:JNTAId` CF) IN" TA- P-..'L_ICY Al IT ) i ACEPTIOIN— CAU011 (11 9 CA0110 1217,1) 9 CAsi1:'1 127"' s C:A0112 0433 r CAJ2'5 0191 9 G532_:3C`3 r AL6,97'' 1765 r G.17204A 9 CA2107 0173 9 CA;-.'X17 0178 9 CA 22 S2 u4"33 9 CA 2 ' 1280 l Co orate Secretary Chairman of the Board ENDORSEMENT 03 r VAL STYPE & SONS, INC. Date 1;1/86 MAIN RD. MATTITUCK, N.Y. 11952 This endorsement forms a part of your policy, and should be attached to the same without fail. (516) 298-8481 Company CNA Policy No. 1 02027573 Coverage Business Auto; Amending number of employees from 42 to 213 gown of Southold for non-owned liability coverage €SAT IONS �•,lowNwo� BUSINESS AUTO POLICY For All the C.4ommitmafa lea Mabe` wAN I VECLARAT ION RENEWAL OF POLICY IT`M ON 1 02027!M R AS£,�N.:=F' 3-i AMENDMENT CHANGED `COVERAGE POLICY NUMBER FRQM POLICY PERIOD TOI COVERAGE IS PROVIDED BY AGENCY 1 02091573: '01/01/86 01/01/97 CONTINENTAL CASUALTY CO 01511573+ NAMED INSURED AND ADDRESS AGENT TOWN , THOLO VAL STYPE & SONS SNC MAIN SYS MAIN ROAD SOUTHOLD* .SLJFFOLK► NY 1°1971 MATTITUCK NY 11952 ESTIMATED TOTAL PREAIUM $59238.0+ ITER THPE—t—:—SEE FORM P-891OC—A _FIR VESCPTPTION OF COVE€'.a 11 AUTO t>.ESIGNATION SY?A8OL Cor orate Secreta Chairman of the Board --gin PAGE <3E RAT IONS CKA PIM BUSINESS AUTO POLICY ML Cmc"%tweoa FFbrAll the Commitments You Malde° AMENDED C)ECLARAT ION RENEWAL OF POLICY :. . i 0202757:: ITEM ONE— REASON F1'A :AMMOIMENT CHANGED COVERAGE POLICY NUMBER FROM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 02027573 01/Q1/8fi 01/01/87 :ONTINENTAL CASUALTY CO 015115731 NAMED INSURED AND ADDRESS AGENT TOWN OF SlitlTHflL!? VAL STYPE & SUN5 .SNC MAIN STs � ` '� MAIN ROAD SOUTHCIL09 SU1 FALKs NY 11971 leIATT ITUCIC NY 11952 FEMI SCHEDULE OF COVERED AUTC'3 YOU O7A` ! r_(J5'T STAT: O CHANGE GT TER YR DESCi IPTION S'.-RIAL NU#�BFi? :�G'= SYM CLA°IS AMT DATE'?61AL:35J63115006Y3 6 7100 l993 01/01/8, NY 076 81 CHE:V r- 6 3900 1998 01/01/8, 013 002 NY 076 79 AMC +9A057'_234K61 014 00 3 I`!Y X176 Ft)P) '9 2FABP-I FSCB21223 5 11300 1 {'13 01/01/3t )3, 6 7911 01101/8 015 004 MY J7',- 69 lILLYS , tw CE 1535 6 641)0 0 7911 1 01 /01/I 016 105 NY 075 78 Fr4D 01/01/9. 017 OOr- mY 076 10 Pf_Y:�1 JL42LAA141294 6 7^00 Z )11 1_33594 5 1 '1': 0:) 7911 J1/01/3 01•`3 J07 NY 0,76 32 ra ;Al ,�'�`� 3,?g�A.C2iO3:3t3? `_� 1c)500 7 =11 01/01/8, 019 0 73 NY 07+'- ?LYS 3^ Vis' �3 326332R??:3386 .4 12100 7911 01/01/£ 020 ()013 i\,Y :'.76 3:3 PLYM 01/01/FV 021 010 1,;Y )76 114 f=LY'•3 l�:i+?'32�P=3�X54?Fi1'� 3 '9300 7{a 11 0?_2 011 NY 071; ?4 aLY+i 1 '3x3 ?ziS .-=.XS ' 3531) 3 i 1 0 ?(1 7C1 1 O1/O1/Ft '023 ()12 t•,Y 076 '34 PLY4 1F) HL3,?6i3f X5 a05 ii 3 l 1000 7`.? Ol01/01/811 c.. 1 =3,3?_£,.`13FX5�U ).12 3 11 ,300 7't? 01/01/ii• 024 Ola NY C7 '34 PLY yE+ 01/01/% 025 0I4 NY 076 14 PLY",PLY", '32f+S::iF X'i,�5�i.�-:� 3 l 100 7 `� ?:al l 1'-�3 r-126S3EX58553.4 3 11000 `T ill 01/01/8 726 015 toy fD76 34 PLY,4 01/01/8 027 016 NY 076 79 C1-1P.Y�L'_R Trio. L9A 1>9306 6 '310 0 791 1 1-p:,,t'%11 '3CAFD27>�i73 3 7000 7911 01/01/8 0'28 017 DIY 07:'• 34 t LYi- Ol/O 1/8x 029 01`1 N, y 1376 34 PLY'4 I P-3'3M I 8C2VD 3 02-2- 3 i 7000 7911 01/01/8; 3ti3515337 >O00 1'393 030 01'? NY1176 713 �_I{-:() 1T1,�-7� U1/O1/�3 031 020 NY 076 {)6 INTL '_11012(;205375 5 01/01/3: 032 0''1 _-7Y '17? : I 'dTL t=037`196G 01'=7g a Sr 6Oi47*} 01/01/`3;. 0.33 02' ;;Y ) 7r, INTi_ 732 6 J1!+7q O1/O1/?3 034 ()j: i •1Y 07r, INTL '�}A0 -66)3'39 11419 )1 0:.:5 0 'iF ,ay ii 7,15 4 I NTV Ir,TL +3i_)40 •1005'�5 6 01 '+79 0 ,.36 02 'Y :17*> y 4 01/01/8 037 0 6 -�Y ')7' T NTL 40 11'71:,7 . ;Y s>7F 0 INTL :,4')fi14?8?0i49 n3 3 01 '+'+'.) 01/01/$ 'i 1')1?G??rel 7--: '' x:39 i 1 N,y :'Tc i7 T. I-01 ?t;:.-74,50 01/01/$ O40 ,) J ',iY )7 ,n T. -NTL 7171+11�3?g50if ::� t) 1�+':D9 041 ,)3v `;Y ';7=� S°3 I `3TL 01/01/8 .? 0 ':1 '!Y s)7_, 7 _ I VTL ?')'7211G475279 , 014'.3:1 Oj+ r Tr-311 '}c, 043 :7 '? 'yY :7+� , I'jTf._ 7')7 1 )1�.v9 :)1/U1/9. +4 0?: :Y 7: 7r� r:iTL 71121 t.,.n �t J O !�t 70 O1 /011'3 045 0 4 > Y ')7f. 71 ]#t7 -:'7Y `,lis 5 t, 1 _i,7UU )th ; O1/i)1/13 Corporate Secreta Chairman of the Board . , DE_ RATI©NS CNA Ptw pkummuRnois606s HUS,INE:SS :AUTO POLICY Fbr All the Commitments You M,aW . AMENDED-DECLARAT I©Fd RENEWAL OF PoLic'Y ITEM UNE- 1 0202757_ REASON FflR. AMENDMENT CHANGED C13VERAGE POLICY NUMBER FROM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 120275.73 01 0.1/86'- Gl/Q1/87 CONTINENTAL CASUALTY Cao 01511573( NAMED INSURED AND ADDRESS AGENT TOWN OF SOUTHOLD' VAL STYPE £ SONS _INC MAIN ST. MAIN RDA(} SOUTH0LDv',SURFt3LK. NY ..41971 MATTITUCK NY 11952 ITC14 FOUR— SC?-iFDCJLE Cir G>)Vc 2ED AUTCS YOU CWN COST STATED CHANGi AUTO ST TER YR DESCRIPTION SERIAL NU`a18ER AGE SYM CLASS AMT DATE 747 036 NY 076 77 RODS- 081GR7J00143? 6 1.3000 91479 01/01/8f 048 037 NY 070- 2 GNIC 3()0_2190200 5 31479 01/01/8 049 0:38 NY 076 31 CHEV 1f.;-i JC34NI88V 1 01385 6 9100 J1479 JI/01/81 050 0:39 MY 075 �31 CHEV 1`.3JC34M2'3V101383 6 9100 01179 01/01/£3t 051 040 PAY 075 73 INTL 0122H(;318573 5 20000 214 79 01/01/8 052 'J?1 'lY 07b 70 INTL 707211:37'1+)3.3 5 21479 01/01/8, 05.3 042 NY 076 7'., INTL CA2SPJHA33.?63 6 21900 21479 01/01/8 054 043 -1Y 07:S '31 IA9TL s'A25534A10967 6 35.100 2147<) 01/01/8 055 044 IN 07r) 31 INTL IIKC'125569HA27031 6 34000 ?_1479 01/01/8 056 045 NY 076 77 FORT) t=10(-,=Y44701 5 4 '00 01499 01/01/3 057 J '�u l )7r: °31 )f-]DG1e t8711T)2It01931 21 603 6 7`)f?O ')1199 0I/01/8 OhS 047 NY 076 'iii I NTL IF")1 12534H _ 11 1•)9 01/01/8 059 043 NY 07S 7? FORD F1f3G'-r9A3544 '. 100 :31.t3i4 01/01/8 Otic 049 NY )76 71-1 FORD : 7Y:'=f:26061 6 .1. �0') 01139 01/01/8 061 050 NY 076 77 ;=nR.") >`i 11500 01499 01/01/$3 '162 051 114Y 076 75 FORD F1`)'3'eiV62236 6 :)14')9 01/01/8 063 052 NY 075 71 9i2r CK`AY 7.748 3 ''_34-)`) 31/01/8 064 O`:i3 NY 075 34 '3TEC-3 159E '2 '_T4:F10117077 :3 47`}00 694'39 01/01/8 065 J54 MY 07,t 114 `ITEC': 1'39----3 R2T2F1 Q07076 3 47900 69499 01/01/8 066 055 MY 07.5 v3j4 FORD IF0YIf,8040EVA0582J 3 34700 ?1479 01/01/8 067 J 9 i NY i}7t5 7ti ) 'I''i : ; '"7�-!F S^5_9f,J2 6 3000 .)l )')'3 01./01/8 068 t) 7 illy •i 7f 3:_' C)a06r= J°37F :) '_474CY7'14104 5 13700 014+ ?q 01/01/9 0.39 0 5'3 "'Y t)76 ''? °Z00iG J ?7F X47? Y 7-)4067 5 1.7700 01499 01/01/3 070 0 71) 4Y 77 : ',2 )ULD z , 77- 313r-:6CK1 7 ::379 5 'i900 014911) 01/01/8 071 064) r;Y 076 ;XI G: ' r4H-3?3Hil )K::_33':.�6, 4 7300 -)11.99 ill/01/3 1.172_' 0 i1 '!Y 1)76 ci'-t• ?LYA 1';H'iC-54U'�FV1277J2 .3 1100 31ft•79 01/01/8 073 ') i2 ' Y 07:-i f34 )u:)G'- J; 7f �'4!)c�rY70' .3<; 3 '-"000 0- 499 01/01/t2 U74 i ...4 f)7<_; 'Ia CHI` I , ;;Mr:_34M7FV127')6.i .: 12100 11'1.1(4 01101/8 173 0_4 AY ')7 '71 F04-40 ` 9+.)SIV 414''''7 00 '14710 01/01/8 )76 0 ;`i vY 0 -f 615 I NTL01 179 01/01/8 ')77 )evi `1Y jfi :i-� F'}fir) 1=r4Ui==`>75478 3003 11499 1111/01/3 076 0` 7 _•!Y )7`i 733 `(tet'_0 i 73'30:1 2:-31 1'300 x,;4,19 01/01/4 079 0 : 3 -.,1f 17-t 7:? IdLY=r -IC 3K1:24?:6ry1 6 7400 ''i4 ll 01/01/3 060 C -') •1v '37 , 30 DOD(:;;^ i:?117AK 1113(43 9 71/01/8 -)til =)70 '1Y 07%+ 10 1'LY'4 1C',KTAk137 )73 5 ! 1000 �-3419 O1/01/'i mx� Cor orate Secreta Chairman of the Bond �IAGE «r AMA PECPKPATIONS CWR pbu .." _ f ca�e.00 aoas 9U S I A S S AUTO POLICY For All the Commitments You Malo' AME NDE0 0ECLAR AT I ON RENEWAL OF POLICY IT=M ONE— 1 0202757. REASON FOR 'AMENDMENT CHANGED COVERAGE POLICY NUMBER FROM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 0.2027573 : O /01/86 01/01/37 CONTINENTAL CASUALTY CO 01511573- NAMED INSURED AND ADDRESS AGENT TOWN OF SOUT'HOLO VAL STYPE $ SONS -INC MAIN ST. MAIN ROAD SOUTHOLD* SUFFOLK* VY 11971 MATTITUCK NY 11952 I TEA r=<3UR— SCHEDULE OF COVERED AUTOS YOU OWN COST STATED CHANG' AUT`:) ST TER YR. DESCRIRT If Til SERIAL NUMBER AGS= SYM, L%.SS AMT DATE O62 071 NY 77Fa 32 ^-3LY:A "I—E63?6N1CR i x33386 S 12000 7911 01/01/8 033 072 `VY 176 75 F1JR0 F685jA221502 6 7=_)DO 791.1 01/01/8 O34 07:3 NY 075 52 F WDDUMP J-31072 0 11-479 79 01/01/8 035 074 NY 0 7--5 ;j,z i�L Yim 1P 3991'+6S3F631773 2 10700 19x13 01/01/8 036 075 VY 07 a5 .3 S f�LYM IP3F:3'?6..1FX63277? 2 10700 1998 01/01/8 087 0 75 NY 07:� 35 ?LYA 1?38326SXS=X632771 2 10 700 1x)9.3 01/01/�3 068 J77 14Y J7:� 3' PLYm 1?3P,P''u53FX6:32770 2 1 J 100 19')x3 01/01/3 089 3-18 NY 077 3S ?LYM l?3r'3265?FX63?769 2 10700 1993 01 /01/8 09 079 NY ?Ifs .3.5 "LYtiI lP7-3326SXFX6327b8 ..'_ 10700 191:3 01/01/8 Of."i1 0:30 *3Y J76 ,,1457 Ff R0 1?Fsof)U15H11:71-A87935 2 14100 3341139 01/01/8 092 (?,31 NY 076 77 F 0':-0 ✓ 'LI 14HH-*>-,'40410 5 11?500 21499 01/01/8 093 0-32 .NY 076 15 PLY;ACUTH lP36925PXFX652563 2 1 ,X700 1 ?•3 01/01/9 094 083 14Y 076 >3S INTL ')UAP IA T?LTV04FHA_a3J9'1 2 42100 35499 421'30 01/01/8 O95 0;34 MY 07fi 15 FfJR9 jU-"-) IFDNF6 H4FUA71660 2 ? 000 3-It97.5000 O1/01/3 096 095 NY 076 i6 i7£3OGr: 0,,"'41 13::SFF.1z3C 3Gf)1 i92rJ` 1 7:3%0 1903 01/21/8 097 0345 NY 076 35 INTPlaI_ 1'-iA',)V?"S INTLAHEMtFHA61054 a 45700 21499 45::300 01/31/F s R J� E i Corporate Secretary Chairman of the Board DEC RATIONS C/ CChNA Pleask"e.t .. 8USI4wFSS AUTO POLICY Fbr All the Commitments You Make' AMENDED, DECLARATION RENEWAL OF POLICY ITEM ONF.— 1 0202757 REASON EOR AMENDMENT CHANGED COVERAGE POLICY NUMBER F OM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 0202757.3 0.1/01/86 01/01/87 CONTINENTAL CASUALTY CO 01511573 NAMED INSURED AND ADDRESS AGENT TOWN OF SOUTHOLD VAL STYPE 6 SONS` -INC :•MAIN ST* MAIN ROAD SOUTHULDs SUFFOLK% NY 11971 MATT ITUCK NY 11952 PREMIUA53,— ADDED MSD IJid—IJD SPEC TOW DEDUCTI3LE TOTAL AUTO LIAR "IP IR,I? PAY MTRST COMP PERIL COLL LA`3OR OTHER COMP COLL PREMIU 012 001 $607 $38 b4 x.35 $72 500 500 $75 013 002 $607 $33 rj4 $17 $51 500 500 $71 014 003 $607 `5.38 .54 '1139 5126 500 500 $86 015 004 $607 A.3,3 ;4 XXXX XXXX $64 016 005 $607 533 `'34 h0 500 500 $73 017 006 $607 $33 :A4 35 $7:'_ 500 500 $75 018 007 $607 ??3 4.1 589 X12:; JOU 500 '$86 019 008 $607 $33 `34 $ 39 `S12b 507 S00 $86 020 009 X607 S-3 3 4 :1,89 4;1 26 5013 500 $86 021 Olt) T607 4!,:38 4 $75 'G1 33 500 50u $85 022 011 :5607 41;3 8 :4 X111 T153 50U 500 $90 023 012 1507 s.';01 ;+ ; 101 s1 53 500 500 $90 024 (313 $617 x.38 r', >101 15 7 500 500 $90 015 014 ''_'b07 `.:.:i' ;:4 `+'-I()I fi1'537 '�00 Soo $90 026 015 5607 `x'33 :fire1 01 fi i ry.-: 500 900, $90 027 016 d5607 .i,-18 '4 ,35 87 500 500 $75 028 017 5607 t,38 ;v4 ,1;54 501) 50^ $31 029 018 $607 ',..:)8 "."4. .54 6111 `00 530 $81 030 019 s•fh07 1.33, ' 4 r,24 S60 51)0 500 $73 031 020 D54:3 »_34 41"It XXXX XXXX $58 032 021 $548 s;34 T4 XXXX XXXX $58 033 022 11154 3 ':'4 r4 XXXX XXXX $53 034 023 fi 143 ,.'4 `;4 XXAX XXXX $53 035 024 --!S4A> 4 %4 XXXX XX`�X $S3 036 ()25 lr,4 ;:-S4 b4 XXXX XXXX $513 037 02o 1,54:: ?,_ 4 ,-a. XXXX XXXX $56 033 027 ,�.:i4 3 ',.:'4 ^'% XXXX XXXX $59 039 02-1 '548 ;;;r; + XXXX XXXX $58 040 :)^mss _�4`; _XXX XXXX $y3 041 +)30 `i4: * .;4 "r, XXXX XXXX $5'3 047 U 1 ` `?4 3 -i4 /- XXXX XXXX $58 043 0.7:? ``'i4.1 4 3 XXXX X:LXX 459 J44 17; 34 p XXXX XXXX $SKS 045 J_, + :D 18 34 rf ; ,l :0'J XXXX $61 046 1=i4<; . :,4 )OJ XXXX $54 Cor orate Secretary Chairman of the Board AOL 6 cw►wm r DE . ARAT IONS cMw�ottwwl.tl9 PUSIMESS AUTO) POLICY Fbr All the Commitments You Make' AMENDS biCL.ARATION RENEWAL OF POLICY ITEM+! ONE- 1 0202757 REASON `F ;AMEN0MENT CHANGED COVERAGE POLICY NUMBER FROM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 02027573 01/01/86 01/11/37 CONTINE-NTAL CASUALTY CO 01511573 NAMED INSURED AND ADDRESS AGENT TOWN OF SOUTHOLD VAL STYPE E SUNS -INC MAIN ST. MAIN ROAD SOUTHOLOs ZUFF'OLKs NY 11971 MATTITUCK NY 11952 PREMIUMS— ADDED MFD UN—UJ SPEC TOW & DEDUCTIBLE TOTAL AUTO LIAS PIP :QIP PAY MTRST COMP PERIL COLL LA30R ETHER COMP COLL PREMIU- 047 036 $548 $34 "54 $61 500 XXXX $64 048 037 $543 '534 54 XXXX XXXX $58 049 03.3 $543 s34 $4 $41 $121 300 500 $74 050 039 $548 $34 $4 X141 4121 SOO 500 $74 051 040 $521 $ 34 5,l4 -i;67 5C0 XXXX $62 052 041 $521 ` a4 �4 XXXX XXXX $55 053 042 55?1 $34 $4 S 17 $217 t3oo 500 $86 054 043 X521 L3-4_ :;4 X129 5311 500 500 $99 755 044 5521 73x4 $4 $129 ;:311 :300 5G') $99 056 045 5548 $'4 :',4 '511 `QUO XXXX b59 057 046; 5546 ti34 _S4 1;31 4a=4 500 5030 $68 058 047 .S43 t,_.14 XXXX XXIIX $5%1 059 0>a 154 3 t74 4;5t7 700 15c U60 049 $548 134 : 4 S61 5110 503 Soo $75 061 050 lr,548 x .4 $4 'r>61 500 XXXX $64 062 1751 $548 :w34 $4 XXXX XXXX $513 063 052 :5730 �*;34 1:4 XXXX XXXX $77 064 053 $�4 416 4 3y281 s44<_> S00 500 $82 065 054 2 a 1 5442 -DUJ 500 $82 066 055 :L521 x334 3;4 -1;197 ;:478 500 500 $123 067 056 JtS48 $34 j;4 &21 SOn XX.Xx $60 068 J57 X548 34 $4 X70 ? 12 7 5013 500 _`578 069 0S8 �_i4; T,.7A l:4 k79 ".127 300 500 $78 070 0-9 �'c`; ^-'4 ": 'i ry.>5 S74 500 501) $6 J71 Oc :i 900 5Ct) $71 072 061 34 _,Q .4 SOO 13-00 $9.3 n73 0rN2 3-11 S34 :x 1 500 Soo $91 1774 04*-3 /4 .Ci r4 1__00 500 075 s)?"4 .`a2l. i4 ?17 =.3 73 J7t� 0 .j ',`34-1 + 4 XXXX XXXX "1.9 8 077 066 4i T Z 4 ;4 *11 t,_, `0() SO{) 3r;3 07n 0fi7 >712 --r4 L4 13 >h1 5:)0 5()U 7 079 06,.', I:F:91 :3 1':-;2 14 `�()0 50 $91 s`.30 06i> ;. ,<.a l 1 :i, �E 5"'1 ,/rte 1.00 a0U ?;0l ;2 4 3;"- +) ) 500 1;=37 i 9 Corporate Secretary Chairman of the Board DE RATIONS CNA am BUSINESS AUTO POLICY 1br All the Commitments You Make AtlENtIEl1.'�ECLARATIiIN RENEWAL OF POLICY ITEM ONE- 1 0202757: REASON AMENDMENT CHANGEO COVERAGE POLICY NUMBER rFPOLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 020275 '3". OY,l01lS6. 01/01/87 CONTINENTAL CASUALTY CO 0151157.34 NAMED INSURED AND ADDRESS AGENT TOWN OF" 'SOUTHOLD VAL STYPE E SONS -INC MAIM STi, MAIN ROAD SOUTHOLD* ' SUEFI0LK,% NY 11971 MATT ITUCK NY 11952 PREMIUMS- ADDED aED UN-UO SPEC TOW F DEDUCTIBLE TOTAL AUTO LIAS PIP PIP PAY MTRST CORP P=-PIL CO'L_L LABOR OTHER COMP COLL PREMIUI 082 071 607 $38 $89 1;12£ 500 509 $86, 083 072 $607 T,38 $4 $S 35 $773 500 500 $75, 084 07;3 5548 >'34 4b4 XXXX xxxx $58t 085 074 S6U7 ,,:58 '-,.A Irl 101 '>15:' 500 50!) $90: 086 076 X607 0,38 44 :3.101 15:1 500 50.3 $90: 087 076 $607 Z-5 f3 $4- '%101 ^:1 S3; 500 500 $19o.- 088 90=088 077 45507 '�3F $4 ;.101 $1153 500 500 $90: 089 078 7607 33 $4 "101 $153 500 500 $90. 090 079 ':F-6 0 7 5-:; $4 1101 b153 -oo 500 $90: 091 080 ' 712 -S34 i:4 4;107 �194 501) 500 $105. 032 081 X579 S74 '€.a! X52 %9-1 500 500 $75 093 032 $607 *:' i .64 10101 15_3 500 500 $90:. 094 08:3 $1015 :.:?4 $4 `531 2 '.'it; 80 500 500 $204' 091`1= 084 $1015 ';::'4 $4 S'+25'9 '.=4?5 500 50+0 $173- 096 035 $714 945 $4 $73 Soo 50t; $98 037 086 :5737 -*;34 S4 1454 500 500 $1831' Cor orate Sec tary Chairman of the Board PA(- DEC RATIONS d111Rlaaa ' -?US IIgFSS AUTO POLICY Cuomo.whtota som For AA the CoMn tneuffi You Mata AKENQEM.OEGL.ARATION RENEWAL. OF POLICY 0202757: ITE1v1 d]NE—" 1 y REASt °FOR AMENDMENT CHANGED COVERAGE POLICY NUMBER FROM POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 02+027573 0IZOl/ 6 OIIOIZ i7 CONTINENTAL CASUALTY CO 01511573 NAMED INSURED AND ADDRESS AGENT TOWNOF50UTi1QtD VAL STYPE E .SONS -4VC CAIN ST. MAIN ROAD SOUTHOLDO , :SUFFOLK* NY 11971 MATTITUCK NY 11952 ITEM FIVE— SCHEDULE SOF HIRE'S OR BORRIDWED COVERED AUTO? COVERAGE AND PREMIUMS LIAi3ILITY INSURANCE— RATING BASIS* COST GF HIRE AUTO) :'=STI>,?ATFD RATE PER `6100 Ct::ST OF Hl�E COST OF HIR faF2L�MIU SEQUENCE STATE $� -I I1 1 VY I ANY 1.,zt5 y TOTAL. PREMIUM $3 CGST OF HIRE ;AEANIS TKF7- TOTAL AAOUIVT YOU INCUR FOR THE HIRE OF AUTC:S YOU DU NOT i'.SIJ (CBOT I*iCLU!)I~IG Ai)T� c YFU -111:RR(3`aJ OR RENT f=P'OA Yi:UF =.lPLQYFF=S f;R THEI P FAMILY AEy1 E:?'S) . COST `7r ;ilf r)gEs 131 INCI_.U!)E C1iARGES t•OR Ff�NICL==`� 'I RFOR�iEi7 t3Y I�i(]TOR CAI�-�IEF?.S C`: OR ?AS'SENCT RS. �9 3 Cor orate Secret Chairman of the Board ewt►aa � �. OF RATIONS t�re.�o t1Yna+aBUSINESS AUTO POLICY Fbor UtheCenualtmenumm maw AMFNE)e bEcLARAT ION "RE1VE'rllAL OF POLICY ITEM ONE- 1 0202757: REASON= R AMENDMENT CHANGED COVERAGE POLICY NUMBER FR M POLICY PERIOD TOI COVERAGE IS PROVIDED BY AGENCY 1 02027573 01 /86 01/01/87 CONTINENTAL CASUALTY CO 01511573, NAMED INSURED AND ADDRESS AGENT T OYV N OF SiflltTNpL O V AL STYPE £ SONS -I NC MAIN STs MAIN ROAD 50UTHOLOs ,SUFFOLKt `NY 11971 MATTITUCK NY 11952 ITEM SIX— SCHEDULE FOR NON—OWNERSHIP L IABIL TTY COVERED AUTOS 6tl#-3POWED FROM YOUR EMPLOYEE-S OR MEM8ERS OF THEIR HOUSEHOLD. RATING3ASIS—N()M`_ER GF f- AMPLgYr- 3=.5 r`iTIMATEJ IdU'+ RFR LIASILIT" lF I-MPL IYFFS PREMIU 213 $25 Cor rate Secreta Chairman of the Board ICU; INESS TO POLICY CNA Plan cMcaaa was PAYMENT PLAN SCHEDULE For All the Commitments You Maty' v POLICY NUMBERFRO POLICY PERIOD TO COVERAGE IS PROVIDED BY AGENCY 1 02027573 01/01/86 01/01/ 37; CONTINENTAL CASUALTY CO 01511573 NAMED INSURED AND ADDRESS AGENT TOWN OF SOUTHOLD VAL STYPE SONS—INC MAIN ST. MAIN ROAD SOUTHOLD* SUFFOLK* NY 11971 MATTITUCK NY 11952 PAY'^€.€_NT PLAN DOt TO A POLICY— C:HAN F-9 TT 1:3 A ;'�f�E0 TPIAT TH3_ E-V I-SEy-) -STI `AAT i D i'R=.1It1" OF Ttil � PULICY IS PAYA+=3LE A � F``.L.l_ 3t9S. !--FF=_CTTVE )aAT = �`2F kIUM CASH ritlf A,'-V`)U-4T 677*00 35/01/^ > S59820.04 £59X320.UO f)7/11/Y13 •';=is:320a 00 03/41/36 5. 12200 u0 ;51820. 00 "s?FMA INI`P- Pp j:* A ltJ" iy9IP17. U;) i Corporate Secretary Chairman of the Board Co mercial Union Insurance Comp a ieS C rcial Union Insurance Company IPC (NAME OF INSURANCE COMPANY) PO Box 7780 ]436 Philadel hia PA. 19182 (ISSUING OFFICE ADDRESS) The policy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Should investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. !7APORTA IT PREMIUMS MUST CE RECEIVED IN COMPANY OFFICE AS REQUIRED BY PLAN. F I • '�Y YOUR AGENT OR BROKER IN AMPLE T!ME TO N NAME Town of Southold M TO FORWARD THE r REMIU,l T;, . s • �'` IT '6j T, U v : 1"ANY IN THE TIME SPECIFIED. R STREETMain Road E • CITY Southold, STATE NY. 11971 MEMO ❑ The premium shown Is due TD ❑ Your policy expires 12:01 A.M.The renewal premium will be'$ THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. INSURED ❑ We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels. be made to the AUTO INSURANCE PLAN EXPIRATION DATE it is suggested that re-application 12:01 A.M. NoticePLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED,POLICY NUMBER,AND AS"AUTO INSURANCE PLAN." to ❑ DEDUCT COMMISSION OF$ AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Producer ❑ You will receive a check shortly for the return premium due the insured less your commission. SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. ARP-180 A UTOMOBILE POLICY NUMBER POLICY PERIOD STAT. Orig. 1st 2nd CHECK ITAA BLE TERR. Policy Renew. Renew. Truckman I.C. Pol. Fin. CODE Beyond I C] 150 Mile Requlyate Reqd. CJD 33 27 95 4-21-86-87 ® ❑ ❑ ❑ Radius ❑FOR PLANNSACTfON STATE DOUBLE EFFECTIVE REPORTING TERR. CO. USE DATE ASSIGNED ECEIVE❑D USE ONLY _CODE CODE CREDIT DATE MONTH CODE COMPLETE �.► AS NEED. ❑ (r.._ VEHICLES —� N ANNUAL PREM. ALANCE PREM. DEPOSIT PREM. WRITTEN AMOUNT PERCENT CLASS E OF W NO. TYPE SURCHARGE SURCHARGE VEHICLES OPRIV. Liab. R PASS. Cov. a ❑ Phys. R Dam. E N Excess E Indem. W A Liab. L Cov. OTHER Phys. Dam. Excess Indem. C UNEARNED-RETURN EARNED-ADDITIONAL NO.AND CLASS OF PREMIUM PREMIUM EFFECTIVE DATE VEHICLE AND REASON 'T SURCHARGE% E R PRIV. Cov. 1851 .00 L PASS. 7-21-86 ❑ INSURED'S REOUEST L® Phys. A E Dam. ❑ NONPAYMENT OF PREMIUM T N I D Excess ' I ❑ CO.REQUEST(attach Letter of Explanation) O O Indem. N R E Cov i OTHER Add veh. 424 & delete MOTHER EPhya ' Veh. # ]0—13 N Dam. I T Excess Indem. VEHICLES REASON POLICY ASSIGNED NOT NO. TYPE ❑ RENEWAL QUOTATION NOT ACCEPTED BY INSURED ❑OTHER ISSUED ❑ INSURED MOVED LEFT NO FORWARDING ADDRESS ❑ THREE YEAR ASSIGNMENT PERIOD EXPIRED P • O NAME Val Stype & Sons Inc. D • D STREET Main Road DATE 9-25-86 dz E • _ R CITY STAT L Mattituck, ENY. 11952 _ tNE,,�D t/ Ge2024 SPECIAL NOTICE AND INSTRUCTIONS TO THE INSURED-AND PRODUCER OlSNI—GTHE REVERSE SIDE Commercial Union Insurance Companies CO Clal Uri nn TriSttranra ( P n3, T r (NAME OF INSURACE COMPANY) PC N PO Box 7780 1436 Philadel hia PA. 12182 (ISSUING OFFICE ADDRESS) The Policy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Should investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. T,A I ?REMIUMS ML15T RE CEI`-/;L):`d:v. PO.NY', 'CE AS P_=C ljiRED BY PLAN, F 7 1 • N NAME ;GENT OR BROKER IN AMP!. TIME TO $ Town of Southold ?j �?°:1 a ='7 34YARD TIME PREN11U,101 TO THE u q STREET Main Road -... i7:'1'<I; =' T,HE Ti.ME SPECIFIED. E • D O1T`' Southold, STATE NY. 11971 :EMO ❑X The premium shown Is due 3978.QO TO ❑ Your policy expires 12:01 A.M.The renewal premium will be$ THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. INSURED We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels,it is suggested be made to the AUTO INSURANCE PLAN ggested that re-application EXPIRATION DATE 12:01 A.M. Notice PLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED,POLICY NUMBER,AND AS"AUTO INSURANCE PLAN." to ❑ DEDUCT COMMISSION OF$ AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Producer ❑ You will receive a check shortly for the return premium due the insured less your commission. SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. ARP-18DFANNUALPREM. POLICY NUMBER POLICY PERIOD STAT. Orig. 1st 4,;m HECK IF APPLICABLE TEORR. Policy Renew. I.C.C. Stat.Pol. Fin. CygE Filing N.V.State Resp. /(6) Required Only Reqd. NY. CJD 33 7 _ _ _ ® ❑ ❑FOR PLANANSACTION STATE DOUBLEEFFECTIVE REPORTING TERR. CO. USENEDDATE a CEIVOUSE ONLYCODE CODE CREDIT DATE MONTH CODE COMPLET AS NEED. I VEHICLES N EM. i BALANCE PREM. DEPOSIT PREM. WRITTEN AMOUNT PERCENT CLASS E OF OF OF W NO. TYPE SURCHARGE SURCHARGE VEHICLES OPRIV. Liab. R PASS. Phys.❑ Phys. R Dam. E N Excess E Indem. W A Liab. L Cov. OTHER Phys. Dam. Excess Indem. C UNEARNED-RETURN EARNED-ADDITIONAL NO.AND CLASS OF PREMIUM PREMIUM EFFECTIVE DATE VEHICLE AND REASON A SURCHARGE% N O E R PRIV. Cot. L®PASS. Phys 1 3978.00 7-1-86 ❑ INSURED'S REQUEST A E Dam. ❑ NONPAYMENT OF PREMIUM T N � I D Excess j O O Indem. FEE I N q E] CO.REQUEST(attach Letter of Explanation) t MOTHERCov O OTHER add Veh. # 18-23 E Phys. N Dam. T Excess Indem. VEHICLES +REASON POLICY ASSIGNED NOT NO. TYPE ❑ RENEWAL QUOTATION NOT ACCEPTED BY INSURED ISSUED ❑ INSURED MOVED LEFT NO FORWARDING ADDRESS ❑OTHER ❑ THREE YEAR ASSIGNMENT PERIOD EXPIRED P O NAME Val Stype & Sons Inc. D • C STRE'Main Road DATE 9-25-86 dz E • R I ITY Mattituck, STATE NY 11952 G62024 SPECIAL NOTICE AND INSTRUCTIONS TO THE-INSURED AND PRODUCER ON THE REVERSE SIDE r Commercial Union Insurance Companies Co tial Union Insurance Company (NAME OF INSURANCE COMPANY) IPC PO Box 7780 1436 Philadelphia, PA. 19182 (ISSUING OFFICE ADDRESS) The policy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Should investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. 1 N NAME Town of Southold -'Y e"G. R i `,n` rNT C:71 1)ar;; Fa, i�� :=' TIME TO R8 • ,hi1T '„l T7 yin 7 THE STREE-Main Road .'_9PANY 'A THE E • D CITY Southold, STATE NY. 11971 J MEMO ❑ The premium shown Is due TO ❑ Your policy expires 12:01 A.M.The renewal premium will be E INSURED THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. ❑ We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels,it is suggested be made to the AUTO INSURANCE PLAN ggested that re-application EXPIRATION DATE 12:01 A.M. Notice PLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED,POLICY NUMBER,AND AS"AUTO INSURANCE PLAN.” to ❑ DEDUCT COMMISSION OF$ AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Producer ❑ You will receive a check shortly for the return premium due the insured less your commission. SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. ARP-18D AUTOMOBILE POLICY NUMBER POLICY PERIOD INSURANCE STAT. Ong. 1st 2nd CHECK IF APPLICABLE PLAN OF STATE OF TERR. Policy Renew. Renew. Truckman I.C.C. Stat.PoI. Fin. C04% 50 Mile Requiired N Only to Regd. NY. CJD 33 27 95 4-21-86-87 �/ ❑ ❑ ❑ Radius FOR PLAN COMPANY TRANSACTION STATE DOUBLE EFFECTIVE REPORTING TERR. 1:1 ❑ ❑ ❑ USE ONIN LY CODE CODE CODE CREDIT DATE MONTH CODE CO. USE DATE ASSIGNED DATE RECEIVED COMPLETE AS NEED. QVEHICLES AMOUNT ANNUAL PREM. BALANCE PREM. DEPOSIT PREM. WRITTEN PERCENT CLASS W OF OF OF ; NO. TYPE SURCHARGE SURCHARGE VEHICLES OPRIV. Liab. R PASS. Cov. ❑ Phys. R Dam. E N Excess E Indem. i1 w A Liab. L Cov. OTHER Phys. Dam. Excess Indem. O F52 D-RETURN EARNED-ADDITIONAL NO.AND CLASS OF N O MIUM i PREMIUM EFFECTIVE DATE SVEHICLE AND URCHARGE q, j REASON E R PRIV. Cov. 0 . L PASS. — — ❑ INSURED'S REQUEST L® Phys. A E Dam. T N ❑ NONPAYMENT OF PREMIUM 1 D Excess O O Indem. 1:1 CO.REQUEST(attach Letter of Explanation) N R `` S Liab.Cov. © OTHER_ delete Veh # 17 MOTHER E Phys. 1 N Dam. T Excess Indem. VEHICLES REASON POLICY ASSIGNED NOT NO. TYPE ❑ RENEWAL QUOTATION NOT ACCEPTED BY INSURED ISSUED 13INSURED MOVED LEFT NO FORWARDING ADDRESS ❑OTHER ❑THREE YEAR ASSIGNMENT PERIOD EXPIRED P • O NAME Val Stype & Sons Inc. D • C STREET Main Road DATE 10-23-86 dz R �ITM Mattituck, STATE NY. ] ]952 J SIGNED 4V2;n��_ Ge2024 SPECIAL NOTICE AND INSTRUCTIONS TO THE INSURED AND PRODUCER ON THE REVERSE SIDE Co mercial Union Insurance Companies IPC C rcial Union Insurance Company• (NAME OF INSURANCE COMPANY) PO Box 7780 141 Ph; larlPWW PA 19181 (ISS - OFFICE AD ESS) T The policy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Should investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. PORTS'NT PREt WIAS..10UST BE RECEIVED IN COMPANY CFF'CE AS PECiUIRED BY PLAN. _ F 7 t • '�y �'nUR AGENT OR BROILER IN AMPLE TIl11111E TO N NAME Town of Southold -,-.,-- _..�, , g ( - .1 TO FORWARD THE PREM11.11 A TO THE U . ,' ;�',1NY;i I THE TEME SPECIFIED. R STREET Main Road E • D CITY Southold, STATE NY 11971 J The promtum shown Is due 122Q� Your policy expires 12:01 A.M.The renewal premium will be$ THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels,it is suggested that re-application be made to the AUTO INSURANCE PLAN EXPIRATION DATE 12:01 A.M. PLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED,POLICY NUMBER.AND AS"AUTO INSURANCE PLAN." oe to ❑ DEDUCT COMMISSION OF S AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Produce ❑ You will receive a check shortly for the return premium due the insured less your commission. - SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. 4- ARP-18D AUTOMOBILE POLICY NUMBER POLICY PERIOD STAT. Orig. 1st 2nd CHECKIF APPLICABLE INSURANCE TERR. Policy Renew. Renew. Truckman -.I.C.C.• Stat.Pot. Fin. PLAN OF STATE OF CODE a Beyond.- Filing N.W.State Resp. 76 150 Mile Required -..Only Reqd. Radius NY CJD33 27 95 4/21/86-87 ® ❑ ❑ E] El . f :❑ ❑ FOR PLAN COMPANY TRANSACTION STATE DOUBLE EFFECTIVEFEPORTING TERR. CO. USE DATE AS GNED DATE RECEIVED USE ONLY CODE CODE CODE CREDIT DATE MONTH CODE COMPLETE AS NEED. -♦ ❑ VEHICLES AMOUNT PERCENT CLASS N ANNUAL PREM. I BALANCE PREM. i DEPOSIT PREM. WRITTEN OF OF OF E W NO. TYPE SURCHARGE SURCHARGE VEHICLES O Liab R . PRIV. Cov. PASS. ❑ Phys. R Dam. E N Excess E Indem. W A Liab. L Cov. OTHER Phys. Dam. Excess Indem. El UNEARNED-RETURN EARNED-ADDITIONAL NO.AND CLASS OF C PREMIUM PREMIUM EFFECTIVE DATE VEHICLE AND REASON A SURCHARGE% NO I E R PRIV. Cov ❑ INSURED'S REQUEST L PASS. j�_ 122.00 ! 2) 3B+25% A E Dam. # 3) 3B+25% ❑ NONPAYMENT OF PREMIUM T N 0 O Indem. ' ' ❑ CO.REQUEST(attach Letter of Explanation) N R S Liab. ; ® OTHER Amend class on Veh MOTHERCov. 2 & 3 E Phys. N Dam. T Excess Indem. VEHICLES REASON POLICY ASSIGNED ❑ NOT NO. TYPE RENEWAL QUOTATION NOT ACCEPTED BY INSURED ❑OTHER ISSUED ❑ INSURED MOVED LEFT NO FORWARDING ADDRESS ❑ THREE YEAR ASSIGNMENT PERIOD EXPIRED 0 NAME Val Stype & Sons Inc. D • 1 U STREET Main Road DATE�'� C 8121/86 E • ` I C'TTM Mattituck, STATE Ny. 11952 Ge2024 SPECIAL NOTICE AND INSTRUCTIONS TO THE INSURED AND PRODUCER ON THE REVERSE SIDE Auto POLICY NO.1llft,Tn33 27 95 INSURANCE Commercial Union Insurance Company CANCELLATIMM TERMINATION WILL TAKE EFFECT AT: COMPANY 209 Senate Ave. , PO Box 8089 9/19/86 12:01 a.m. Camp Hill, PA 17011 (DATE) tHOUR-STANDARD TIMET DATE OF MAILING: 8/25/86 ISSUED THROUGH AGENCY OR OFFICE AT: NAMEAND Town of Southold Commercial Union Insurance Company ADDRESS Main Road OF INSURED Southold, NY 11971 Val Stype & Sons Inc. , Main Road, Mattituck, NY 11952 (Applicable item marked 0) CANCEL- ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your insurance will cease at and from the LATION hour and date mentioned above. If the premium has been paid, premium adjustment will be made as soon as practicable after cancellation becomes effective. If the premium has not been paid, a bill for the premium earned to the time of cancellation will be4orwarded in due course. ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your insurance will cease at and from the hour and date mentioned above due to nonpayment of premium.A bill for the premium earned to the time of cancellation will be forwarded in due course. ® You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your insurance will cease at and from the hour and date mentioned above. If the premium has been paid, premium adjustment will be made as soon as practicable after cancellation becomes effective. If the premium has not been paid, a bill for the premium earned to the time of cancellation will be forwarded in due course. Reason(s) for cancellation:_Fn re r�_ p rnv;(je c_on;Pc of 1;censes for Ted Beebe and Carl Conbran Jr. NON- RENEWAL ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned policy that the above mentioned policy will expire effective at and from the hour and date mentioned above and the policy will NOT be renewed. ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned policy that the above mentioned policy will expire effective at and from the hour and date mentioned above and the policy will NOT be renewed. Reason(s) for nonrenewal: IMPORTANT Automobile Insurance Plan Information Applicable to Auto Insurance Not Obtained through the New York Automobile Insurance Plan: You have been NOTICES notified herewith that this Company does not desire to carry your automobile insurance any longer. You are possibly eligible for automobile insurance under the New York Automobile Insurance Plan. For further information, contact your agent or broker or the Plan at 733 Third Avenue, New York,New York 10017. a Review by Automobile Insurance Plan Governing Committee:As your policy was one obtained through the New York Automobile Insurance Plan,you are hereby advised, regarding the above notification of cancellation,that you have the right to a review of such action by the Governing Committee of the Plan, 733 Third Avenue, New York, New York 10017. Consumer Report: Pursuant to fair credit reporting laws, you are informed that the above action is taken wholly or partly because of information con- tained in a consumer report, copy of which you may inspect and receive by contacting the following consumer reporting agency: (NAME. A00RESS PROOF OF FINANCIAL SECURITY IS REQUIRED TO BE MAINTAINED CONTINUOUSLY THROUGHOUT THE REGISTRATION PERIOD. IF YOU DO NOT KEEP YOUR INSURANCE IN FORCE DURING THE ENTIRE REGISTRATION PERIOD, YOUR REGISTRATION WILL BE SUBJECT TO SUSPENSION. IF YOUR VEHICLE IS STILI UNINSURED AFTER 90 DAYS, YOUR DRIVER LICENSE WILL BE SUSPENDED. TO AVOID THESE PENALTIES YOU MUST SURRENDER YOUR REGISTRATION CERTIFICATE AND PLATES BEFORE YOUR INSURANCE EXPIRES. BY LAOUR INSURANCE CARRIER IS REQUIRED TO REPORT SPECIFIC TERMINATION INFORMAT TO TH COMMISSIONER 0 MOTOR VEHICLES. oxi -yl(qLe IF YOU HAVE A LAPSE IN INSURANCE COVERAGE 0 N TY AYS OR LESS, THE LAW PERMITS YOU TO AVOID A SUSPENSION OF YOUR R GISTRATION BY THE PAYMENT OFF A CIVIL PENALTY OF FOUR DOLLARS FOR EACH DAY OR ANY PORTION THEREOF T TO NINETY DAYS FOR WHICH YOUR INSURANCE COVERAGE WAS NOT IN EFFECT. HIS GRACE PROVISION APPLIES ONLY ONCE DURING ANY 36 M NTH ERIO . — Authoriz Representative GU 6512c(Ed.4-85) ,m,, .Eo• ids ©1985 i4vrOCn'4z f nPY Commercial Union Insurance Companies ial Union Insurance Compa" IPC (NAME OF INSURANCE COMPANY) • PO Ho, 7780 1436, Philadelphia, PA. 19182 (ISSUING OFFICE ADLALdS) The policy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Shour'd investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. IMPORTANT PREMIUMS MUST BE RECEIVED IN COMPANY OFFICE AS REQUIRED BY PLAN. F t • PAY YOUR AGENT OR BROKER IN AMPLE TIME TO N NAME town of Southold PERMIT HIM TO FORWARD THE PREMIUM TO THE S • R STREET.�iU Road COMPANY IN THE TIME SPECIFIED. E • D CITY Southold! STATE NY. 11971 I MEMO ❑ —J The premium shown Is due TO ❑ Your policy expires 12:01 A.M.The renewal premium will be$ THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. INSURED ❑ We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels.it is suggested that re-application be made to the AUTO INSURANCE PLAN EXPIRATION DATE 12:01 A.M. Naics PLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED.POLICY NUMBER,AND AS"AUTO INSURANCE PLAN." to ❑ DEDUCT COMMISSION OF$ AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Producar ❑ You w-!!receive a chick shorty for the return premium Cdu3 the nsureC loss your commis;iorr, SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. ARP-150 AUTOMOBILE POLICY NUMBER POLICY PERIOD STAT. Ong 1st 2nd CHECK IF APPLICABLE INSURANCE TERR Policy Renew. Renew. Truckman I C.C. Stat Pol. Fin. PLAN OF STATE OF COD Beyond Filing N.Y State Reso 150 Mile Required Only Reqd. r W�++��!!`` 9 2 8 8 / Radius 1.12. WAN ..' L l J� t}�-2 1'8�-S J '❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ FOR PLAN' COMPANY TRANSACTION STATE DOUBLE EFFECTIVE REPORTING TERP.. CO. USE r�SIGNED DATE RECEIVED 175E ONLY CODE CODE CODE CREDIT DATE MONTH CODE COty1PLETE AS NEED. VEHICLES AMOUNT PERCENT CLASS N ANNUAL PREM. BALANCE PREM. DEPOSIT PREM. WRITTEN OF OF OF ENO. TYPE SURCHARGE SURCHARGE VEHICLES VRIV. Lisb. - R PASS. Cov_ J Phys. R Dem" _ N Fxcess E Indem. W _ A Liab. L Cov. OTHER Phys. Dam. Excess I--1 Indem. u UNEARNED-RETURN EARNED-ADDITIONAL NO AND CLASS OF C PREMIUM PREMIUM EFFECTIVE DATE VEHICLE AND 4 REASON tA SURCHARGE% C RPRIV clw IU51.�U 7-21'116 ❑ PASS. INSUREO'S REQUEST L `� Phys. A E Dam. ❑ NONPAYMENT OF PREMIUM T N I D Excess ❑ CO.REQUEST(attach Letter of Explanation) O O Indem N S Liab. OTHER— MOTHER— Acid vee. 024 b dclete E Cov. MOTHER 1 C,1—13 E Phys N Dam. T Excess Indem. VEHICLES REASON POLICY ASSIGNED NOT NO. TYPE ❑ RENEWAL QUOTATION NOT ACCEPTED BY INSURED ❑OTHER ISSUED ❑ INSURED MOVED LEFT NO FORWARDING ADDRESS ❑ THREE YEAR ASSIGNMENT PERIOD EXPIRED P • o NAME Val Stype Sons Inc U • DATE C STREET gain Road -%� E • J R 1 CITY 14atLituck, STAT11y. 1195 / -ir 02 662024 PART I Commercial Union Insurance Companies Cm&ial Union Unaura=e Company IS IPC (NAME OF INSURANCE COMPANY) !0 Dox, 77811 I436, Philadelphia, PA. 19182 ' (ISSUING OFFICE ADUHESS) " The A?icy listed below has been issued on the basis of information contained in the application;subject to adjustment upon completion of our usual investigation. Should investigation indicate the applicant is not in good faith entitled to insurance under the terms of the auto insurance plan,the policy is subject to cancellation in accordance with the plan. ,. »- IMPORTANT ""- PREMIUMS9AUST BE RECEIVED IN COMPANY OFFICE AS REQUIRED BY PLAN. I PAY YOUR AGENT OR BROKER IN AMPLE TIME TO N NAME To`o f southollf PERMIT HIM TO FORWARD THE PREMIUM TO THE - COMPANY IN THE TIME SPECIFIED. R STREET Main.. Road - - E • k DI CITY SOUthold. +� STATE NY. 11971 MEMO The premium shown Is due t �Z . r $3976.00 TO ❑ Your policy expires 12:01 A.M.The renewal premium will be$ THIS IS A MEMORANDUM ONLY,NOT A BINDER OR POLICY. INSURED ❑ We shall NOT renew because the normal period of assignment has expired.If coverage cannot be secured through regular channels, it is suggested that re-application be made to the AUTO INSURANCE PLAN EXPIRATION DATE 12:01 A.M. Naks PLEASE IDENTIFY ALL CORRESPONDENCE AND REMITTANCES BY NAMED INSURED,POLICY NUMBER,AND AS"AUTO INSURANCE PLAN." to ❑ DEDUCT COMMISSION OF$ AND FORWARD NET PREMIUM TO THE COMPANY WITH THIS COPY. Prodwor ❑ You will ecewe a check shortly for the return premium due the insured less your commission. SEND CHECK FOR GROSS RETURN PREMIUM TO THE NAMED INSURED. ARP-18D AUTOMOBILE POLICY NUMBER POLICY PERIOD STAT. Ong 1st 2nd CHECK IF APPLICABLE INSURANCE TERR Policy Renew. Renew. Truckman . . Stat PoI Fin. PLAN OF STATE OF Cy PE Beyond Filing N Y State Resp- 9) 150 Mile �Re'QCuCiredl Only ReqC3D 3' 27 9,5 4-z 1-bb-87 Q ❑ ❑ ❑ Ra❑5 ❑ ❑ ❑ FOR PLAN COMPANY TRANSACTION STATE DOUBLE EFFECTIVE REPORTING TERR CO. USE DATE ASSIGNED DATE RECEIVED USE ONLY CODE CODE CODE CREDIT DATE MONTH CODE COMPLETE 11 11---I- 0 AS NEED. VEHICLES AMOUNT PERCENT CLASS N ANNUAL PREM. BALANCE PREM. DEPOSIT PREM. WRITTEN OF OF OF S W NO. TYPE SURCHARGE SURCHARGE VEHICLES OPRIV. Liab. R Cov.PASS. M Phys. R Dam. E N Excess E Indem. W _ A Liab. L Cov. OTHER Phys. Dam. Excess Indem. UNEARNEDIU ETUF.N EARN PREMIUM ITIONAL NO AND CLASS OF C EFFECTIVE DATE VEHICLE AND A PREMIUM PREMIUM REASON SURCHARGE% N O R, Liab.,.. 39753.OG 7-1-86 INSURED'S REQUEST L ASS. L Dam.Phys. A E E] NONPAYMENT OF PREMIUM T N I D Excess ❑ CO.REQUEST(attach Letter of Explanation) O O Indem. A N R OTHER addVeil. 8 IS-23 S Liab. M OTHERCov. E Phys. N Dam. T Excess Indem. VEHICLES REASON POLICY ASSIGNED RENEWAL QUOTATION NOT ACCEPTED BY INSURED NOT NO. TYPE ❑OTHER ISSUED ❑ INSURED MO.ED LEFT NO FORWARDING ADDRESS ❑ THREE YEAR ASSIGNMENT PERIOD EXPIRED F P • p NAME Val .Stype & Sons ILtc D • U STREE*Jain Road DAT C E • R Lf, Mattituck, STATE My. IitS� SIGNED 682024 DAFT Z i 1 FLEET SCHEDULE This endorsement is effective 7-21-86 for attachment to Policy No. CJD 33 27 95 IPC { issued to Town of Southold by Commercial Union Insurance Company (Name of Insurance Company) The insurance afforded for any one automobile is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges opposite that automobile. Delete veh. # 10-13 P/R .751 PREMIUMS VEHICLE - SYMBOL OR N0. TRADE NAME,BODY TYPE,MODEL PRINCIPAL PLACE OF GARAGING ZLL COST NEW COLLISION YEARGVW OR GCW d '- INC.EOUIPMT. BODILY* PERSONAL PROPERTY LIMITS OF VEHICLE IDENTIFICATION N0. Ee MEDICAL UNINSURE LIABILITY OF OPERATING RADIUS .-oo MONTH INJURY INJURY DAMAGE COMPREHENSIVE FIRE THEFT MODEL in¢ou YEAR LIABILITY PROTECTION LIABILITY PAYMENTS MOTORIST (DIRECT AMOUNT usc'.',in COVERAGES) DEDUCTIBLE PREMIUM # 10 580530 1984 Plymouth ell IR 366.00 127.00 116.Od 8.00 # 11 580531 1 112 580533 1984 Plymouth l: 3B 366.00 127.0 116.00 8.00 # 13 585534 1984 Plymouth cl: 3B Totals 1 1464.00 508.00 464.00 32.00 *Enter Combined Single Limit Here oaozs 9..... i`nmmarrial I Wain 1nci rnnep 1rnm»anioc , ... ,_.. ..., - _ ��.. FLEET SCHEDULE This endorsement is effective 7-1-86 for attachment to Policy No. CJD 33 27 95 IPC issued to Town of Southold by Commercial Union Insurance Company (Name of Insurance Company) The insurance afforded for any one automobile is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges opposite that automobile. Add Veh. # 18423 P/R .805 PREMIUMS VN0.EHICLE - SYMBOL OR COLLISION PRINCIPAL PLACE OF GARAGING a! COST NEW TRADE NAME,BODY TYPE,MODEL r„ t LIMITS OF YEAR GVW OR GCW m INC.EOUIPMi. BODILY PERSONAL PROPERTY VEHICLE IDENTIFICATION N0. `-'=E LIABILITY OF OPERATING RADIUS oa MONTH 8 INJURY INJURY DAMAGE COMap ENEN SIVE MODEL y��� YEAR LIABILITY PROTECTION LIABILITY PAYMENTS MOTORIST (DIRECT AMOUNT PREMIUM FIRE THEFT COVERAGES) DEDUCTIBLE N¢Uy 18 IMB26SMX7163 4 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 19 IP3BB26SOHX7163 3 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 20 IP3BB26S4HX7163 5 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 21 1P3BB26S6HX7163 6 1987 Plymouth cl: 3B 393.00 136.00 125 .00 9.00 22 1P3BB26S8HX7163 7 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 23 1P3BB26SXHX7163 8 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 I Totals 2358.00 816.00 750.00 54.00 147 t *Enter Combined Single Limit Here 10 G1026 9 rnmmQrr 6l Vninn Tnc;ir%nea rnr».van:rsc DUCER ' • 31C �0 ICY NUMBER -00960 Insurance 3 27 95 The Company issuing this policy is indicated by the first letter in the POLICY NUMBER,as follows: BUSINESS AUTO POLICY C-COMMERCIAL UNION INSURANCE COMPANY A-AMERICAN EMPLOYERS'INSURANCE COMPANY DECLARATIONS - SECTION II F-THE EMPLOYERS'FIRE INSURANCE COMPANY CA 00 02 (Ed. 01 80) N-THE NORTHERN ASSURANCE COMPANY OF AMERICA A STOCK COMPANY ITEM OW-NAMED INSURED AND ADDRESS BOSTON,MASSACHUSETTS Town of Southold Main Road POLICE CARS -- Southold, NY 11971 L I FORM OF NAMED INSURED's BUSINESS. ❑ CORPORATION; LJ PARTNERSHIP, ❑INDIVIDUAL OR ❑OTHER: 31-76 NAMED INSURED'$ BUSINESS POLICY PERIOD Policy covers FROM 4-21-86 To 4-21-87 12:01 A.M.Standard Time at the Named Insured's Address stated above. ITEM TWO— SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those tabs shown as covered ootfa Autos are shown as covered autos for a particular coverage by the entry of one or more of the symbols from ITEM THREE next to the name of the coverage COVERED AUTOS LIMIT COVERAGES (Entry of one or more of the symbols from ITEM TaaEE THE MOST WE WILL PAY FOR ANY ONE PREMIUM snows wroth oius are Covered alai ACCIDENT OR LOSS LIABILITY INSURANCE 7 $ 250,000/500,000/100,000 $ 11,317.00 PERSONAL INJURY PROTECTION(P.I.P) SEPARATELY STATED IN EACH P.I.P. ENDORSEMENT MINUS (or egt^)valent No-fault coverage) 7 $ Deductible $ 2,974.00 ADDED P.I.P. (or equivalent added No-fault cov.) SEPARATELY STATED IN EACH ADDED P.LP. ENDORSEMENT $ OROPERTY PROTECTION INSURANCE(P.P.I.) SEPARATELY STATED IN THE P.P I. ENDORSEMENT MINUS (Michigan Only) $ Deductible FOR EACH ACCIDENT $ AUTO MEDICAL PAYMENTS INSURANCE S $ UNINSURED MOTORISTS INSURANCE 7 $ 10,000/20,000 vo 1 $ w COMPREHENSIVE COVERAGE ACTUAL $ Deductible FOR EACH COVERED AUTO FOR ALL OR ACTUAL UE LOSS EXCEPT FIRE OR LIGHTNING $ �a REPAIR, $25 Deductible FOR EACH COVERED AUTO FOR LOSS �¢ SPECIFIED PERILS COVERAGE WHICHEVER <=i IS LESS CAUSED BY MISCHIEF OR VANDALISM $ } COLLISION COVERAGE MINUS $ Deductible FOR EACH COVERED AUTO $ ii TOWING AND LABOR 'NO��,"b� $25 for each disablement of a private passenger aoto Is 6.00 FORMS AJq�N %PfiMENTSXONTAINED IN THIS POLICY AT ITS INCEPTION G8003-5 PREMIUM FOR EEN3DORSEMENTS$ AP.AL9551,AP112,AP12/39a,AP208,AP143,AP346,A771,A773b,A1030,A874,A91 E t O A TALPREMIUM $ 14,484.00 The estimated total premium for this policy is based on the exposures you told us you would have when this policy began We will compute your final premium due when we determine your actual exposures.The estimated total premium will be credited against the final premium due and you will be billed for the balance,if any. If the estimated total premium exceeds the final premium due you will get a refund.To determine your final premium due we may examine your records at any time during the period of coverage and up to three years afterward. If this policy is issued for more than one year, the premium shall be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. Countersigned M Authorized R ental it f THIS DECLARATIONS MUST RE COMPLETED BY tHE ATTACHMENT OF DECLARATIONS(CONTINUED) THESE DECLARATIONS TOGETHER WITH"POLICY PROVISIONS- SECTION I" AND ENDORSEMENTS. IF ANY. ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. IncMrdes copyrghted matenai d Insurance services Office,with its permission Copyright,Insurance services office 1977.1979 (1,8181 A-1 IFrt 1.04.4 BUSINIS AUTO POLICY—DECLARATIONS—(Conti ) cA 00 02(Ed 011 800) A 9 ipc For a4tachment to Policy No.CJD 33 27 95 to complete said policy. • ITEM THREE Refer to Policy Provisions - Section I for DESCRIPTION OF COVERED AUTO DESIGNATION SYMBOLS 1 through 9. Enter SYMBOL 10 DESCRIPTION here: ITEM FOUR—SCHEDULE OF COVERED AUTOS YOU OWN Covered DESCRIPTION PURCHASED TERRITORY: Town&State Where the Covered Auto Year Model.Trade Name;Body Type Original Cost New Actual NEW(N) Auto will be principally garaged No. Serial Number(S):Vehicle Identification Number(VIN) Cost& USED(U) 1 2 3 4 see schedule 5 6 Covered CLASSIFICATION Auto Radius of Business use Size GVW.GCW Primary Secondary Except for towing all physical damage y a p payable to you and the loss Operation s=service or Vehicle Age Rating Rating code payee named below as interests may appear at the time of the loss No. (In Mlles) r_retail seatin Capacit Group Factor Factor c-comm'I g y 1 2 3 4 5 see schedule b COVERAGES—PREMIUMS, LIMITS AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry In the corresponding ITEM TWO column applies instead) ADDED PROP PROTUNINSURED SPECIFIED COLLISION TOWING& LIABILITY P.I.P P 1.P. (Mich only) AUTO. MED PAY. MOTORISTS COMPREHENSIVE PERILS LAaOR Covered Limit' Limit' Limit" Limit** $25 per Auto Limit minus Limit' minus Limit Limit — minus Limit minus Disable- No. (In Premium deductible Pre- deductible Pre- (In Pre- in Pre- Pre- deducbdel deductible Premium merit Thou- mium mium Thou- mium Thou- mwm shown mium Premium shown sands) shown Premium shown sands) sands; below below Premium below below 1 Z 3u sc u e 4 5 6 Total Premium VFUNUMA ����� �� 'Limit stated in each applicable P I P,Added P.LP or P P.I Endorsement. "Limit stated in ITEM TWO. ITEM FIVE—SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS LIABILITY INSURANCE—RATING BASIS,COST OF HIRE STATE ESTIMATED COST OF HIRE FOR EACH STATE RATE PER EACH $100 COST OF HIRE PREMIUM S I S S TOTAL PREMIUM S Cost of hire means the total amount you incur for the hire of autos you don't own (not including autos you borrow or rent from your employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. ITEM SIX—SCHEDULE FOR NON-OWNERSHIP LIABILITY NAMED INSURED'S BUSINESS RATING BASIS NUMBER PREMIUM Other than a Social Service Agency Number of Employees $ Number of Employees E Social Service Agency s Number of Volunteers S Countersigned by ue ne osiotA.1 Includes copyrighted material 0Insurance Services Office.with its permission Copyright. urance�vlcesffice, 1 . 197 NEW YORK AUT(WBILE INSURANCE PLAN POLICY CVGE REQUEST IF FS75/76/77 ISSUED,PLAN COPY OF I.D. CARD MUST BE SENT TO PLAN • IF APPLICATION NOT YET ASSIGNED,SEND THIS FORM TO NYAIP AND GIVE DATE THE ORIGINAL APPLICATION WAS MAILED TO NYAIP. NAME OF INSURANCE COMPANY PRODUCER'S NAME S.S.OR IRS NO. f STREET STREET aly zpwx,�/ CITY STATE ZIP CITY STATE ZIP G.9m - /7a M,47T 1 Tuc,c-,- IkV .�- POLICY NUMBER TELEPHONE NUMBER IF r GJn 77 9S (INCLUDE AREA CODE) ( svz vel NAME OF INSURED Complete the following items only if applicable: G � ` S• 1. VEHICLE DELETION VEHICLE YEAR MAKE VEHICLE IDENTIFICATION NUMBER No.1 No.2 2. VEHICLE ADDITION YEAR MAKE MODEL NAME&BODY STYLE VEHICLE IDENTIFICATION NUMBER a.Priv.Pass.Type Replacement Veh.: ❑ CYLS CCPURCHASED NEW USED COST NEW PRINCIPAL PLACE OF GARAGING STATE OF REGISTRATION or MO. YR. ❑ ❑ Added Veh. ❑ PLEAS BUS COMM FARM IMILESTOWORKOR ANTI THEFT DEVICE ACTIVE PASSIVE TO TRANSPORTATION ❑ ❑ ❑ ❑ MODEL BRAND _ ❑ ❑ Use and Classification: ADDRESS OF APPLICANT AS APPEARS ON REGISTRATION TERRITORY I RATE CLASS PENALTY POINT$ SYMBOL AGE GROUP SEE EXPLANATION CARD—FORM NO.AIP 7070 Classes'/Factors b.Commercial/ YEAR,TRADE NAME,BODY TYPE-TRUCK, PURCHASED 'GROSS VEHICLE A TRUCKTRACTORTRAILER,SEMI TRAILER, e.a errs sus WEIGHT(GVW) SIZE 'RADIUS 'FOR SIZE „yk;x. Public Auto. C Caeuencu, NEW IL-MH-EH) (LI-L-OI BUS RAD BUS SEATING CAPACITY,MODEL NUMBER MO/YR USED TRUCKS ONLY Replacement Veh. ❑ Slale or ------- IG COSTNEW ---- 'GRSSSCOM B. IDENTIFICATION NUMBER .Ration n r,c (CHASSIS 8 BODY INCL. W BUSINESS 'SPEC.IND. SPECIAL FINAL -- ---- C, IF�c.r�op USE IM T FbSDI INDUSTRY RATING Or „ GARAGING LOCATION Raging SPECT O O A ❑ (TOWN.STATE) Te.ntory RATI IS-RCI WO-F-D Added Veh. A — ----------------------— LOS . ;:.....,.: ., ---------------------- --- /yeaiw C. v LBS c. If Public Auto: Use of Veh.: Seating Capacity(excluding driver's seatl. Territory(s)in which or through which vehicle customarily operated: Radius Class(Circle one) L,I,LO TAXICABS CHECK APPROPRIATE CLASSIFICATION WAPDIdOWN OWNER-DRIVER I SINGLE SHIFT NAMED DRIVER I OWNER AND ANOTHER DRIVERS.OTHER THAN OWNER 7[y:] MEDALLIONFCABI C]YES ❑NO ❑ ❑ ❑ TUI.^»y M IF"YES",GIVE MEDALLION NUMBER. 3. LOSS PAYEE ADD DELETE CHANGE TO YEAR MAKE VEHICLE IDENTIFICATION NUMBER ❑ ❑ APPLICABLE TO VEHICLE - NAME OF LOSS PAYEE STREET CITY STATE ZIP CODE 4.COVERAGES: In Accordance ❑ADD ❑CHANGE ❑DELETE YEAR MAKE VEHICLE IDENTIFICATION NO. with Plan Rules. APPLICABLE TO ❑NO CHANGE VEHICLE BODILY PROPERTY MANDATORY MEDICAL STATUTORY VOLUNTARY COMPRE COMPRE- HE HENSIVE INJURY DAMAGE PERSONEL INJURY PROTECTION PAYMENTS U.M. UM ISION 40 AND LIABILITY LIABILITY II NCLUDES DEATH BENEFITS) COVERAGES e COVERAGE, COVERAGES COLLISION Check Applicable ' ❑ ❑ ❑ ❑ ❑ ❑ BOX DEDUCTIBLE ❑NONE ❑$200 FAMILY SEP19 ❑GUEST OCCUPANT OUT-OF STATE ti Limits/Ded. S $ ❑FULL ADO'L PIP S S S vlf& RPI. cri ��g' Ded (INCL.GUEST OUT OF STATE)Annual Premium S S S S S S $ *For private passenger vehicles,not for hire. Subject to the New York Comprehensive Automobile Reparations Act. ��� 404IncludesUnderinsured Motorists Coverage. For vehicles,not for hire,written on a specified car basis. D 4DApplicable to private passenger vehicles and motorcycles only 1 For light commercial,non-fleet vehicles only. Estimated Annual Premium$ Deposit(30%of Estimated Annual Premium or Pro Rata Premium for the Remainder of Polley Period, whichever is less)S Make check Payable to Insurance Company and mail directly to Insurance Company. AIP 4453(Rev.10/85) - COMPANY ACKNOWLEDGEMENT COPY(must Show date vocelved) This endorsement,effective 6 forms part of Policy No, CM 33 27 95 ]EPC issued to Tolim of Southold by Catoercial Union Iasnrance company (Name of Insurance Company) It is agreed that with respect only to such and so many of the following particulars as are indicated by specific entry or entries, the policy is amended to read as follows: 1. Insurance is hereby afforded on the following described auto garaged at (No and Street) (City m Tow,-.! ICou�•tyl Istat, for such and so many of the coverages as are indicated by entry of additional premium in Paragraph III. Year of Body Type, Gross Vehicle Vehicle Operating Class Code Zone Code Cost New; Model Trade Name wgt;Gross Identification No. Radius 16 Digrtsl 15 Digits) Incl Eqpmt. Combined Wqt. Month-Year `24 1978 Ford F26HEM 1535 33 I1. Insurance is hereby terminated on the following described auto: Vehicle 24 Year 1977 Trade Name and Model Plymouth Vehicle No, PK4 07D176803 for such and so many of the coverages as are indicated by entry of return premium in Paragraph III. III. The limit of the company's liability against each coverage indicated by entry of "additional"or "return" premium is hereby amended or added to the amount entered opposite each such coverage herein: ADJUSTMENT OF PREMIUMS ADDL. Anne A—ywuv ADDITIONAL RETURN COV. LIMITS OF LIABILITY COVERAGES R—, Prmium N—um Premoum Eic!,Acc-d­! S Liability Insurance Each Person I Each Accident. S s BodJy Injury Each Aec•de^! y L - S Property Damage Personal Injury Protect.on IP I P I S for Equ-valent No Fault Coverage! S Added P I for Equivalent No-fault Coverage) S Property Protecnnr,Insurance IMich.gan Only! Auto Medical S Payments Insurance S Uninsured Motorists Insurance Each Person. Each Accident: Uninsured Motorists f �S Bodily Injury nE Each Accident. S - Uninsured Motorists Property Damage S Comprehensive Coverage S E Specified Perls Coverage o� �a S - Coulson Cgverage 0 Towing and Labor S for each disablement (Not Available n Calf Or-d) TOTAL PREMIUMS $ S If coverage is written for the first time.so nd,cate by marking an"X"opposite that coverage involved. NET 1W Cham PREMIUM S - Any loss hereunder is payable as interest may appear,subject to Loss Payable Clause on reverse,to the named Insured and (state name and address): 4-21-86-87 Address of Named Insured is changed to 9-25-86 dZ Rating classification is changed to Other changes: Producer 31—M60 Producer al Stnw i Soon Inc., Main Road, Mattitnek, DT. 1 19 2 G3522-2 (PART 3) CHANGE OF COVERAGE OR AUTO ENDORSEMENT (COMMERCIAL VEHICLES) CounterslgnedJ ' h exp y 9 �10 Commercial Union Insurance Companies �- This endorsement,effective8-4x86 D forms part of Policy No. & 33 27 95 IPC issued to Toms of ;Ald by cawnv=ial Union Iaauramm CMPMY (Name of Insurance Company) It is agreed that with respect only to such and so many of the following particulars as are indicated by specific entry or entries, the policy is amended to read as follows: I. Insurance is hereby afforded on the following described auto garaged at ;No and Street) (City or Tow.. ICountyi (State) for such and so many of the coverages as are indicated by entry of additional premium in Paragraph III. Year of Gross Vehicle Cost New; Body Type, Vehicle Operating Class Code Zone Code Incl. Eqpmt. Model Trade Name III Gross Identification No. Radius I6 Digits) 15 Digits) Combined Wgt. Month-Year #16 1978 PlYmmth BC2B=1124662 36 — i . Insurance is hereby terminated on the following described auto: Vehicle Wear 1982 Trade Name and Model 1'iyottth I.D. No. 21"3IIE26*41CB183382 for such and so many of the coverages as are indicated by entry of return premium in Paragraph III. III. The limit of the company's liability against each coverage indicated by entry of "additional"or "return" premium is hereby amended or added to the amount entered opposite each such coverage herein: ADJUSTMENT OF PREMIUMS ADD L. Aee.e A—1r.- ADDITIONAL RETURN COV LIMITS OF LIABILITY COVERAGES R.re,nr Prrm•um Premum Pemum Enc,Aec,uent g Liability insurance Each Person Each Accident: S Ig Bodily Injury Each Acc.dent. H s Property Damage j Personal Injury Protection IF I P I $ for Equwalent No Fault Coverage) Adoed P.I.P (or Equivalent No Fault Coverage) $ Property Protection insurance (M.ch,gan Only) $ Auto Medical Payments Insurance S Uninsured Motorists Insurance Each Person: Each Acuc Uninsured Motorists S g BoUiiy Injury Each Accident. rn E $ Uninsured Motorists Property Damage $ Comprehensive Coverage $ a E t Specified Penjs Coverage a S S Collision Coverage A. Towing and Labor $ for each disablement (Not Avauable in Cal TOTAL PREMIUMS S s It coverage rs written for the first time,so indicate by marking an X-opposite that coverage involved. !10 Chasse NET PREMIUM$ Any loss hereunder is payable as Interest may appear,subject to Loss Payable Clause on reverse,to the named Insured and (state name and address): 4-21-86-87 Address of Named Insured is changed to 9-25-85 ds Rating classification is changed to Other changes: Producer 31-W960 I Producer pal Stype i Sone Inc., Nal xa 2 G3522-2 pgp13 CHANGE OF COVERAGE OR AUTO ENDORSEMENT(COMMERCIAL VEHICLES) Counters) Ted--) 141 Aurnorrred Representatwe000— Commercial Union Insurance Companies This endorsement,effective }—S6 fol ms part of Policy NnAdik = 33 27 95 IPC issued to ?own of Southold by Commercial Union InsuranceCody (Name of Insurance Company) It is agreed that with respect only to such and so many of the following particulars as are indicated by specific entry or entries, the policy is amended to read as follows: I. Insurance is hereby afforded on the following described auto garaged at (No and Street) IC,ty a lowni (County) ISta,,i for such and so many of the coverages as are indicated by entry of additional premium in Paragraph I It. Year of Body Type, Gross Vehicle Vehicle Operating Class Code Zone Code Cost New; Model Trade Name Wgt;Gross Identification No. Radius (6 Digits) 15 Digits) Incl. Eqpmt Combined Wqt. Month-Year I. Insurance is hereby terminated on the following described auto: Vehicle 10—bear Trade Name and Model Ste Schedule I.D. No. for such and so many of the coverages as are indicated.by entry of return premium in Paragraph III. The limit of the company's liability against each coverage indicated by entry of "additional"or "return" premium is hereby amended or added to the amount entered opposite each such coverage herein: ADJUSTMENT OF PREMIUMS ADD L. Aaara sum v.,nr. ADDITIONAL RETURN COV. LIMITS OF LIABILITY COVERAGES Each Acc.d—t. S Liability Insurance Each Person Each Acadent: 1952.00 1464.00 S 250,000 S 500,000 Bodily Injury Each Acadent. n j 620.00 464.00 S 100,000 Property Damage 676 /� Personal In,u ry Protection(P I.P) .00 508.00 S (or Equ,valent No Fault Coverage) S Added P.LP (or Equivalent No Fault Coverage) - S Property Protection Insurance (Michigan Only) Auto Medical b Payments Insurance s Uninsured Motorists Insurance Each Person: Each Acadent: Uninsured Motorists 44.00 32.00 a 10,000 $ 20.000 _ Bodily In,u,y Each Accident, In'E S Uninsured Motorists Property Damage S Comprehensive Coverage S Specified Penis Coverage o� c $ Collision Coverage s Towing and Labor s for each disablement (Not Available,n Cai,tor-a) TOTAL PREMIUMS S IS 24 63.00 If coverage,s written for the first time,so.nd,cate by marking an"X"opposite that coverage'nvolved. NET turn PREMIUM S 2468.00 P/R •751 Any loss hereunder is payable as Interest may appear,subject to Loss Payable Clause on reverse,to the named Insured and (state name and address): 4-21-66-87 Address of Named Insured is changed to 9—,25-86 di Rating classification is changed to Other changes: delete veh. 410-13 Producer a 31-00960 1 Producer lVal StM d Sons Inc. Ma G3522-2 (PART 3) CHANGE OF COVERAGE OR AUTO ENDORSEMENT (COMMERCIAL VEHICLES) Counte — Authorized Representatt Commercial Union Insurance Companies This endorsement,effective forms part of Policy No. CJD 33 27 93 IPC 14 .w issued to Town of Southold by Commercial Union Insurance Company (Name of Insurance Companyl It is agreed that with respect only to such and so many of the following particulars as are indicated by specific entry or entries, the policy is amended to read as follows: I. Insurance is hereby afforded on the following described auto garaged at INo.and street) (Gty or Town) (County) (statel for such and so many of the coverages as are indicated by entry of additional premium in Paragraph III. Year of Body Type, Gross Vehicle Vehicle Operating Class Code Zone Code Cost New; Model Trade Name Wgt;Gross Identification No. Radius (6 Digits) 15 Digits) Incl. Eqpmt. Combined Wqt. Month-Year 924 1977 Plymouth PM41=176603 I I. Insurance is hereby terminated on the following described auto: Vehicle Year Trade Name and Model I.D. No. for such and so many of the coverages as are indicated by entry of return premium in Paragraph III. I I I. The limit of the company's liability against each coverage indicated by entry of "additional"or "return" premium is hereby amended or added to the amount entered opposite each such coverage herein: ADJUSTMENT OF PREMIUMS ADDL. Add dAvta v.,.i. ADDITIONAL Rr TVRN COV LIMITS OF LIABILITY COVERAGES Rar .. Premium N— E3en ACC�denl S Liability insurance Each Person. Each Accident: 488.00 366.00 s 250,000 s 500,000 Bodily Injury Z MEach Aix-dr•1t. u1 135.00 1166*00 s 100,000 Property Damage 169.00 12/.00 S oerr Eou lvaent No Fauit CoveraProtection iP ge) age) $ Added P I (or Equivalent No Fault Coverage) $ Property Protect.on Insurance (Michigan Only) Auto Medical S Payments Insurance $ Uninsured Motorists Insurance Each Person. Each Accident: Uninsured Motorists 11.00 8.00 $ 10,000 I$ 20,000 _ Boddy Injury dE Each Accident. m $ Uninsured Motorists Property Damage $ Comprehensive Coverage $ ' Specified Perils Coverage E'L L $ — Collision Coverage Towing and Labor $ for each disablement (Not Available in Cahforn•al TOTAL PREMIUMS S 617.00 S 'If coverage is written for the Inst time,so indicate by marking an"X"opposite that coverage involved NET !Additional V PREMIUM s 617.00 P/8 .751 Any loss hereunder is payable as Interest may appear,subject to Loss Payable Clause on reverse,to the named Insured and (state name and address): 4-21-86-87 Address of Named Insured is changed to 9-25-86 dz Rating classification is changed to Other changes: Producer #1 31-00900 Producer iral St 6 Sons Inc. Main tilt 10 G3522-2 (PARTS) CHANGE OF COVERAGE OR AUTO �A�ihor&4d ENDORSEMENT(COMMERCIAL VEHICLES) Countersi resentative �-r Commercial Union Insurance Companies This endorsement,effective 7A ^$6 forms part of Policy No. D 33 27 95 ZPC issued to Town of Siomthold by Commercial Union Immraaee Company (Name of Insurance Company) It is agreed that with respect only to such and so many of the following particulars as ale indicated by specific entry or entries, the policy is amended to read as follows: 1. Insurance is hereby afforded on the following described auto garaged at tNo.and Stirell (Gtv of Town( ICountyl ($tate for such and so many of the coverages as are indicated by entry of additional premium in Paragraph 111. Year of Body Type, Gross Vehicle Vehicle Operating Class Code Zone Code Cost New; Model Trade Name Wgt;Gross Identification No. Radius (6 Digits) (5 Digits) Incl. Combined Wgt. Month-Year d18-23 Ssa Schedule 33 — 1 I. Insurance is hereby terminated on the following described auto: Vehicle Year Trade Name and Model I.D. No. for such and so many of the coverages as are indicated by entry of return premium in Paragraph 111. 111. The limit of the company's liability against each coverage indicated by entry.of "additional"or "return" premium is hereby amended or added to the amount entered opposite each such coverage herein: ADJUSTMENT OF PREMIUMS AD Dr L. A—d Agro yntl. ADDITIONAL RETURN COV LIMITS OF LIABILITY COVERAGES Ran,w e..m�m Rr�mium eremium Each n Acc-Uet S Liabrhty Insurance Each Person Each Accident. 2928.00 2358.00 s 250,000 is500,WO = Bodily Injury n E Each Acudent. 930.00 750.00 S 100,000 Property Damage 1014.00 816.00 $ Personal Injuraient o FaProteult C ve I P I la Equwafent No Fault Coverage( $ AddedP.I P (or Equivalent No-Fault Coverage) $ Proper:v Protection Insurance (fill Only) Auto Medical S Payments insurance $ Uninsured Motorists Insurance Each Person: Each Accident: Uninsured Motorists 66.00 54.00 $ 10,000 $ 20,000 godly Injury �E Each Accident. $ Uninsured Motorists Property Damage $ Comprehensive Coverage $ Specified Perils Coverage �a $ Coths—Coverage n Towing and Labor $ for each disablement (Not Available Cal,fo,nal TOTAL M PREMIUMS $3978.00 $ 'If coverage is written for the first time,so indicate by marking an••X••opposite that coverage involved. NET Additional PREMIUM$ 3978.00 PIR .805 Any loss hereunder is payable as interest may appear,subject to Loss Payable Clause on reverse,to the named Insured and (state name and address): Address of Named Insured is changed to 4-2186-87 Rating classification is changed to 9-25-86 ds Other changes: add vah. 018-23 Producer 31-00960 Producer al St b Sops Inc., Wn G3522.2 (PART 3) CHANGE OF COVERAGE OR AUTO ENDORSEMENT(COMMERCIAL VEHICLES) Counters uth zed resenrat`i�� Commercial Union Insurance Companies FLEET SCHEDULE This endorsement is effective 7-1-86 for attachment to Policy No. CJD 33 27 95 IPC issued to Town of Southold by Commercial Union Insurance Company (Name of Insurance Company) The insurance afforded for any one automobile is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges opposite that automobile: Add Veh. 018-023 P/B .805 PREMIUMS VEHICLE — SYMBOL OR COLLISION NO PRINCIPAL PLACE OF GARAGING ZLL COST NEW TRADE NAME,BODY TYPE,MODEL m _ • LIMITS OF YEAR GVW OR GCW INC.EO�iIPMT. BODILY PERSONAL PROPERTY VEHICLE IDENTIFICATION NO. `-yea MEDICAL UNINSURE LIABILITY OF OPERATING RADIUS Z'Z E MONTH B INJURY INJURY DAMAGE PAYMENTS MOTORIST (DIRECT COMPREHENSIVE wMouNr FIRE THEF� MODEL �"'c�� YEAR LIABILITY Pfl01ECT10N LIABILITY PREMIUM COVERAGES) DEDUCTIBLE i„ 18 IMB26S2HZ716 4 1987 Plymouth cl: 3B 393.00 136,00 125.00 9.00 19 1P3BB26SO8Z7163 3 1987 Plymouth cl: 311 393.00 136.00 125.00 9.00 20 IPM26SM716316 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 21 1P3BB26S6RX716346 1987 Plymmth cl: 3B 393.00 136.00 125 .00 9.00 22 IMB26S8HZ7163 7 1987 Plywath cl: 33 393.00 136,00 125.00 9.00 23 1P311B26SM716 8 1987 Plymouth cl: 3B 393.00 136.00 125.00 9.00 I Totals 2358.00, 816,9k_750.00 54.00 *F'ntnr rnmhlnPri Sinnip I Imit Here ._ ,y .. ,- FLEET SCHEDULE page 1 of 2 This endorsement is effective 4-21-86 for attachment to Policy No. CJD 33 27 95 ` issued to Town of Southold by Commercial Union Insurance Company IPC (Name of Insurance Company) The insurance afforded for any one automobile is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges opposite that automobile. T-26 S PREMIUMS VEHICLE - SYMBOL OR COLLISION N0, PRINCIPAL PLACE OF GARAGING ' COST NEW YEAR TRADE NAME,BODY TYPE.MODEL e • LIMITS OF VEHICLE IDENTIFICATION N0. GVW OR GCW INC.EpUIPMT. BODILY PERSONAL PROPERTY MEDICAL UNINSURE LIABILITY =e OF OPERATING RADIUS o=oma MONTH INJURY INJURY DAMAGE COMPREHENSIVE FIRE THEFT PAYMENTS MOTORIST (DIRECT AMOUNT MODEL rnV; YEAR LIABILITY PROTECTION LIABILITY PREMIUM Peconic , NY A., COVERAGES DEDUCTIBLE 1 1P3BB26S3FX632 73 1985 Plymouth cl: 3B+25% 610.00 211,00 194.00 11.00 2 1P3BB26S1EX632 72 1985 Plymouth cl: 313+35% 659.00 228.00 209.0 11.00 3• 1P3BB26SXFX632 71 488.00 1985 Plymouth cl: 3B 169.00 155.00 11.00 4 1P3BB26S8FX632 70 1985 Plymouth cl: 3B 488.00 169.001 155.00 11.00 5 1P3BB26SM632 69 1985 Plymouth cl: 3B 488.00 169.00 155.00 11.00 6 1P3BB26SXFX632 68 1985 Plymouth cl: 3B 488.00 169.00 155.0 11.00 7 1FMDU15H1FLA87 85 1985 Ford cl: 3B 488.00 169.00 155.0 11.00 � iP3BB26PXFX65263 1985 Plymouth cl: 313 488.00 169.00 155.00 11.00 1P3BB26P3EX542 15 1984 Plymouth cl: 3B 488.00 169.00 155.0 11.00 1P3BB26S3EX580 30 1984 Plymouth cl : #3B 488.00 169.0 1 • *Enter Combined Single Limit Here 6.NIN U&A. Commercial Union Insurance Companies CoonTersigned � r FLEET SCHEDULE This endorsement is effective 4-21-86 for attachment to Policy No. CJD 33 27 95 page 2 of 2 issued to Town of Southold ` Commercial Union Insurance Company IPC by (Name of Insurance Company) The insurance afforded for any one automobile is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges opposite that automobile. PREMIUMS as VEHICLE - N0. PRINCIPAL PLACE OF GARAGING - SYMBOL OR COLLISION COST NEW TRADE NAME.BODY TYPE,MODEL -„ • LIMITS OF GVW OR GCW ,�, INC.EOUIPMT. BODILY PERSONAL PROPERTY YEAR VEHICLE IDENTIFICATION N0. 2 E^ MEDICAL UNINSURE LIABILITY OF OPERATING RADIUS 000� MONTHB INJURY INJURY DAMAGE COMPREHENSIVE FIRE THEFT MODEL I; Is-- YEAR LIABILITY PROTECTION LIABILITY PAYMENTS MOTORIST (DIRECT AMOUNT PREMIUM Vi¢ciHCOVERAGES DEDUCTIBLE it 1P3BB26S3EX580531 Plymouth cl: 3B 488.00 169.01 155.0 11.0 12 1P3BB26S3EX580533 1984 Plymouth cl: 313 488.00 169.00 155.00 11.0 13 1P3BB26S3EX5855 4 1984 Plymouth cl: 3B 488.00 169.Oq 155.00 11,0 14 2P 3BB26S32R2293 6 1983 Plymouth cl: 3B 488.00 169.00 155.00 11.0 15 2P3BB26L2CR1335 4 1982 Plymouth cl: 3B 488.00 169.001 155.00 11.00 16 2P3BB26N4CR1833 2 1982 Plymouth cl: 3B 488.00 169.00 155.00 11.00 17 29859 1968 Jeep cl: 3B 488.00 169.00 155.00 11.00 ,974.0 totals 8,589. DO 2,728.DO 187.0 26-9 *Enter Combined Single Limit Here "`ifl1oNTEO IN U.S.A. Commercial Union Insurance Companies Countersigned (Authorized Representative) Fq E IVE OFFICE:150 WILLIAM STREET,NEW YORK,N.Y.10038 AGiTi7 L' HULL ❑ PROTECTION& INDEMNITY ❑ LIABILITY ❑ CO.SYM. POL.SYM. POLICY NUMBER P I M 211987 PRoou.H34680 Royal , CODE: Insurance ❑ AMERICAN AND FOREIGN INSURANCE COMPANY ❑ GLOBE INDEMNITY COMPANY ROYAL INSURANCE COMPANY (A Delaware Stock Company) (A Delaware Stock Company) 'OF AMERICA (An Illinois Stock Company) ❑ SAFEGUARD INSURANCE COMPANY ❑ NEWARK INSURANCE COMPANY ❑ ROYAL INDEMNITY COMPANY (A Connecticut Stock Company) (A New Jersey Stock Company) (A Delaware Stock Company) Town of Southold North American Boating Assured Main Road Producer . Association Southold, New York 11971 52 Duane Street L _j New York, N.Y. 10007 POLICY PERIOD - - — FROM January 22,1986 TO Jan »*w ?_y 1987 This Company, indicated above,does insure the Assured, named above,for account of themselves, in consideration of the premium and stipulations here- inafter mentioned. LOSS,IF ANY,PAYABLE TO THE NAMED ASSURED AND Assured or order As Interest May Appear. AMOUNT OF INSURANCE/LIMIT OF LIABILITY PREMIUM $ As Per Schedule s3-0393.650. ON Hull and Machinery/protection tion and Indemty But warranted as follows: — AS PER FORM(S) ATTACHED THIS POLICY SHALL NOT BE VALID UNLESS ENDORSEMENT ISSUED BY THIS COMPANY IS ATTACHED HERETO, AND IS MADE AND ACCEPTED SUBJECT TO THE FOREGOING STIPULATIONS AND CONDITIONS WHICH ARE HEREBY SPECIALLY REFERRED TO AND MADE A PART OF THIS POLICY, together with such other provisions, agreements or conditions as may be endorsed hereon or added hereto;and no officer,agent or other representative of this Company shall have power to waive or be deemed to have waived any provision or condition of this Policy unless such waiver, if any,shall be written upon or attached hereto,nor shall any privilege or permission affecting the insurance under this Policy exist or be claimed by the Assured unless so written or attached. In Witness Whereof, this Company has caused this policy to be executed and attested, but this policy shall not be valid unless countersigned on the declarations page by a duly authorized representative of this Company. r� z2 Assistant Corporate Secretary Vice President-Marine Manager Countersigned By Representative 12160D(ED.5/83) j L Conditions Navigation Limits Warranted by the assured that the within insured vessels shall be confined to the navigable waters of the Peconic Bay, Mattituck Inlet and Long Island Sound within fifteen (15 ) miles of the Assured's dock. - It is understood and agreed that vessels scheduled under this policy are covered only while operated by duly authorized persons and only while performing official duties for the Town of Southold. • - It is understood and agreed that each Boston Whaler is equiped with a Trailer which is included in the insured value. ti SCHEDULE OF VESSELS HULL AND MACHINERY VESSEL VALUE DEDUCTIBLE PREMIUM 1) 1981 24' Privateer T/150 H.P.O.B. $360,000 $ 500. $ 990. 2) 1966 13' Boston Whaler 40 H.P.O.B. $ 21000. $-250. $ 165. 3) 1967 13' Boston Whaler 40 H.P.O.B. $ 28000. $ 250. $ 165. 4) 1968 19 ' Wellcraft 150 H.P.O.B. $ 28500. $ 250. $ 165. 5) 1983 23 ' Sea OX 200 H.P.O.B. $11,000. $ 500. $ 385. PROTECTION AND INDEMNITY VESSEL LIMIT OF LIABILITY PREMIUM 1) 1981 Privateer $ 5001000. $ 385. 2) 1966 Boston Whaler $ 500,000. $ 220. 3) 1967 Boston Whaler $ 5000000. $ 220. 4) 1968 Wellcraft $ 5001000. $ 423.50 5) 1983 Sea Ox $ 5001000. $ 275. Each vessel is to be considered separately insured. Atimriratt Ittottlutr 1jull (91a situ 7 (June 2, 1977) To be attached to and form a part of Policy No. 211987 .... of the ....Royal IASuran.ce_ C011lj�a'�i117,.,.q£.................. ........... ...........America................ .............................. The terms and conditions of the following clauses are to be regarded as substituted for these of the policy form to which they are attached, the latter being hereby waived, except provisions required by law to be inserted in the Policy. All captions are inserted only for purposes of reference and shall not be used to interpret the clauses to which they apply. ASSURED This Policy insures ....`'h�-`....TOWII...Of... 11Q. .d,....NOW...York..................................... .... .. ................................................ 1 .................................................................... ...................................................._......................_ .............................. ..... ...........................I....................... 2 ....................................................................................... ..................................... ...-_......... ...... ........ ...._. _ hereinafter referred to as the Assured. 3 If claim is made under this Policy by anyone other than the Owner of the Vessel, such person shall not be entitled to recover to a greater extent 4 than would the Owner, had claim been made by the Owner as an Assured named in this Policy. 5 Underwriters waive any right of subrogation against affiliated, subsidiary or interrelated companies of the Assured, provided that such waiver shall 6 not apply in the event of a collision between the Vessel and any vessel owned, demise chartered or otherwise controlled by any of the aforesaid com- 7 panies, or with respect to any loss, damage or expense against which such companies are insured. 8 LOSS PAYEE - Assured...cr...Ordor..................... ... ........ .. . . s Loss, if any, payable to ........_...... ..................................................................................... .........................................................._....... ....................... .......................................................... 10 ...... .......................................................................................... ............................................................................. or order. 11 Provided, however, Underwriters shall pay claims to others as set forth in the Collision Liability clause and may make direct payment to persons 12 providing security for the release of the Vessel in Salvage cases. 13 VESSEL The Subject Matter of this insurance is the Vessel called the ...As Per Schedule 14 or by whatsoever name or names the said Vessel is or shall be called, which for purposes of this insurance, shall consist of and be limited to her hull, 15 launches, lifeboats, rafts, furniture, bunkers, stores, supplies, tackle, fittings, equipment, apparatus, machinery, boilers, refrigerating machinery, insula- 16 tion, motor generators and other electrical machinery. 17 In the event any equipment or apparatus not owned by the Assured is installed for use on board the Vessel and the Assured has assumed respon- 18 sibility therefor, it shall also be considered part of the Subject Matter and the aggregate value thereof shall be included in the Agreed Value. 19 Notwithstanding the foregoing, cargo containers, barges and lighters shall not be considered a part of the Subject Matter of this insurance. 20 DURATION OF RISK From the ....22nd day of .Janu4ry........ 19 .86., ...NO" Eastern...Standard......................... ........... time 21 to the ..........22nc1.............. day of .Januar,........ 19 .87., ...NOon,...Eastern...Standard ................ time. 22 Should the Vessel at the expiration of this Policy be at sea, or in distress, or at a port of refuge or of call, she shall, provided previous notice be 23 given to the Underwriters, be held covered at a pro rata monthly premium to her port of destination. 24 In the event of payment by the Underwriters for Total Loss of the Vessel this Policy shall thereupon automatically terminate. 25 AGREED VALUE The Vessel, for so much as concerns the Assured, by agreement between the Assured and the Underwriters in this Policy, is and shall be valued at 26 As Per Schedule..................................I....... ... Dollars. 27 .................................................................................. ........................................................................................... AMOUNT INSURED HEREUNDER ........ .... ...........A .. Per. Schedule ........................................... . . ... .... .. ..... . .... ................. ..... ............................... Dollars. 28 DEDUCTIBLE Notwithstanding anything in this Policy to the contrary, there shall be deducted from the aggregate of all claims (including claims under the Sue 29 and Labor cause and claims under the Collision Liability clause) arising out of each separate accident, the sum of $ As ..Per.. Schedualeas the 30 accident results in a Total Loss of the Vessel in which case this clause shall not apply. A recovery from other interests, however, shall not operate to 31 exclude claims under this Policy provided the aggregate of such claims arising out of one separate accident if unreduced by such recovery exceeds that 32 sum. For the purpose of this clause each accident shall be treated separately, but it is agreed that (a) a sequence of damages arising from the same acci- 33 dent shall be treated as due to that accident and (b) all heavy weather damage, or damage caused by contact with floating ice, which occurs during a 34 single sea passage between two successive ports shall be treated as though due to one accident. 35 PREMIUM As Per Schedule The Underwriters to be paid in consideration of this insurance _.. _......... ............... ..... ..... _ .......... _ ......................... .. .......................... . 36 Dollars being at the annual rate ofAs_Per .Schedulent., which premium shall be due on attachment. If the Vessel 37 is insured under this Policy for a period of less than one year at pro rata of the annual rate, full annual premium shall be considered earned and immedi- 38 ately due and payable in the event of Total Loss of the Vessel. 39 RETURNS OF PREMIUM Premium returnable as follows: 40 Pro rata daily net in the event of termination under the Change of Ownershir clause; 41 Pro rata monthly net for each uncommenced month if it be mutually agreed to cancel this Policy; 42 For each period of 30 consecutive days the Vessel may be laid up in port for account of the Assured, 43 N/A_ ..... .... cents per cent. net not under repair, or 44 N/A . _._ _ cents per cent. net under repair; 45 provided always that: 46 (a) a Total Loss of the Vessel has not�rred during the currency of this Policy; 47 (b) in no case shall a return for lay allowed when the Vessel is lying in exposed or unected waters-or in any-location not approved by 4488` the Underwriters; (c) in the event of any amendment of the annual rate, the above rates of return shall be adjusted accordingly; 50 (d) in no case shall a return be allowed when the Vessel is used as a storage ship or for lightering purposes. 51 If the Vessel is laid up for a period of 30 consecutive days, a part only of which attaches under this Policy, the Underwriters shall pay such pro- 52 portion of the return due in respect of a full period of 30 days as the number of days attaching hereto bears to 30. Should the lay-up period exceed 30 53 consecutive days, the Assured shall have the option to elect the period of 30 consecutive days for which a return is recoverable. 54 NON-PAYMENT OF PREMIUM In event of non-payment of premium 30 days after attachment;-or of an'y additional premium,when due, this Policy may be cancelled by the Under- 55 writers upon 10 days written or telegraphic notice sent to the Assured at his last known address or in care of the broker who negotiated this Policy. 56 Such proportion of the premium, however, as shall have been earned up to the time-.of cancel tation'sha I I be payable. In the event of Total Loss of the 57 Vessel occurring prior to any cancellation or termination of this Policy full annual premium shall be considered earned. 58 ADVENTURE Beginning the adventure upon the Vessel, as above, and so shall continue and endure during the period aforesaid, as employment may offer, in port or 59 at sea, in docks and graving docks, and on ways, gridirons and pontoons, at all times, in all plaices, and on all occasions, services and trades; with leave 60 to sail or navigate with or without pilots, to go on trial trips and to assist and tow vessels or craft in.distress, but the Vessel.may not be towed, except 61 as is customary or when in need of assistance, nor shall the Vessel render assistance or undertake towage or salvage services under contract-previously 62 arranged by the Assured, the Owners, the Managers or the Charterers of the Vessel, nor shall the Vessel, in the course of trading operations, engage in 63 loading or discharging cargo at sea, from or into another vessel other than a barge, lighter or similar craft used principally in harbors or inland waters. 64 The phrase "engage in loading or discharging cargo at sea' shall include while approaching, leaving or alongside, or while another vessel is approaching, 65 leaving or alongside the Vessel. 66 The Vessel is held covered in case of any'breach-oT con`2litions as to'cargo, trade, locality, towage or salvage activities, or date of sailing, or loading 67 or discharging cargo at sea, provided (a) notice is given to the Underwriters immediately following receipt of knowledge thereof by the Assured, and (b) 68 any amended terms of cover and any additional premium,required by the Underwriters are agreed to by the Assured. 69 PERILS Touching the Adventures and Perils which the Underwriters are contented to bear and take upon themselves, they are of the Seas, Men-of-war, Fire, 70 Lightning, Earthquake, Enemies, Pirates, Rovers, Assailing Thieves, Jettisons, Letters of Mart and Counter-Mart, Surprisals, Takings at Sea, Arrests, Re- 71 straints and Detainments of all Kings, Princes and Peoples, of what nation, condition or quality soever, Barratry of the Master and Mariners and of all 72 other like Perils, Losses and Misfortunes that have or shall come to the Hurt, Detriment or Damage of the Vessel, or any part thereof, excepting, how- 73 ever, such of the foregoing perils as may be excluded by provisions elsewhere in the Policy or by endorsement thereon. 74 ADDITIONAL PERILS'(INCHMAREE) r r 74 1. y r , C T _r Subject to the conditions of this Policy, this insurance also covers'loss of or damage to the Vessel directly caused by the following: 75 Accidents in loading, discharging or handling cargo, or in bunkering; 76 Accidents in going on or off, or while on drydocks, graving docks, ways, gridirons or pontoons; 77 Explosions on shipboard or elsewhere; 78 Breakdown of motor generators or other electrical machinery and electrical connections thereto, bursting of boilers, breakage of shafts, or any 79 latent defect in the machinery or hull, (excluding the cost and expense of replacing or repairing the defective part); 80 Breakdown of or accidents to nuclear installations or reactors not on board the insured Vessel; 81 Contact with aircraft, rockets or similar missiles, or with any. land conveyance; 82 Negligence of Charterers and/or Repairers, provided such Charterers,and/or,Repairers,-are 7fot an Assured hereunder; 83 ;< bi Negligence of Masters, Officers, Crew or Pilots; 84 provided such loss or damage has not resulted from want of due diligence by the Assured, the Owners or Managers of the Vessel, or any of them. 85 Masters, Officers, Crew or Pilots are not to be considered Owners within the meaning of this clause should they hold shares in the Vessel. 86 DELIBERATE DAMAGE (POLLUTION HAZARD) Subject to the conditions of this Policy, this insurance also covers loss of or damage to the Vessel directly caused by governmental authorities .87 acting for the public welfare to prevenl:,of mitigate.a pollution hazard, or threat thereof, resulting directly from damage to the Vessel for which the 88 Underwriters are liable under this Policy,''provided sath act'of governmental authorities has not resulted from want of due diligence by the Assured, the 89 Owners, or Managers of the Vessel or any of them to prevent or mitigate such hazard or threat. Masters, Officers, Crew or Pilots are not to be considered 90 Owners within the meaning of this clause should they hold shares in the Vessel. 91 CLAIMS (GENERAL PROVISIONS) In the event of any accident or occurrence which could give rise to a claim under this Policy, prompt notice thereof shall be given to the Under- 92 writers, and: 93 (a) where practicable, the Underwriters shall be advised prior to survey, so that they may Appoint their own surveyor, if they so desire; 94 (b) the Underwriters shall be entitled to decide where the Vessel shall proceed for docking and/or repair(allowance to be made to the Assured for the 95 actual additional expense of the voyage arising from compliance with the Underwriters' requirement); 96 (c) the Underwriters shall have the right of veto-,in connection with any repair-firm proposed; 97 (d) the Underwriters may take tenders, or may require in writing that tenders be taken for the repair of the Vessel, in which event, upon acceptance 98 of a tender with the approval of the Underwriters, an allowance shall be made at the rate of 30 per cent. per annum on the amount insured, for 99 each day or pro rata for part of a day, for time lost between the issuance of invitations to tender and the acceptance of a tender, to the extent 100 that such time is lost solely as the result of tenders having been taken and provided the tender is accepted without delay after receipt of the 101 Underwriters' approval. 102 Due credit shall be given against the allowances in (b) and (d) above for any amount recovered: 103 41-*.respect of fuel, stores, and wages and maintenance of the Master, Officers or Crew allowed in General or Particular Average; 104 (2) from third parties in respect of damages for detention and/or loss of profit and/or running expenses; 105 for the period covered by the allowances or any•part thereof. ..t"�. < 106 No claim shall be allowed in Particular Average for wages and maintenance of the Master, Officers or Crew, except when incurred solely for the 107 necessary removal of the Vessel from one port to another for average repairs or for trial trips to test average repairs, in which cases wages and mainte- 108 nance will be allowed only while the Vessel is under way. This exclusion shall not apply to overtime or similar extraordinary payments to the Master, 109 Officers or Crew incurred in shifting the Vessel for tank cleaning or repairs or while specifically engaged in these activities, either in port or at sea. 110 ,General and Particular Average shall be payable without deduction, new for old. 111 The expense of sighting the bottom after stranding shall be paid, if reasonably incurred especially for that purpose, even if no damage be found. 112 ;n •aeoarf of crraninv or naintino the Vatcpl'¢ hnttnm. 113 Assured has assumed responsibility, claim shall not exceed ()lythe amount the Underwriters would pay if the Assured were owner of such 'equipment or 115 apparatus,-or (2) the contractual responsibility assuy the Assured to the owners or lessors thereof, whi r shall be less. 116 No claim for unrepaired damages shall.be alloweWe ept to the extent that.the aggregate damage caused rifs insured against during the period 117 of the Policy and left unrepaired at the expiration ofolicy shall be demonstrated by the Assured to have diminished the actual market value of the 118 Vessel on that date if undamaged by such perils. 119 GENERAL AVERAGE AND SALVAGE General Average and Salvage shall be payable as provided in the contract of affreightment, or failing such provision or the:L be no contract of 120 affreightment, payable at the Assured's election either in accordance with York-Antwerp Rules 1950 or 1974 or with the Laws and Usages of the Port of 121 New York. Provided always that when an adjustment according to the laws and usages of the port of destination is properly demanded by the owners 122 of the cargo, General Average shall be paid accordingly. 123 In the event of salvage, towage or other assistance being rendered to the Vessel by any vessel belonging in part or in whole to the same Owners or 124 Charterers, the value of such services (without regard to the common ownership or control of the vessels) shall be ascertained by arbitration in the man- 125 ner provided for under the Collision Liability clause in this Policy, and the amount so awarded so far as applicable to the interest hereby insured shall 126 constitute a charge under this Policy. 127 When the contributory value of the Vessel is greater than the Agreed Value herein, the liability of the Underwriters for General Average contribution 128 (except in respect to amounts made good to the Vessel), or Salvage, shall not exceed that proportion of the total contribution due frim the Vessel which 129 the amount insured hereunder bears to the contributory value, and if," because of damage for which the Underwriters are liable as Particular Average, the 130 value of the Vessel has been reduced for the purpose of contribution, the amount of such Particular Average damage recoverable under this Policy shall 131 first be deducted from the amount insured hereunder, and the Underwriters shall then be liable only for the proportion which such net amount bears 132 to the contributory value. _ 133 TOTAL LOSS In ascertaining whether the Vessel is a constructive Total Loss the Agreed Value shall be taken as the repaired value and nothing in respect of the 134 damaged or break-up value of the Vessel or wreck shall be taken into account. 135 There shall be no recovery for a constructive Total Loss hereunder unless the expense of recovering and repairing the Vessel would exceed the 136 Agreed Value. In making this determination, only expenses incurred or to be incurred by reason of a single accident or a sequence of damages arising 137 from the same accident shall be taken into account, but expenses incurred prior to tender of abandonment shall not be considered if such are to be 138 claimed separately under the Sue and Labor clause. 139 In the event of Total Loss (actual or constructive), no claim to be made by the Underwriters for freight, whether notice of abandonment has been 140 given or not. 141 In no case shall the Underwriters be liable for unrepaired damage in addition to a subsequent Total Loss sustained during the period covered by this 142 Policy. 143 SUE AND LABOR And in case of any Loss or Misfortune, it shall be lawful and necessary for the Assured, their Factors, Servants and Assigns, to sue, labor and travel 144 for, in, and about the defense, safeguard and recovery of the Vessel, or any part thereof, without prejudice to this insurance, to the charges whereof 145 the Underwriters will contribute their proportion as provided below. And it is expressly declared and agreed that no acts of the Underwriters or Assured 146 in recovering, saving or preserving the Vessel shall be considered as a waiver or acceptance of abandonment. 147 In the event of expenditure under the Sue and Labor clause, the Underwriters shall pay the proportion of such expenses that the amount insured 148 hereunder bears to the Agreed Value, or that the amount insured hereunder (less loss and/or damage payable under this Policy) bears to the actual 149 value of the salved property, whichever proportion shall be less; provided always that their liability for such expenses shall not exceed their proportionate 150 part of the Agreed Value. 151 If claim for Total Loss is admitted under this Policy and sue and labor expenses have been reasonably incurred in excess of any proceeds realized 152 or value recovered, the amount payable under this Policy will be the proportion of such excess that the amount insured hereunder (without deduction 153 for loss or damage) bears to the Agreed Value or to the sound value of the Vessel at the time of the accident, whichever value was greater; provided 154 always that Underwriters' liability for such expenses shall not exceed their proportionate part of the Agreed Value. The foregoing shall also apply to 155 expenses reasonably incurred in salving or attempting to salve the Vessel and other property to the extent that such expenses shall be regarded as having 156 been incurred in respect of the Vessel 157 COLLISION LIABILITY And it is further agreed that: 158 (a) if the Vessel shall come into collision with any other ship or vessel, and the Assured or the Surety in consequence of the Vessel being at fault 159 shall become liable to pay and shall pay by way of damages to any other person or persons any sum or sums in respect of such collision, the 160 Underwriters will pay the Assured or the Surety, whichever shall have paid, such proportion of such sum or sums so paid as their respective sub- 161 scriptions hereto bear to the Agreed Value, provided always that their liability in respect to any one such collision shall not exceed their propor- 162 tionate part of the Agreed Value; 163 (b) in cases where, with the consent in writing of a majority (in amount) of Hull Underwriters, the liability of the Vessel has been contested, or pro- 164 ceedings have been taken to limit liability, the Underwriters will also pay a like proportion of the costs which the Assured shall thereby incur 165 or be compelled to pay, 166 When both vessels are to blame, then, unless the liability of the owners or charterers of one or both such vessels becomes limited by law, claims 167 under the Collision Liability clause shal! be settled on the principle of Cross-Liabilities as if the owners or charterers of each vessel had been compelled 168 to pay to the owners or charterers of the other of such vessels such one-half or other proportion of the latter's damages as may have been properly allowed 169 in ascertaining the balance or sum payable by or to the Assured in consequence of such collision. 170 The principles involved in this clause shall apply to the case where both vessels are the property, in part or in whole, of the same owners or chart- 171 erers, all questions of responsibility and amount of liability as between the two vessels being left to the decision of a single Arbitrator, if the parties 172 can agree upon a single Arbitrator, or failing such agreement, to the decision of Arbitrators, one to be appointed by the Assured and one to be appointed 173 by the majority (in amount) of Hull Underwriters interested; the two Arbitrators chosen to choose a third Arbitrator before entering upon the reference, 174 and the decision of such single Arbitrator, or of any two of such three Arbitrators, appointed as above, to be final and binding. 175 Provided always that this clause shall in no case extend to any sum which the Assured or the Surety may become liable to pay or shall pay in conse- 176 quence of, or with respect to: 177 (a) removal or disposal of obstructions, wrecks or their cargoes under statutory powers or otherwise pursuant to law; 178 (b) injury to real or personal property of every description; 179 (c) the discharge, spillage, emission or leakage of oil, petroleum products, chemicals or other substances of any kind or description whatsoever; 180 (d) cargo or other property on or the engagements of the Vessel; 181 (e) loss of life, personal injury or illness. 182 Provided further that exclusions (b) and (c) above shall not apply to injury to other vessels or property thereon except to the extent that such injury 183 arises out of any action taken to avoid, minimize or remove any discharge, spillage, emission or leakage described in (c) above. 184 PILOTAGE AND TOWAGE • ' ' This insurance shall not be prejudiced by reason of any contract limiting in whole or in part the liability of pilots, tugs, towboats, or their owners 185 ` when the Assured or the agent of the Assured accepts such contract in accordance with established local practice. Where in accordance with such practice, pilotage or towage services are provided under contracts requiring the Assured or the agent of the Assured: 187 (a) to assume liability for damage resulting from collision of the Vessel insured with any other ship or vessel, including the towing vessel, or 188 189 (b) to indemnify those providing the pilotage or towage services against loss or liability for any such damages, it is agreed that amounts paid by the Assured or Surety pursuant to such assumed obligations shaWbe deemed payments "by way of damages to any other 190 person or persons" and to have been paid "in consequence of the Vessel being at fault" within themeaning of the Collision Liability clause in this Policy 191 to the extent that such payments would have been covered if the Vessel had been legally responsible in the absence of any agreement. Provided always 192 that in no event shall the aggregate amount of liability of the Underwriters under the Collision Liability clause, including this clause,—be greater than 193 the amount of any statutory limitation of liability to which owners are entitled or would be entitled if liability under any contractual obligation referred to in 194 195 this clause were included among the liabilities subject to such statutory limitations. CHANGE OF OWNERSHIP In the event of any change, voluntary or otherwise, in the ownership or flag of the Vessel, or if the Vessel be placed under new management, or be 196 chartered on a bareboat basis or requisitioned on that basis, or if the Classification Society of the Vessel or her class therein be changed, cancelled or 191 withdrawn, then, unless the Underwriters agree thereto in writing, this Policy shall automatically terminate at the time of such change of ownership, flag, 199 management, charter, requisition or classification; provided, however, that: (a) if the Vessel has cargo on board and has already sailed from her loading port, or is at sea in ballast, such automatic termination shall, if 2000 required, be deferred until arrival at final port of discharge if with cargo, or at port of destination if in ballast; (b) in the event of an involuntary temporary transfer by requisition or otherwise, without the prior execution of a written agreement by the 202 03 Assured, such automatic termination shall occur fifteen days after such transfer. This insurance shall not inure: to the benefit of any transferee or charterer of the Vessel and, if a loss payable hereunder should occur between 204 the time of change or transfer and any deferred automatic termination, the Underwriters shall be,subrogated to all of the rights of the Assured against 205 the transferee or charterer in respect of all or part of such loss as is recoverable from the transferee or charterer, and in the proportion which the 2007 amount insured hereunder bears to the Agreed Value. The term "new management" as used above refers only to the transfer of the management of the Vessel from one firm or corporation to another, 20088 and it shall not apply to any internal changes within the offices of the Assured. ADDITIONAL INSURANCES It is a condition of this Policy that no additional insurance against the risk of Total Loss of .the Vessel shall be effected to operate during the cur- 210 rency of this Policy by or for account of the Assured, Owners, Managers, Operators or Mortgagees except on the interests and up to the amounts enum- 211 erated in the following Sections (a) to (g), inclusive, and no such insurance shall be subject to P.P.I., F.I.A. or other like term on any interests whatever 212 excepting those enumerated in Section (a); provided always and notwithstanding the limitation on recovery in the Assured clause a breach of this condition 213 shall not afford the Underwriters any defense to a claim by a Mortgagee who has accepted this Policy without knowledge of such breach: 214 (a) DISBURSEMENTS, MANAGERS' COMMISSIONS, PROFITS OR EXCESS OR INCREASED VALUE OF HULL AND MACHINERY, AND/OR SIMILAR INTER- 215 ESTS HOWEVER DESCRIBED, AND FREIGHT (INCLUDING CHARTERED FREIGHT OR ANTICIPATED FREIGHT) INSURED FOR TIME. An amount not exceeding 217 in the aggregate 25% of the Agreed Value. (b) FREIGHT OR HIRE, UNDER CONTRACTS FOR VOYAGE. An amount not exceeding the gross freight or hire for the current cargo passage and next 218 succeeding cargo passage (such insurance to include, if required, a preliminary and an intermediate ballast passage) plus the charges of insur- 219 ance. In the case of a voyage charter where payment is made on a time basis, the amount shall be calculated on the estimated duration of the 220 voyage, subject to the limitation of two cargo passages as laid down herein. Any amount permitted under this Section shall be reduced, as the 221 freight or hire is earned, by the gross amount so earned. Any freight or hire to be earned under the form of Charters described in (d) below shall 222 not be permitted under this Section (b) if any part thereof is insured as permitted under said Section (d). 223 (c) ANTICIPATED FREIGHT IF THE VESSEL SAILS IN BALLAST AND NOT UNDER CHARTER. An amount not exceeding the anticipated gross freight 224 on next cargo passage, such amount to be reasonably estimated on the basis of the current rate of freight at time of insurance, plus the charges of 225 insurance. Provided, however, that no insurance shall be permitted by this Section if any insurance is effected as permitted under Section (b). 226 (d) TIME CHARTER HIRE OR CHARTER HIRE FOR SERIES OF VOYAGES. An amount not exceeding 50% of the gross hire which is to be earned under 227 the charter in a period not exceeding 18 months. Any amount permitted under this Section shall be reduced as the hire is earned under the charter 228 by 50% of the gross amount so earned but, where the charter is for a period exceeding 18 months, the amount insured need not be reduced while 229 it does not exceed 50% of the gross hire still to be earned under the charter. An insurance permitted by this Section may begin on the signing 230 of the charter. — 231 (e) PREMIUMS. An amount not exceeding the actual premiums of all interest insured for a period not exceeding 12 months (excluding premiums 232 insured as permitted under the foregoing Sections but including, if required, the premium or estimated calls on any Protection and Indemnity or 233 War Risks and Strikes insurance) reducing pro rata monthly. 234 (f) RETURNS OF PREMIUM. An amount not exceeding the actual returns which are recoverable subject to "and arrival" or equivalent provision under 235 any policy of insurance. 236 (g) INSURANCE IRRESPECTIVE OF AMOUNT AGAINST: Risks excluded by War, Strikes-and Related Exclusions clause; risks enumerated in the American 237 Institute War Risks and Strikes Clauses; and General Average and Salvage Disbursements. 238 WAR STRIKES AND RELATED EXCLUSIONS The following conditions shall be paramount and shall supersede and nullify any contrary provisions of the Policy. 239 This Policy does not cover any loss, damage or expense caused by, resulting from, or incurred as a consequence of: 240 (a) Capture, seizure, arrest, restraint or detainment, or any attempt thereat; or 241 (b) Any taking of the Vessel, by requisition or otherwise, whether in time of peace or war and whether lawful or otherwise; or 242 (c) Any mine, bomb or torpedo not carried as cargo on board the Vessel; or 243 (d) Any weapon of war employing atomic or nuclear fission and/or fusion or other like reaction or radioactive force or matter; or 244 (e) Civil war, revolution, rebellion, insurrection, or civil strife arising therefrom, or piracy; or 245 (f) Strikes, lockouts, political or labor disturbances, civil commotions, riots, martial law, military or usurped power; or 246 (g) Malicious acts or vandalism, unless committed by the Master or Mariners and not excluded elsewhere under this War Strikes and Related Exclu- 247 sions clause; or 248 IN Hostilities or warlike operations (whether there be a declaration of war or not) but this subparagraph (h) not to exclude collision or contact with 249 aircraft, rockets or similar missiles, or with any fixed or floating object, or stranding, heavy weather, fire or explosion unless caused directly by 250 a hostile act by or against a belligerent power which act is independent of the nature of the voyage or service which the Vessel concerned or, in 251 the case of a collision, any other vessel involved therein, is performing. As used herein, "power" includes any authority maintaining, naval, mili- 252 tary or air forces in association with a power. 253 If war risks or other risks excluded by this clause are hereafter insured by endorsement on this Policy, such endorsement shall supersede the above 254 conditions only to the extent that the terms of such endorsement are inconsistent therewith and only while such endorsement remains in force. 255 For Sale by Joseph Lazard, 11 John Street, New York, N.Y. 10038 Printed in U.S.A. ,PRlO'j'>ICTION AND IIQDEMNITY SP-23 (Revised 1/56) Amount Inured$.5.00...00.0.0.0..... Nolte---------------------------------------- Premium $............................ Rate ................................. The Town of Southold, New York ..__._.._____._..._..._.......__.._..._...._......................................................_....................._...._...._.........._.........._..... hereinafter called the Assured; Lou, it anp, papable to _..._..-�s�� or Order .._..._............_....._._.___........._..._...._...._..._........................................................................................................................................._..._............__or order In the Sum of.....__Five Hundred Thousand Dollars at and from the.- 22nd day of_...JTa1 UaaX7._-..-...._...-............ 19..81£ at.Nfaon.r_..Eastern....S.tat3dard............. time _.__. 22nd day of.-.— , 19.87 a Noon,- Eastern—Standard time until the _...._. _. .. _... _._ _._. against the liabilities of the Assured as hereinafter described, and subject to the terms and conditions hereinafter set forth, in respect of the vessel called theAk.. Per SChedul¢ (Tonnage............................._...........) or by whatsoever other names the said vessel is or shall be named or called. In consideration of the Stipulations Herein Named and of ..... �....Per.._SChedule _. ................................_....._. ................._.......................... ...............................__...___............._.............................._.................... Dollars, being Premium at the rate of....AB....Per....8Chtid"4k.............. The Assurer hereby undertakes to make good to the Assured or the Assured's executors, administrators and/or successors, all such loss and/or damage and/or expense as the Assured shall as owners of the vessel named herein have become liable to pay and shall pay on account of the liabilities, risks, events and/or happenings herein set forth: Loss of Life. M-Liability forlose of Ufa of,or personal injury to, or illness of, any person, excluding, however, unless otherwise injury and illness agreed by endorsement hereon, liability under any Compensation Act to any employee of the Assured, (other than a seaman) or in case of death to his beneficiaries or others. Protection hereunder for loss of life or personal injury arising in connection with the handling of cargo of the vessel named herein shall commence from the time of receipt by the Assured of the cargo on dock or wharf or on craft alongside the said vessel for loading thereon and shall continue until delivery thereof from dock or wharf of discharge or until discharge from the said vessel on to another vessel or craft. Hospital,medical. (2) Liability for hospital, medical, or other expenses necessarily and reasonably incurred in respect of loss of life of, e.pe.ses personal injury to, or illness of any member of the crew of the vessel named herein or any other person. Liability hereunder shall also include burial expenses not exceeding Two Hundred ($200) Dollars, when necessarily and reasonably incurred by the Assured for the burial of any seaman of said vessel. Repatriation (3) Liability for repatriation expenses of any member of the crew of the vessel named herein, necessarily and reason- expOD8e$ ably incurred,under statutory obligation, excepting such expenses as arise out of or ensue from the termination of any agreement in accordance with the terms thereof, or by mutual consent, or by sale of the said vessel, or by other act of the Assured. Wages shall be included in such expenses when payable under statutory obligation, during unemployment due to the wreck or loss of the said vessel. Damage to (4) Liability for loss of, or damage to, any other vessel or craft, or to the freight thereof, or property on such other other vessel o property on vessel or craft, caused by collision with the vessel named herein, insofar as such liability would not be covered by by rd by full insurance under the . ... . ............................................................... Principle of ............................... ............ .... ........ .....(including the four-fourths running-down clause). to cross-liabilities pre (a) Claims under this clause shall be settled on the principle of cross-liabilities to the same extent only as provided in the running-down clause above mentioned. (b) Claims under this clause shall be divided among the several classes of claims enumerated in this policy and each class shall be subject to the deduction and special conditions applicable in respect of such class. (c) Notwithstanding the foregoing, if any one or more of the various liabilities arising from such collision has been compromised, settled or adjusted without the written consent of the Assurer, the Assurer shall be relieved of liability for any and all claims under this clause. Damage to othef (5) Liability for loss of or damage to any other vessel or craft, or to property on such other vessel or craft, not caused vessel or property board not by collision, provided such liability does not arise by reason of a contract made by the assured. vessel caused by collision Where there would be a valid claim hereunder but for the fact that the damaged property belongs to the Assured,the Assurer shall be liable as if such damaged property belonged to another, but only for the excess over any amount recoverable under any other insurance applicable on the property. Damage to (6) Liability for damage to any dock, pier, harbor, bridge, jetty, buoy, lighthouse, breakwater, structure, beacon, cable, docks,piers,etc. or to any fixed or movable object or property whatsoever, except another vessel or craft, or property on another vessel or craft. Where there would be a valid claim hereunder but for the fact that the damaged property belongs to the Assured,the Assurer shall be liable as if such damaged property belonged to another, but only for the excess over any amount recoverable under any other insurance applicable on the property. Removal of (7) Liability for cost or expenses of, or incidental to, the removal of the wreck of the vessel named herein when such "r`ck reme-al is compulsory by law, provided, however, that: (a) There shall be deducted from such claim for cost or expenses, the value of any salvage from or which might have been recovered from the wreck, inuring, or which might have inured, to the benefit of the Assured. (b) The Ass r shall not be liable for such costs or expenses which would be covered by full insurance under rArIiC'77' �.. .......... ........ .. . . ............... . ... .. ......... . ...... ....... the .. ............. . . or claims arising out of hostilities or war-like operations, whether before or after declaration of war. cargo (8) Liability for loss of, or damage to,or in connection with cargo or other property,excluding mall and parcel post, In- cluding baggage-and-personal effects of passengers, to be carried, carried, or which has been carried on board the vessel named hereto: ' t t Provided however, that no liability shall exist under this provision for: specie,bullion; (a) :Loss, damage or expense arising out of or in connection with the custody,care, carriage or delivery of specie, Precious stones. bullion, precious stones, precious metals, jewelry, silks, furs, bank notes, bonds or other negotiabledocu- ments or similar valuable property, unless specially agreed to and accepted for transportation. under a form of contract approved, in writing, by the Assurer. Refrigeration (b) Loss of, or damage to, or in connection with cargo requiring refrigeration unless the space, apparatus and means used for the care,custody,and carriage thereof have been surveyed by a classification surveyor or other competent disinterested surveyor under working conditions before the commencement of each voyage and found in all respects fit, and unless accepted for transportation under a form of contract approved,in writing, by the Assurer. Pae s sera' (c) Loss, damage, or expense in connection with any passenger's baggage or personal effects, unless the form of effectsticket issued to the passenger shall have been approved,in writing,by the Assurer. stowage in (d) Loss, damage, or expense-arising from stowage of underdeck cargo on deck or stowage of cargo in spaces not improper Places suitable for its carriage,unless the Assured shall show that every reasonable precaution has been taken by him to prevent such improper stowage. Deviation (e) Loss, damage, or expense arising from any deviation,or proposed deviation, not authorized by the contract of :affreightment, known to the Assured in time to insure specifically the liability therefor, unless notice thereof is given to the Assurer and the Assurer agrees, in writing, that such insurance is unnecessary. Freight on cargo (f) Freight on cargo short delivered, whether or not prepaid or whether or not included in the claim and paid by abort delivered the .Assured. Misdescription (g) ]Loss,damage,or expense arising out of or as a result of the issuance of Bills of Lading which,to the knowledge of Goods of the Assured, improperly describe the goods or their containers as to condition or quantity. Failure to (h) :Loss, damage, or.expense arising out of delivery of cargo without surrender of Bill of Lading. surrender Bill of Lading And provided further that (as) Liability hereunder shall in no.event exceed that which would be imposed by law in the absence of contract. Protective (bb) Liability hereunder shall be limfted.to.such as would exist if the Charter Party,Bill of Lading or Contract of clauses required .Affreightment contained the following clause (in substitution for the clause commonly known as the Jason in ontract of affreightment Cause): In the event of accident, danger, damage or disaster before or after commencement of the voyage, resulting from any cause whatsoever, whether due to negligence or not, fbr which, or for the consequences of which. the shipowner is not responsible, by statute or contract or otherwise, the shippers, consignees or owners of the cargo shall contribute with the shipowner in general average.to the payment of any sacrifices, losses or expenses of a general average nature that may be made or incurred,and shall pay salvage and special charges incurred in respect of the cargo." When cargo is carried by the vessel named herein under a bill of lading or similar document of title subject or made subject to the Carriage of Goods by Sea Act, April 16, 1936, liability hereunder shall be limited to such as is imposed by said Act, and if the Assured or the vessel named herein assumes any greater liability or obligation than the minimum liabilities and obligations imposed,by said Act, such greater liability or obliga- tion shall not be covered hereunder. When cargo is carried by the vessel named herein under a charter party, bill of lading or contract of af- freightment not subject or made subject to the Carriage of Goods by Sea Act, April 16, 1936, liability here- under shall be limited to such as would exist if said charter party,bill of lading, or contract of affreightment contained the following clauses: a clause limiting the Assured's liability for total loss or damage to goods Limit per shipped to Two Hundred and Fifty ($250) Dollars per package, or in case of goods not shipped in packages, package per customary freight unit, and providing for pro rata adjustment on such basis for partial loss or damage; a clause exempting the Assured and the vessel named herein from liability for losses arising from unsea- worthiness,even though existing at the beginning of the voyage, provided that due diligence shall have been exercised to make the vessel seaworthy and properly manned,equipped,and supplied; a clause providing that the carrier shall not be liable for claims in respect of cargo unless notice of claim is given within the time limited in such Bill of Lading and suit is brought thereon within the limited time prescribed therein; and such other protective clauses as are commonly in use in the particular trade; provided the incorporation of such clauses is not contrary to law. The foregoingpprovisions as to the contents of the Bill of Lading and the limitation of the Assurer's liability may, however, be waived or altered by the Assurers on terms agreed,in writing. Assured'' (cc) Where cargo on board the vessel named herein is the property of the Assured, such cargh'ahall be teemed to own cargo be carried under a contract containing the protective clauses described in the preceding paragraph, and such cargo shall be deemed to be fully insured under the-usual form of cargo policy, and in case of loss thereof or damage thereto the Assured shall be insured hereunder in respect of such loss or damage only to the extent that they would have been covered if said cargo had belonged to another,but only in the event and to the extent that the lose or damage would not be recoverable under a cargo policy as hereinbefore specified. Cotton (dd) The Assured's liability for claims under Custody Cotton Bills of Lading issued under the conditions laid down Bills of Lading by the Liverpool Bill of Lading Conference Committee, is covered subject to previous notice of contract and payment of an extra premium of two (24) cents per ton gross register per voyage, but such additional premium shall be waived provided every bale is re-marked at.port of shipraent,ou another portion of.the•bale. Land trans- (ee) No.liability shall exist hereunder for any loss, damage or expense tin respect of"cargo or other property being o nott included transported on land or on another vessel. -' - not No liability shall exist hereunder for any loss, damage or expense in respect of cargo before loading on or after discharge from.the vessel named herein caused by flood,tide,windstorm, earthquake, fire, explosion, heat, cold, deterioration,collapse of wharf, leaky shed,theft or pilferage unless such loss, damage or expense is caused directly by the vessel named herein, her master, officers or crew. customs.immi• (9) Liability for fines and penalties, including expenses necessarily and reasonably incurred in avoiding or mitigating gration or other fine or penalties same, for the violation of any of the laws of-the United States, or of any State thereof, or of any foreign country; provided,however, that the Assurer shall not be liable to indemnify the Assured against any such fines or penalties resulting directly or indirectly from.the failure, neglect, or default of the Assured or his managing officers or managing agents to exercise th�•highest degree of diligence to prevent a violation of any such laws. Mutiny or other ..(10) Expenses incurred in resisting any unfounded claim by the master or crew or other persons employed on the vessel misconduct named herein, or in prosecuting such persons in case of mutiny or other misconduct. Extraordinary (11) Liability for extraordinary expenses resulting from outbreak of plague or other contagious disease,including such expenaes in expenses incurred for disinfection of the vessel named h ein or persons on board,or for quarantine,but excluding case of quaran• tine,etc. the ordinary expenses of loading and/or discharging, an the wages and provisions of crew and passengers; each claim under this provision is subject to a deduction of Two Hundred ($200) Dollars. It is provided further, how- ever, that if the vessel named herein be ordered to proceed to a port when it is or should be known that•c#lling there will subject the vessel to the extraordinary expenses above mentioned, or to quarantine or disinfection there or elsewhere, the Assurer shall be under no obligation to indemnify the Assured for any such expenses. 'Deviation fee purpose of, (12) Net loss due to deviation incurred solely for the purpose of landing an injured or sick seaman in respect of port landing saluted phot.... :,.r„r,•ori. irtcnrstnee. blinkers. stores, and provisions consumed as a result of the deviation.. a•efi$° Charter Party, Bill of Lading, or Contract of Affreightment does not contain the quoted.ciaune under bee- the tion 8 (bb) the Assurer's liability hereunder shall be limited to such as would exist if such clause were contained therein. Cats and (14) Costs, charges, and expenses, reasonably incurred and paid by the Assured in defense against any liabilities insured changes against hereunder in respect of the vessel named herein, subject to the agreed deductibles applicable, and subject further to the conditions and limitations hereinafter provided. GENERAL CONDITIONS AND/OR LIMITATIONS prompt notice Warranted that in the event of any occurrence which may result in loss, damage and/or expense for which this of clam Assurer is or may become liable, the Assured will use duediligence to give prompt notice thereof and forward to the Assurer as soon as practicable after receipt thereof,.all communications,processes,pleadings and other legal papers or documents relating to such occurrences. sewet,entof The Assured shall not make any admission of liability, either before or after any occurrence which may result in claims a claim for which the Assurer may be liable. The Assured shall not interfere in any negotiations of the Assurer, for settlement of any legal proceedings in respect of any occurrences for which the Assurer is liable under this policy; provided, however, that in respect of any occurrence likely to give rise to a claim under this policy,the Assured are ob- ligated to and shall take steps to protect their (and/or the Assurers) interests as would reasonably be taken in the ab- sence of this or similar insurance.If the Assured shall fail or refuse to settle any claim as authorized by Assurer, the liability of the Assurer to the Assured shall be limited to the amount for which settlement could have been made. Assdtea cs Whenever required by the Assurer the Assured shall aid in securing information and evidence and in obtaining wit- ...is t with nesaea and shall cooperate with the Assurer in the defense of any claim or suit or in the appeal from any judgment,in evidence in defense,etc. respect of any occurrence as hereinbefore provided. LAW Costa The Assurer shall not be liable for the cost or expense of prosecuting or defending any claim or suit unless the same shall have been incurred with the written consent of the Assurer, or the Assurer shall be satisfied that such approval could not have been obtained under the circumstances without unreasonable delay,or that such costs and charges were reasonably and properly incurred, such cost or expense being subject to the deductible.The cost and expense of posecut- hig any claim in which the Assurer shall have an interest by subrogation or otherwise,shall be divided between the As- sured and the Assurer, proportionately to the amounts which they would be entitled to receive respectively, if the suit should be successful. The Assurer shall be liable for the excess where the amount deductible under this policy is exceeded by (A) the cost of investigating and/or successfully defending any claim or suit against the Assured based on a liability or an allesed liability of the Assured covered by this insurance,or (B) the amount paid by the Assured either under a Judg- ment or an agreed settlement based on the liability covered herein including all costs,expenses of defense and taxable disbursements. sucroaatton The Assurer shall be subrogated to all the rights which the Assured may have against any other person or entity, in respect of any payment made under this policy, to the extent of such payment, and the Assured shall, upon the request of the Assurer, execute all documents necessary to secure to the Assurer such rights. The Assurer shall be entitled to take credit for any profit accruing to the Assured by reason of any negligence or wrongful act of the Assureds,servants or agents, up to the measure of their loss, or to recover for their own account from third parties any damage that may be provable by reason of such negligence or wrongful act. Cover Provided that where the Assured is, irrespective of this insurance, covered or protected against any lose or claim elsewhere which would otherwise have been paid by the Assurer, under this policy, there shall be no contribution by the Assurer on the basis of double insurance or otherwise. Assignments No claim or demand against the Assurer under this policy shall be assigned or transferred, and no person, except- ing a legally appointed receiver of the property of the Assured, shall acquire any right against the Assurer by virtue of this insurance without the expressed consent of the Assurer. Actions against No action shall lie against the Assurer for the recovery of any loss sustained by the Assured unless such action is As-mf` brought against the Assurer within one year after the final judgment or decree is entered in the litigation against the Assured, or in case the claim against the Assurer accrues without the entry of such final judgment or decree,unless such action is brought within one year from the date of the payment of such claim. 'rimeThe Assurer shall not be liable for any claim not presented to the Assurer with proper proofs of loss within six limitation (6) months after payment thereof by the Assured. Lay-up At the expiration of this policy, the Assurer is to return.. / ••••••••••for each thirty (30) consecutive days ft1u-s during the term of this insurance the vessel may be laid up in a safe port; or .................... for each thirty (30) consecutive days during the term of this insurance the vessel may be laid up in a safe port without loading and/or dis- charging and without crew or cargo on board,provided the Assured give written notice to the Assurer as soon as practi- cable after the commencement and the termination of such lay-up period. Cancellation provisions: (a) If the v9jyj CaOmed herein should be sold or requisitioned and this policy be cancelled and surrendered,the Assurer to returnn..��.77�t�.JJ�a. tom�.. Jolr�teach thirty (30) consecutive days of the unexpired term of this insurance. (b) InWek even!8 nom �f premium within sixty (60) days after attachment, this policy may be cancelled by the Assurer upon five (5) days' written notice being given the Assured. (c) In the event that Sections 182 to 189, both inclusive, of U. S. Code, Title 46, or any other existing law or laws de• termining or limiting liability of shipowners and carriers, or any of them,shall,while this policy is in force,be mollified, amended or repealed, or the liabilities of shipowners or carriers be increased in any respect by legislative enactment,the aoeana filiall n the event ofrsuchtcancellat cancancel cinsurance ellation, return of premion um upthirton a pro arat daily basias'written ce of their intention so to Notwithstanding anything to the contrary contained. in this policy,no liability attaches to the Assurer: For any loss, damage, or expense which would be payable under the terms of the .....( .'7V.) •.... . .. .... ... ... .... .form of policy on hull and machinery,etc., if the vessel were fully covered by such insur- ance sufficient in amount to pay such lose, damage, or expense. For any loss, damage or expense sustained by reason of capture, seizure, arrest, restraint or detainment, or the consequence thereof or of any attempt thereat; or sustained in consequence of military, naval or air action by force of arms, including mines and torpedoes or other missiles or engines of war, whether of enemy or friendly origin; or sus- tained in consequence of placing the vessel in jeopardas an act or measure of war taken in the actual process of a military engagement, including embarking or disembarking troops or material of war in the immediate zone of such engagement; and any such Ices, damage and expense shall be excluded from this policy without regard to whether the Assured's liability therefor is based on negligence or otherwise,and whether before or after a declaration of war. For any loss,damage,or expense arising from the cancellation or breach of any charter,bad debts, fraud of agents, Insolvency, loss of freight hire or demurrage, or as a result of the breach of any undertaking to load any cargo, or in respect of the vessel named herein engaging In any unlawful trade-or performing any unlawful act, with the knowl- edge of the Assured. For an},lossoage,expense,or claim arising out of or having0tion to the towage*bf any other vessel oricraft, whether under agreement or not,unless such towage was to assist:such other vessel or craft in distress to a port or place of safety, provided, however, that this clause shall not apply to'claims under this policy for loss of life or personal injury to passengers and/or members of the crew of the vessel named herein arising as a result of towing. For any claim for loss of life or personal injury in relation to the handling of cargo where such claim arises under a contract of indemnity between the Assured and his sub-contractor. It is expressly understood and agreed if and when the Assured under this policy has any interest other than as a shipowner in the vessel or vessels named herein, in no event shall the assurer be liable hereunder to any greater extent than if such Assured were the owner and were entitled to all the rights of limitation to which a shipowner is entitled. Unless otherwise agreed by endorsement to this policy, liability hereunder shall in no event exceed that which+ioo>rlti be Imposed on. the Assured by law in the absence of contract. Liability hereunder in respect of any one accident or occurrence is limited to the amount hereby insured. Attached to and fortning part of Policy No. PM. 211987 of Royal II1Sti=:tI1GA Company Of America For sale Ey Jam= LaisJO.11 Jobs Street.New York, N.Y. 10038 Printed in U.S.A. v . ALSTYD ItM 1. NAMEU (NSUMtU-AT rVTFULT►VGRuumtz ' SOUT!40L )r TOWN OF P . D . MAIN ROAD PECONICr NY 11459 AGENT NAME AND ADDRESS ' '4ARKEL SERV IC Er INC . 531J MARKEL ROAD RICHMOND.- VA.. 23?30 ITEM 2. POLICY PERIOD From: National Casualty Company Comprehensive Law Enforcement LiabilityPolicy PL-J-1 (7-82) -� COMPREANSIVE LAW ENFORCEMENT LIAE&Y POLICY 0;7'10 U-P 1000 5S? Policy Number National Casualty Company Renewal of Number Property/Casualty Division PL 6991 E. Camelback Road SJn Z75 DECLARATIONS Scottsdale, Arizona 85251 A STOCK COMPANY ITEM 1. NAMED INSURED AND MAILING ADDRESS OSOUTIIOL�).- TOWN OF P . D . ^1A Itd ROAD PE CONI C. ;VY 1195 AGENT NAME AND ADDRESS — IARKEL SERVICE. INC . 5313 MARKEL ROAD RICAMONDP VA. 232.30 Agent No. &S0.0_Q_2 ITEM 2. POLICY PERIOD From: 01 /01 / >40 To: 01 /01 /81 12:01 A.M.Standard Time at the address of the Named Insured as stated herein. :::J ITEM 3: Limits of Liability $ 500 ,,.0!-W each person $ 501-1.000 each occurrence $ 1 "I gill'0' (100 annual aggregate ITEM 4: Premium Computation ESTIMATED NUMBER OF PAID EMPLOYEES RATE PER PREMIUM (FULL&PART TIME) MEMBER Class A 41 4 . 011 X 13 P 661_ Class B 1 L) 1 110 X1 .656 Class C J v 1;1 04 _001 ,Q76 Class D 9 X 6 2 . 00 $496 TOTAL ADVANCE PREMIUM $ T 1 7 7'4 11 ITEM 5: Location of premises _c,A m E a c T ,I c I I u F n r n r)2F- g e Ar- ITEM 6: Deductible $ per claim, including loss adjustment expenses. ITEM 7: Endorsements attached to Policy at Inception. ITEM 8: During the past three years no insurer has cancelled insurance issued to the NAMED INSURED, similar to that afforded hereunder unless otherwise stated herein: ITEM 9: Notice of all OCCURRENCES must be given to the Company whether or not such OCCURRENCES appear likely to involve this policy. AUDIT PERIOD: ANNUAL UNLESS OTHERWISE STATED HEREIN 2-20-86 fflC Cntersig ed by COUNTERSIGNATURE DATE AUTHORIZED REPRESENTATIVE National Casualty Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (STANDARD TIME) POLICY NUMBER MO. DAY YR. 12:01 INSURED AGENCY AND CODE A.M. PL600275 1 1 86 xx Town of Southold, P.D., W Markel 450002 ADDITIONAL INSURED STATE OR POLITICAL SUBDIVISIONS It is hereby understood and agreed that the definition of INSURED is amended to include as an INSURED the state or political subdivision designated below,but only with respects to liability arising out of activities of the NAMED INSURED. Designation of State or Political Subdivision: Town of Southold, W All other terms and conditions remain unchanged Date 2-20'86 me AUTHORIZED REPRESENTATIVE PL-2(7-82) National Casualty Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (STANDARD TIME) POLICY NUMBER MO. DAY YR. 12:01 INSURED AGENCY AND CODE A.M. R-600275 1 1 86 xx Town of Southold P.D., NY Markel 450002 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION In consideration of the premium charged,it is agreed that this policy shall not apply to a claim of or indemnification for punitive or exemplary damages. If suit is brought against the INSURED for a claim falling within the coverage provided under the policy,seeking both compensatory and punitive orexemplary damages,then the Company,will afford a defense to such action;however, the Company shall have no obligation to pay for any costs, interest,or damages attributable to punitive or exemplary damages. 4.� Date 2-20-86 rrc AUTHORIZED REPRESENTATIVE PL-3(7-82) National Casualty Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (STANDARD TIME) POLICY NUMBER MO DAY YR. 12.01 INSURED AGENCY AND CODE AM PL600275 1 1 86 xx Town of Southold, P.D., NY Markel 450002 NEW YORK DEDUCTIBLE ENDORSEMENT The INSURED,or any person authorized to sign on behalf of the INSURED,acknowledges that the INSURED is aware that the deductible provision stated in the policy shall apply to all legal and loss adjustment expenses. INSURED OR AUTHORIZED REPRESENTATIVE DATE DATE 2_20 trc UT-78 I»-871 AUTHORIZED REPRESENTATIVE MARKEL SERVICE, INft ' LAW ENFORCEMENT PTWESSIONAL LIABILITY INSURANC 1. "AMC or APPLICANT 3- TYIL OF JUNISDICTION TCW SU•�I-1-,\Q CP IRIIG4i - TOWN ❑COUNTY ❑STATE ❑OTHER {. ADOwc{{ a. POPULATION DCfIwCD erre Vc OA TC .�t\ 2.00.0 CITY/COUNTY/STATE/21► S. NAME OP rwc VIOUS INSURER POLICY NUMUCR eGor;c �cF�o�k 1laSa N 'Ic:oao�P Cas�rtl� �� • PL 000SS� s. HASSIMILAR COVERAGE BEEN CANCELLED. DECLINED OR RENEWAL REFUSED BY ANY INSURER IN THE LAST FIVE YEARS? DYES ®N IF YES.PLEASE EXPLAIN 7• CLAIM HISTORY FOR THE LAST THREE YEARS(INSURED OR UNINSURED) A.SUMMARY ` YEAR PREMIUM NO. OF PAID CLAIMS CLAIMS EXPENSE RESERVES TOTAL e CLAIMS 1 RgS g( 1 6 'p� -41- ccrtknOw n, ulrN.161%AD •..� N <<j 1+ t.t r�knc•AJ r"t � 193 "Y kf1-% dL ­41P­- krLlCt%o%.J.VN �f -ISO B.DETAILS OF CLAIMS SUMMARIZED ABOVE (USE SEPARATE SHEET IF NECESSARY) DATE OF CLAIMA r n YP F CLAIM AMOUNT RESERVED CASE INCIDENT t L 11F7N OR PAID OPEN CLOSEC q 03P ` 19-3 -1, !�d a•rtn S FuIS� C;C rej+P-N h.RNMENTAt RIOGRAIWs A. LIMIT Or L/AGILITY DESIRED EACH OCCURRENCE ANNUAL AGGREGATE EACH PERSON f.OCDUCTIBLC OC SIN Lp S Soo, o00 Is Soo, oao Is er.-e YY,%kLII, \ s 11 pao ALTERNATIVE QUOTE: LIMIT Or LIAGILITY DCSIRCO CACH OCCURRENCE [ACM PERSON AHNIJgL AGGRGGAT6 DCDV CTIGLC DESIRED SS S 5 S IG• DO YOU OPERATE A JAIL 2-YES ONO 1II.ARE JAIL PREMISES REGULARLY INSPECTED BY: Corrections 72 HRS.OR LONGER? State Cor,-� —YEAR JAIL WAS BUILT: '�_ Fin Inspectors ❑Yes ❑No Dept of Health ❑Yes ❑No Officia!s LYJYes ON DO YOU HAVE WRITTEN POLICIES GOVERNING: / AVG. DAILY NUMBER OF INMATES: O ®14 MEDICAL TREATMENT/SICK CALLE/YES ONO STATE CERTIFIED CAPACITY OF JAIL: 4 aiZ1• INMATE DISCIPLINE/GRIEVANCE PROCEDURES 13y1y,--ES 0N ARE JAILERS ON DUTY 24 HRS.PER DAY? i ES ONO D ACCESS TO LEGAL SERVICE OR MATERIALS YES ONO NAME OF GENERAL LIABILITY INSURANCE COMPANY: RECREATION DYES CRNO INTAKE SCREENING �OJ/YES ONO STRIP SEARCHES LJ✓YES ONO CORRECTIONAL OFFICERS TRAINING DYES CRINO POSITIONS TO BE INSURED W NUMBER OP FULL TIMC SOLNUMBCR OP PART - IS.NUMBER OP PA-T-TIM-/AUXIL- j!.NUMBER Or 17.NUMBCn Or COURT iuCHOOL CROSSING GUARD/ PCRSONNCL WITH wLGU- IARY OR RCSCR VL WITH UN- IARY/RC{CRVC WITH NO AR- JAILERS/ {L CURITV/CIVIL HUMANS OFFICERS/CAIML LAR STwLCT/ROAD ACCOM PANIEO ARwCfT AVTHO- RC{T AUTHORITY MATRONS ►R OC[tf(SPC CIrr) PROTECTION OFrICCwB ;xOUTIL{/O[TE CTIVLB RITY ({rcuFr) 3.3 3 n,0>n t Y HUMBBR DP CLUMICALI 11.PUBLIC OFFICIALS TO BE COVERED AS ADDITIONAL INSUREDS: OTHCRS IS►CCIPV) UIB►ATCHEw{ "AVON JCITY/COUNTY COMM/Sf10NCRS/ CITY/COUNTY COUNCILMEN I GMANAGER SU/[R VISOR{ CLERK () I Q Yl a CJ r% le f-c_%v-- EDUCATIONAL AND TRAINING REQUIREMENTS H. COU CATIONAL TRAINING BACKGROUND RCOUIRED or ►ER{ONNCL S���al1c OLA 1-14 Piz)Ce aCO3cl e .. 011.0271/1 EDWIONAL AND TRAINING REG UIREMENTS ICO, ED) 1 �1. DOES THE APPLICANT CONTRACT LAW ENFORCEMENT TO ANY OTHER PUBLIC OR PRIVATE ENTITY, OTHER THAN MUTUAL AID OR RECIPROCAL AGREEMENTS? OYES X-1 O L IF COVERAGE FOR CONTRACT LAW ENFORCEMENT IS DESIRED, Nob* OID YOU INCLUDE THE ADDITIONAL PERSONNEL IN THE ABOVE PERSONNEL FIGURES? OYES ONO 1r MOT,/LCACC INCLUOC /CAsONNCL"CAC AT OCCCAI/TION AMO ATTACH A CO•T OF TNC CONTRACT TO TMC A►TLICAT10N �1 DO YOU CONTROL OR AUTHORIZE AUTHORIZED MOONLIGHTING IS COVERED WITHOUT ADDITIONAL CHARGE. EMPLOYEE-MOONLIGHTING"? OYES MNO PLEASE PROVIDE US WITH ALIST OFAUTHORIZED"MOONLIGHTIP:G"EMPLOYERS. 14. DO YOU"AVC A TOLICICC ANO x1.10 IT CUAACNT NOV IACOUCNTLT V/DATLO AT VNO" YES ONO YES ❑NO Yv IS THE MANUAL DISTRIBUTED TO ALL PERSONNEL OR REVIEWED WITH THEM PERIODICALLY ©— �� DOES YOUR TRAINING PPOGRAM INCLUDE PERIODIC REVIEW OF ALL OR EXEP.PTS FROM THE MANUAL LICYES ONO THE STATEMENTS AND ANS.dERS HEREIN ARE WARRANTED TO BE TRUE AND ARE MADE WITH THE K-NOWLEDGE THAT THE COMPANY WILL ACT IN PELIANCE UPCN TH=tI. THIS REQUEST IS DESIGNED TO SOLICIT INFORMATION AND IS NOT A POLICY OR A POLICY BINDER ON THE PART OF THE APPLICANT, ITS AGENCY OR THE INSURANCE CCMPANY, ` i 4ctc-ola w ;"A-,:,rs NA"C OF GCIAAT"CNT AD"INIITAATOA IPLCAIC PAINT) PHONE NUMBER: ( 5 �! ,�sr r AGENT A TNo IxcD srIC N.TVNe of Ar.ucANT `.IARKELSERVICE,INC. C�n��' � OF PO`�Ge ,' O. BOX 5611 •ourloN � P CHN•C'.D. VIRGINIA 23220 Iola-7160-5— DATE H.:NxD " ' '2) To PERSONAL INJURY,BODILY INJURY,or PROPERTY DAMAGE 7) Violation of civil rights protected under 42 USC 1981 et sequential sustained by any paid full time or part time and/or auxiliary or volunteer or State Law; law enforcement officer of the NAMED INSURED directly or indirectly 8) Violation of property rights; related to his employment by the NAMED INSURED. 9) Wrongful entry, eviction or other invasion of the right of public 3) To BODILY INJURY or PROPERTY DAMAGE arising out of the occupancy; if such offense is committed during the policy period. ownership, maintenance, operation, use, loading or unloading of any (a) AUTOMOBILE,watercraft,or aircraft owned by or operated by or POLICY TERRITORY — means the United States of America, its rented or loaned to the INSURED; (b)or to any other AUTOMOBILE, territories or possessions,or Canada. watercraft or aircraft operated by any person in the course of his PROPERTY DAMAGE—means(a)physical injury to ordestruction of employment by the INSURED. tangible property which occurs during the policy period,including loss 4) To liability assumed by the INSURED under any contract or of use thereof at any time resulting therefrom, or (b) loss of use of agreement,except mutual law enforcement assistance agreements or tangible property which has not been physically injured or destroyed contracts between political subdivisions. provided such loss of use is caused by an OCCURRENCE during the 5) To claims arising out of the performance of any act or service of policy period. police duty for anyone other than the NAMED INSURED.This exclusion WRONGFUL ACT—means any actual or alleged act,error,omission, shall not apply if the act or service arises as the result of a mutual law neglect or breach of duty by the INSURED. enforcement assistance agreement or contract between political sub- divisions,nor does it apply to any departmentally approved activities. CONDITIONS 6) To claims arising out of the official employment policies or practices 1. PREMIUM. The premium for this policy shall be based upon the of the INSURED(including,but not limited to:claims due to demotion, numberof employees employed bythe INSUREDand shall be computed selection,dismissal,failure to promote,etc.) at the rate(s) set forth in the Declarations. The advance premium is 7) To damages arising out of the willful violation of a penal statute or based upon the estimated exposures for the policy period as stated in ordinance committed by or with the knowledge or consent of any the Declarations. For the purpose of determining the actual premium, INSURED or claims of injury arising out of the acts of fraud committed the following definitions will apply: by or at the direction of the INSURED with affirmative dishonesty or "Class A Employees"— those employees who deal directly with the actual intent to deceive or defraud. public and exercise general powers of arrest.Included in this category 8) To PROPERTY DAMAGE to: are: (a) County Sheriff/Police Chief exercising powers of arrrest 1) Property owned,used or occupied by or rented to the INSURED: (b) Peace officers exercising powers of arrest 2) Property in the care,custody or control of the INSURED or as to "Class BEmployees"—those employees who do not deal directly with which the INSURED is for any purpose exercising physical the public or only exercise limited power of arrest under the direct control. Part 2 of this exclusion does not apply to property on persons at time of arrest. supervision of a certified officer. Included in this category are: (a) Jailers/Matrons 9) To any use or handling by the INSURED of any radioactive materials (b) Auxiliary or reserve peace officers under the direct supervision or hazardous,radioactive properties. of a certified peace officer(only)exercising arrest powers. 10) To any actions,claims,suits or demands seeking relief or redress in (c) Court Security any form other than money damages,nor shall the Company have any (d) Civil Process Officers obligation to indemnify the INSURED for any costs,fees or expenses "Class CEmployees"—those employees who do not exercise powerof adverse judgement for injunctive or declaratory relief; however,, the which the INSURED shall become obligated to pay as a result an arrest and whose duties are only administrative in nature. Included in this category are: Company will afford defense to the INSURED for such actions,claims, (a) County Commissioners suits or demands, if not otherwise excluded, where compensatory (b) City Council damages are requested. (c) Mayor 11) Claims against the INSURED named herein for acts of another (d) City Manager officer or employee unless said officer or employee is also insured for (e) Auxiliary or reserve police officers not exercising powers of said acts in a policy of insurance issued by this Company. arrest. (f) Coroner (g) School crossing guards/humane officers/crime prevention DEFINITIONS officers Whenever used in this policy,the following words have these meanings: "Class D Employees"—those employees whose ordinary duties are AUTOMOBILE — means a land motor vehicle, trailer or semi-trailer only indirectly related to the enforcement of criminal laws.Included in designed for travel on public roads. this category are: (a) Clerical Staff/Fingerprinting/License Examination BODILY INJURY—bodily injury,sickness or disease sustained by any (b) Stenographic Personnel/Food Service/Photographic person which occurs during the policy period, including death at any (c) Dispatcher/Record Keeping Duties time resulting therefrom. The final premium shall be based on the average number of all INSURED—means the NAMED INSURED and all full or part-time and employees of the NAMED INSURED,during the policy period and shall all auxiliary or volunteer law enforcement officers of the NAMED be determined as follows: INSURED.The insurance afforded applies separately to each INSURED (a) The NAMED INSURED shall maintain records and report, against whom claim is made or suit is brought,except with respect to within thirty days IN after the shall d of the twinpolirecords ,the highest the limits of the Company's liability. number of full or part time employees specified in Item 4 of the NAMED INSURED — means the organization named in Item 1 of the Declarations,on anyone dayforeach month this policy was in Declarations page. effect. OCCURRENCE—means an event,including continuous or repeated (b) The average number of such employees shall be determined by exposure to conditions,which results in PERSONAL INJURY,BODILY dividing the sum of the number of such employees shown per INJURY or PROPERTY DAMAGE sustained,during the policy period, month by the number of monthly reports. by any person or organization and arising out of the performance of the (c) If the earned premium as computed exceeds the advance INSURED'S law enforcement duties. premium paid,the NAMED INSURED shall pay the excess to All claims arising out of(a)a riot or insurrection,(b)a civil disturbance the Company;if less,the Company shall return to the NAMED resulting in an official proclamation of a state emergency, (c) a INSURED, the unearned portion paid by such INSURED, temporary curfew, or (d) martial law are agreed to constitute one subject to the Company's retention of the minimum premium,if Occurrence. any. PERSONAL INJURY te means: 1) Assault and battery; 2. INSPECTION AND AUDIT.The Company shall be permitted but not 2) Discrimination,unless insurance thereof is prohibited by law; obligated to inspectthe NAMED INSURED'S property and operations at 3) False arrest,detention or imprisonment,ormalicious prosecution*, any time. Neither the Company's right to make inspections nor the 4) False or improper service of process; making thereof nor any report thereon shall constitute an undertaking, 5) Humiliation or mental distress; on behalf of or for the benefit of the NAMED INSURED or others, to 6) The publication or utterance of a libel or slander or of other determine or warrant that such property or operations are safe or defamatory or disparaging material,ora publication or utterance healthful,or are in compliance with any law,rule or regulation. in violation of an individual's right to privacy;except publications The Company may examine and audit the NAMED INSURED'S books or utterances in the course of or related to advertising,broadcast- and records at any time during the policy period and extensions thereof ing or telecasting activities by or on behalf of the NAMED and within three years after the final termination of this policy,as far as INSURED; they relate to the subject matter of this insurance. PL-J-1 (7-82) (2) 3. TERMS OF POLICY-STATUTE. Terms of this policy which are in such loss bears to the total applicable limit of liability of all valid conflict with the statutes of the state wherein this policy is issued are and collectible insurance against such loss. hereby amended to conform to such statutes. Theremises liability y insurance afforded by this policy shall be in 4. INSURED'S DUTIES IN THE EVENT OF OCCURRENCE,CLAIM OR excess of any other valid and collectible premises liability insurance SUIT. available to the INSURED whether such premises liability is stated to be (a) In the event of an OCCURRENCE,written notice containing otheary, contributory, story,ex only as a contingent specific excess insurance over the particulars sufficient to identify the INSURED and also limits of liability provided in this policy. reasonably obtainable information with respect to the time, place and circumstances thereof,and the names and addresses 7. SUBROGATION.In the event of any payment under this policy,the of the injured and of available witnesses,shall be given by orfor Company shall be subrogated to all the INSURED'S rights of recovery the INSURED to the Company or any of its authorized agents therefor against any person or organization and the INSURED shall as soon as practicable. execute and deliver instruments and papers and do whatever else is (b) If claim is made or suit is brought against the INSURED, the necessary to secure such rights.The INSURED shall do nothing after INSURED shall immediately forward to the Company every loss to prejudice such rights. demand,notice,summons or other process received by him or 8. CHANGES. Notice to any agent or knowledge possessed by any his representative. agent or by any other person shall not effect a waiver or a change in any (c) The INSURED shall cooperate with the Companyand upon the part of this polcy or estop the Company from asserting any right under Company's request shall submit to examination and interrog- the terms of this policy;nor shall the terms of this policy be waived or ation by a representative of the Company, under oath if changed,except by endorsement issued to form a part of this policy, necessary, attend hearings, depositions and trials and shall signed by a duly authorized representative of the Company. assist in effecting settlement, securing and giving evidence, 9. ASSIGNMENT. Assignment of interest under this policy shall not obtaining the attendance of witnesses and in the conduct of bind the Company until its consent is endorsed hereon;if,however,the suits, as well as in the giving of a written statement or NAMED INSURED, shall die, such insurance as is afforded by this statements to the Company representatives and defense.In the policy shall apply(1)to the NAMED INSURED'S legal representative,as event of a claim occurring likely to involve the Company the INSURED, but only while acting within the scope of his duties as hereunder,the INSURED shall not make any payment,assume such,and(2)with respect to the property of the INSURED,to the person any liability or incur any expense without the consent of the having proper temporary custody thereof,as INSURED,but only until Company first being obtained.The Company shall conduct in the appointment and qualification of the legal representative. the name of the INSURED the defense of any claim, and 10. DEDUCTIBLE.The deductible amount,stated in the Declarations, prosecute in his name for its own benefit any claim for if any,is applicable to each claim and shall be subtracted from the total shall have y or ion in the handling onst any claim,an and amount of money damages and claims expenses including (1) loss shall have full discretion in the handling of any claim,and the INSURED shall give full information and assistance as the Payments and (2) investigation, adjustment, defense and/or appeal Company may reasonably require. expenses,whether or not loss payment is made, resulting from each claim and the Company shall be liable only for the difference between S. ACTION AGAINST COMPANY. No action shall lie against the such deductible amount and the amount of insurance otherwise Company unless, as a condition precedent thereto, there shall have applicable to each claim. been full compliance with all of the terms of this policy, nor until the 11. CANCELLATION. This policy may be cancelled by the NAMED amount of the INSURED'S obligation to pay shall have been finally INSURED by surrender thereof to the Company oranyof itsauthorized determined either byjudgmentagainst the INSURED after actual trial or agents or by mailing to the Company written notice stating when by written agreement of the INSURED,the claimant and the Company. thereafter the cancellation shall be effective. This policy may be Any person or organization or the legal representative thereof who has cancelled by the Company by mailing to the NAMED INSURED at the secured such judgment or written agreement shall thereafter be entitled address shown in this policy,written notice stating when not less than to recover under this policy to the extent of the insurance afforded by sixty (60) days thereafter such cancellation shall be effective. The this policy. No person or organization shall have any right under this mailing of notice as aforesaid shall be sufficient proof of notice.The policy to join the Company as a party to any action against the time of surrender or the effective date and hourof cancellation stated in INSURED to determine the INSURED'S liability,nor shall the Company the notice shall become the end of the policy period. Delivery of such be impleaded by the INSURED or his legal representative.Bankruptcy written notice either by the NAMED INSURED or by the Company shall or insolvency of the INSURED or of the INSURED'S estate shall not be equivalent to mailing. relieve the Company of any of its obligations hereunder. If the NAMED INSURED or Companycancels,earned premium shall be computed in accordance with paragraph 1 of the Conditions.Premium 6. OTHER INSURANCE. The insurance afforded by this policy is adjustment may be made eitherat the time cancellation iseffected oras primary insurance, except when stated to apply in excess of or soon as practicable after cancellation becomes effective,but payment contingent upon the absence of other insurance.When this insurance is or tender of unearned premium is not a condition of cancellation. primary and the INSURED has other insurance which is stated to be applicable to the loss on an excess or contingent basis,the amount of 12. DECLARATIONS. By acceptance of this policy, the NAMED the Company's liability under this policy shall not be reduced by the INSURED agrees that the statements in the Declarations are his existence of such other insurance. agreements and representations, that this policy is issued in reliance When both this insurance and other insurance apply to the loss on the upon the truth of such representations,and that this policy embodies all pp y agreements existing between himself and the Company or any of its same basis,whether primary,excess orcontingent,the Company shall agents relating to this insurance. not be liable under this policy for a greater proportion of the loss than that stated in the applicable contribution provision below: 13. SOVEREIGN IMMUNITY. It is agreed that the Company will not avail itself of the defense of sovereign immunity to which the INSURED (a) CONTRIBUTION BY EQUAL SHARES.If all of such othervalid may be entitled by reason of its being a public and/or governmental and collectible insurance provides for contribution by equal entity, unless the INSURED requests the Company to raise such shares,the Companyshall not be liable fora greater proportion defense by written notice to the Company not less than ten(10)days of such loss than would be payable if each insurer contributes before the time to file an answer to any suit.It is further agreed that the an equal share until the share of each insurer equals the lowest INSURED hereby releases the Companyfrom all liability because of the applicable limit of liability under any one policy or the full failure on the part of the Companyto raise such defense,except in cases amount of the loss is paid,and with respect to any amount or where the INSURED specifically requests the Company to do so in a loss not so paid the remaining insurers then continue to manner provided herein. contribute equal share of the remaining amount of the loss until each such insurer has paid its limit in full or the full 14. SETTLEMENT.The Company shall not settle any suit without the amount of the loss is paid. INSURED'S consent. If,however,the INSURED refuses to consent to any settlement received by the Company and shall elect to contest the (b) CONTRIBUTION BY LIMITS. If any of such other insurance claim or continue any legal procedings in connection with such claim, does not provide for contribution by equal shares, the the Company's liability for the claim shall not exceed the amount for Company shall not be liable for a greater proportion of such which the claim could have been so settled plus claims expense loss than the applicable limit of liability under this policy for incurred up to the date of such refusal. In Witness Whereof,the Company has caused this policy to be executed and attested,but this policy shall not be valid unless countersigned by a duly authorized representative of the Company. SECRETARY PRESIDENT Home Office Southfield, Michigan PL-J-1 (7-82) (3) . MAK R0 �VIATTITUCK ITEM 1. NAMED INSURED AND MAILING ADDRES1?HONE: 516 29 =. 0 - 000THOLDo TOWN OF C/ o SUPEP.VISOR 1AIN ROAD SOOTHOLDP NY 11V11 _ AGENT NAME AND ADDRESS • HARKEL SERVICER INC . 5310 MARKEL ROAD RICOMOND. VA. 23230 ITPRA 9 pn, Iry p;=ninn National Casualty Company Public Officials Eand Liability Legal Policy THIS IS A CLAIMS MADE POLICY. PLEASE READ IT CAREFULLY. PO-J-1 (1-83) r THIS IS A CLAIMS MADE POLICY. PLEASE READ IT CAREFULLY. National Casualty Insurance Company Scottsdate,Arizona (A stock insurance company,herein called the Company) Agrees with the INSURED,named in the Declarations and made a part hereof,in consideration of the payment of the premium and in reliance upon statements in the Declarations and subject to the limits of liability,exclusions,conditions and other terms of this policy as follows: INSURING AGREEMENT The Company will pay on behalf of the INSURED all sums which the WRONGFUL ACT upon which such claims are based. INSURED shall become legally obligated to pay as damages as a result 2)If the Companyorthe INSURED cancels this policy or if the Company of claims first made during the period of this policy, against the refuses to renew for reasons otherthan the INSURED's non-payment of INSURED by reason of any WRONGFUL ACT, rendered in the premium,then the INSURED shall have the right to extend the coverage discharge of PUBLIC ENTITY duties. provided by this policy to any claims first made against the INSURED, DEFENSE,SETTLEMENT AND SUPPLEMENTARY PAYMENTS for a period to be selected by the INSURED,immediately following the The Company shall have the right and duty to defend any suit against effective date of such non-renewal orcancellation but onlywith respect the INSURED seeking damages on account of such WRONGFUL ACT to any WRONGFUL ACT(S)committed before the date of cancellation even if any of the allegations of the suit are groundless, false, or or non-renewal. This interval shall hereinafter be referred to as the fraudulent, and may make such investigation and settlement of any "extended discovery period". claim or suit as it seems expedient.However,the Company shall not be The INSURED, subject to the terms and conditions set forth herein, obligated to pay any claim or judgement or defend any suit,after the shall have a right to select that period to which the extended discovery applicable limit of the Company's liability has been exhausted by period shall apply,which in no event shall exceed thirty six(36)months payment of judgments or settlements. immediately upon such cancellation or refusal to renew.An additional The INSURED shall not,except at his own cost and for his own account, premium is immediately due in an amount equal to twenty five (25) make any payment, admit any liability, settle any claim, assume any percent of the premium previously charged by the Company for each obligation, or incur any expense without the written consent of the year for which the INSURED selects to have the extended discovery Company. period rendered applicable. The Company will pay, in addition to the applicable limit of liability: The right of extension shall terminate unless written notice is given to the Company, not later than thirty(30) days after the effective date of 1)all expenses incurred by I:he Company(excluding salaries of officers cancellation or non-renewal. or employees of the PUBLIC ENTITY,or any other governmental body) all costs taxed against the INSURED in any suit defended by the LIMITS OF LIABILITY Company and all interest on the entire amount of any judgment therein Regardless of the number of (a) INSUREDS under this policy (b) which accrues after entry of the judgment and before the Company has persons or organizations who sustain damages payable under this paid or tendered or deposited in court that part of the judgment which policy or (c) suits brought on account of insurance afforded by this does not exceed the limit of the Company's liability thereon; policy,the Company's liability is limited as follows: 2) premiums on appeal bonds required in any suit defended by the (1)The limit of liability stated in the Declarations as applicable to"each Company and costs of attachment or similar bonds. loss"is the limit of the Company's liability for all loss arising out of one EXTENSIONS WRONGFUL ACT covered hereby. 1)This policy shall cover loss arising from any claim first made during (2)The limit of liability stated in the Declarations as applicable to the the policy period against !;he estates, heirs, legal representatives or "annual aggregate"is,subject to the above provision respecting"each assigns of deceased persons, who were INSURED at the time of the loss",the maximum limit of the Company's liability foreach policy year, PO-J-1 (1-83)Page 1 of 3 PUBLIC OMCIALS & EMPLOYEES LEGAL LIASTY POLICY Policy Number E-A National Casualty Company Renewal of Number Property/Casualty Division P� 523505 Scottsdale, Arizona 85251 A STOCK COMPANY DECLARATIONS ITEM 1. NAMED INSURED AND MAILING ADDRESS • eOiJTNOLDo TOWN OF C/ o SUPERVISOR MAIN ROAD SOdTHOLD, NY 11911 _ AGENT NAME AND ADDRESS 01ARKEL SERVICEo INC . 5310 MARKEL ROAD Agent No. 455001 RICHIMOND. VA. 23230 ITEM 2. POLICY PERIOD From: 11 / '11035 To: 11 / 17 /66 12:01 A.M.Standard Time at the address of the Named Insured as stated herein. ITEM 3. Limit of Liability (A) Each Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (B) Annual Aggregate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1 .UU(1.01JU ITEM 4. Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Amount to be borne by INSURED each loss, including loss adjustment expense) ITEM 5. Premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $9.31 5 ITEM 6. Designee of public entity to report claims and receive notices: CONTACT PERSON DESIGNATED A90VE ITEM 7. Notice of claim shall be given to: National Casualty Company Property/Casualty Division 6991 E. Camelback Road, Suite A210 Scottsdale, Arizona 85251 ITEM 8. Endorsements attached at inception: THIS IS A CLAIMS MADE POLICY. PLEASE READ IT CAREFULLY. 2-13-86 rrc COUNTERSIGNATURE COUNTERSIGNATURE DATE u Cori PO-D-1 (1-83) National Casualty Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (STANDARD TIME) POLICY NUMBER MO DAY YR. 12:01 INSURED AGENCY AND CODE AM P0523503 11 17 85 xx Town of Southhold, W Markel 450002 NEW YORK DEDUCTIBLE ENDORSEMENT The INSURED,or any person authorized to sign on behalf of the INSURED,acknowledges that the INSURED is aware that the deductible provision stated in the policy shall apply to all legal and loss adjustment expenses. INSURED OR AUTHORIZED REPRESENTATIVE DATE DATE 2-13-86 ffc s UT-78 l4-851 AUTHORIZED REPRESENTATIVE National Casualty Company ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (STANDARD TIME) POLICY NUMBER MO. DAY YR. 12:01 INSURED AGENCY AND CODE A.M. P0523503 11 17 85 xx Town of Southhold, NY Markel 450002 PUBLIC OFFICIALS LIABILITY New York Mandatory Endorsement In consideration of the premium charged the "notice of claim" section of the policy is amended to include: 5) Any notice given by or on behalf of the insured, or written notice by or on behalf of the injured person or any claimant, to any licensed agent of the in- surer in the state of New York, with particulars sufficeint to identify the insured, shall be deemed notice by the insurer. ,! , DATE 2-13-86 mc UT-2(8-82) �� �. AUTHORIZED REPRESENT I E it - lam, MARKEL SERVICE, WS ; A REQUEST FIt'- ` OR A CLAIMS MADE POLICY PUBLIC OFFICIALS LIABILITY INSURANCE I.A. L[BAL NAM[OF PUBLIC RNTITY SO O C. D'AT[ORGANI2[D OR INCOR►ORATBD Toter of •. AODR[ [R,Sf(NUMB /TR[[T) 11af3 i. POPULATION.ACCORDING TO LAT[/T C[NfY/ MQ�r (�� arP 19 4�{ Z elrr,srwrB,:IP c� o d (IP PULIC[NTITY 1f A UTILITY.NUMB[,O.Uf[Rf) .) a`�- o I ry e w Ljo�' D S.A. BUDGET(FOR PAST THREE(3)YEARS) N�oI YEAR REVENUES EXPENDITURES SURPLUS 1+) DEFICIT(-) ■•.IfcwL 38 (r o0 0 -a rvtlr.T,1 198y- -lag o Ito t.3 ••A• NAMES AND OFFICIAL TITLES OF GOVERNING BOARD MEMBERS NAME TITLE ELECTED `` APPOINTED Fr Ant G: S 1 rN\k d' L/\-t -c-100 V I J o r ►�� �c A^-% W. Co Coo t,a,r.c; l III c� ✓' G4_-ba r_r. it, � •. 1/ ROAR.MRM.[..AR[A.►OINT[D,•Y WHOM t.A. NuMB[R oP ER OF LICENSED OR CERTIFIED POSITIONS fM.LOYRB• IT ACCOUN• ARCNITRCT• [NGIN[[R• OTN[R/(f.[CIPY) 1 1 TARTS ;-DOES`THE PUBLIC ENTITY ADMINISTER THE FOLLOWING UNITS: T• --- DOES THE PUBLIC ENTITY PRESENTLY CARRY: 7'4 ' es,Indicate Budget A. GENERAL LIABILITY INSURANCE. . ES • rr--,,�� ❑NO A. SCHOOL B. PERSONAL INJURY INSURANCE . . . . . . .G YES ONO -- C. COVERAGE FOR DISCRIMINATION . . . . . 'EKES ❑NO B. AIRPORT D. POLICE PROFESSIONAL LIABILITY . .EjjVES ONO �O Q Q /• .L.A..IN.ICAT[.OLICY LIMIT/.IN7V R6R. ABOVB INRURANC[ 6%PIRATION DATE O. - _C. HOSPITAL A 5-0.71 g 40 o f C r/14 1 2 1311 ji— 1. D. MUNICIPALLY UTILITY -/ Or�G MY�I Ny�I•CoNcQ CQSILfv�`'1 \ I�1 IQ t coverage is desired for these limits,please submit a separate application) v s% ►� I a ,1 I�`. 00ES THE PUEILIC ENTITY IF ref,cow.wnv T Poucv reRM CARRY PUBLIC OFFICIALS FO✓ Iws�►C•4�LC.. ��• LIABILITY INSURANCE? 1IN, 1%1 1 ph't yNj11jdn GA. \e11 DODUCTIOL[ 1 PR 6MtUM --YES ONOm0.gqyee�(gqgnhqqucQ 0. HAS ES, SIMILAR INSURANCE EVER BEEN DECLINED,CANCELTEO,OR NOT RENEWED? . . . . . . . I� (IF VES, INDICATE COMPANY, TERMINATION DATE,AND REASONS FOR TERMINATION ON LAST PAGE) ' ' ' . • .QYES ❑ISO I.HAS ANY CLAIM BEEN PRESENTED TO THE CURRENT OR PAST CARRIER? (IF YES, DETAIL ON LAST PAGE) ' ' • ' • • • • • • . . . ., YES ONO a. A. TOTAL AMOUNT O. OUTSTANDING BOND/ _— ■. LATE/T BONG P.ATINO (MOOD Y'S OR C. .Re VIOUf BOND RATINGS(I►CNANG[D IN — STANDARD 81.00R'7) LAST a YQARf) D. HAS ANN' BOND ISSUE BEEN DEFEATED WITHIN THE PAST THREE (3) YEARS?. YES NO E. IF YES,HAS THE PROPOSAL BEEN RESUBMITTED OR IS IT EXPECTED TO BE RESUBMITTED? . . . . . . . . . . . . . . .❑ F. HAS THE PUBLIC ENTITY BEEN IN DEFAULT ON PRINCIPAL OR INTEREST ON ANY BOND?. . . . . . . . . . . .O (IF YES ON ANY OF THE ABOVE,PLEASE DETAIL ON LAST PAGE) 011-0282/1 13. HAVE ANY OF THE FOLLOWING SITUAT' OCCURRED WITHIN THE PAST THREE YARS? 1 ` E (IF'YES,PLeASE DESCRIBE BELOW OR'.�TTACH DETAILS) n A. STRIKE,SLOWDOWN OR OTHER DISRUPTION BY EMPLOYEES?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑YES. ' B. LAYOFF OF EMPLOYEES OR REDUCTION IN SERVICE? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑YES LINO C. ANY PERSON,FORMER EMPLOYEE OR JOS APPLICANT MADE CLAIM ALLEGING UNFAIR OR IMPROPER TREAT- MENT REGARDING EMPLOYEE HIRING REMUNERATION,ADVANCEMENT OR TERMINATION OF EMPLOYMENT? . .❑YES dN0 D. DISPUTES INVOLVING INTEGRATION,SEGREGATION,DISCRIMINATION,OR VIOLATION OF CIVIL RIGHTS? . . . . .OYES 12 NO (IF YES TO ANY OF THE ABOVE,PLEASE DETAIL ON LAST PAGE INCLUDING THE DATE,THE NATURE OF THE COMPLAINT AND ITS PRESENT STATUS) 14. A. HAS ANY CLAIM BEEN MADE OR IS NOW PENDING AGAINST ANY PERSON IN HIS/HER CAPACITY AS AN OFFICIAL _/ OR EMPLOYEE OF THE PUBLIC ENTITY?. . LI✓YES ❑NO B. DOES ANY OFFICIAL OR EMPLOYEE HAVE ANY KNOWLEDGE OF ANY ACT,ERROR,OR OMISSION,WHICH MIGHT ,��,�� GIVE RISE TO A CLAIM AGAINST THEM?. . . . . . . OYES LYNO (IF YES TO ANY OF THE ABOVE,PLEASE DETAIL ON LAST PAGE-THE DATE,THE NATURE-OF THE COMPLAINT AND ITS PRESENT STATUS) C. NO FACT,CIRCUMSTANCE OR SITUATION INDICATING THE PROBABILITY OF A CLAIM OR ACTION IS NOW KNOWN TO ANY PUBLIC OFFICIAL OR EMPLOYEE;AND IT IS AGREED BY ALL CONCERNED THAT IF THERE BE ANY KNOWLEDGE OF ANY SUCH FACT, CIRCUMSTANCE,OR SITUATION,ANY CLAIM OR ACTION SUBSEQUENTLY THEREFROM SHALL BE EXCLUDED FROM COVERAGE \ UNDER THE INSURANCE BEING APPLIED FOR. 15. DOES THE ENTITY AWARD EXCLUSIVE CONTRACTS FOR: CABLE TELEVISION . . . . . . . LJVES ONO UTILITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑YES ��NO FOODSERVICES .❑YES L1N0 SANITATION. . . . . . . . . . . . . . . . . .D�IES ONO SECURITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .a�-�yES ❑NO ARE THESE CONTRACTS AWARDED BY COMPETITIVE BIDDING PRACTICES?. . . . . . . .L=IYES ONO (IF NO,PLEASE DESCRIBE) CG b1-c Aa\cv:s%'D ., un,cfA.. a Pra,J: s c. OL g r c cw, d d{.r s t.rd.+JZ_ So`.g V O nCCt(9t-Gv,S",5 r cS 0,c)v\Acj. 16. DOES THE ENTITY HAVE AN INSURANCE COMMITTEE THAT SELECTS COVERAGE AND COMPANIES?. . . . . . . . . . . .EKES ONO 00 MEMBERS RECEIVE ANY FORM OF COMPENSATION? . . . . . . . . . . . . . . . . . . .OYES 290. . . . . . . . . . . . . . . . . . . . . . HOW IS THIS COMPENSATION DETERMINED? HOW ARE COMMITTEE MEMBERS SELECTED? NAM[ 17. THE OFFICIAL DESIGNATED TO RECEIVE ANY AND ALL NOTICES FROM THE INSURER TO THEIR AUTHORIZED �Y U.,n REPRESENTATIVE CONCERNING THIS INSURANCE SHALL TITL[ BE: [+ LIMIT OF LIA�`4TY RCOUlfTlp p[DU GTI/l[R[OU[fT[p ons, ♦-.% `%O1l� Gam, '(� 103 S [PI[DTIV[OAT[w[QU[STUD I oh-r- hntkktav% V..V% t-e q,4r- �Z $b-0 1 I11 1 - THE UNDERSIGNED WHO ARE AUTHORIZED TO SIGN THIS APPLICATION DECLARE TO THE BEST OF THEIR KNOWLEDGE,THE STATEMENTS SET FORTH HEREIN ARE TRUE. SIGNING OF THIS APPLICATION DOES NOT BIND THE UNDERSIGNED TO COMPLETE THE INSURANCE,BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED,AND THIS FORM WILL BE ATTACHED TO AND BECOME A PART OF THE POLICY. TWO SIGNATU EO RE Avs- naN[ (SJtl [x TI ! IC w) 0AT[ Oa N[D -�8 DAT[ AGENT: ✓ S+ BROKER: S'On.Sop /N C. MARKELSERVIC I O RICHMONDD,,VIRGINIA 23230 NMRih QOaef mc't�y ck, Ny RICHV AGENT/BROKER: ATTACH A COPY OF BID SPECIFICATIONS,IF ANY 9 S ! i Anti irl no event shall the Company's total limit of liability be increased any persons providing services to the PUBLIC ENTITY under any for any extended discovery period. mutual aid or similar agreement.The term"employee"shall not include (3) The Company shall only be liable to pay, subject to the limit of any person working on a retainer or contractual agreement. liability provisions stated above for loss in excess of any retention PUBLIC ENTITY-means the municipality,governmental body,depart- shown in the Declarations in respect of each and every loss hereunder, ment or unit, which is named in Item 1 of the Declarations as legally and such retention shall be uninsured. constituted at the inception of this policy. (4)Losses based on or arising out of the same act or interrelated acts of WRONGFUL ACT-means any actual or alleged error or misstatement one or more of the INSUREDS shall be considered a single loss and only or act or omission or neglect or violation of any federal or state civil one retention shall be applicable to such single loss. rights, or breach of duty including misfeasance, malfeasance, or EXCLUSIONS nonfeasance by the INSUREDS in the discharge of their duties for the PUBLIC ENTITY, individually or collectively, or any matter claimed The Company shall not be obligated to make any payment or defend against them solely by reason of their being or having been INSUREDS. any lawsuit in connection with any claim made against the INSURED: NOTICE OF CLAIM 1)Based upon or attributed to theirgaining in fact any profit,advantage 1) If, during the policy period or the extended discovery period,the or remuneration to which they were not legally entitled; INSUREDS shall receive written or oral notice from any party that it is 2)Brought about or contributed to by fraud,dishonesty or bad faith of the intention of such party to hold the INSUREDS responsible for a an INSURED;however,notwithstanding the foregoing,the INSUREDS WRONGFUL ACT,they shall give written notice to the Company of the shall be protected under the terms of this policy,as to any claims upon receipt of such written or oral notice,as soon as practicable,but in no which suit may be brought against them by reason of any alleged fraud event exceeding one year;then,any claims made against the INSUREDS or dishonesty on the part of any INSUREDS,unless judgment or other arising out of such WRONGFUL ACT shall,forthe purpose of this policy final adjudication thereof adverse to such INSUREDS shall establish be treated as a claim made during the policy year in which such notice that acts of active or deliberate dishonesty or fraud committed by such was given,or if given during the extended discovery period,as a claim INSUREDS was material to the cause of action so adjudicated; made during the last policy year. 3)Which is insured by another valid policy or policies,or which shall be 2) The INSUREDS, or the named designee shall, as a condition deemed uninsurable under the law pursuant to which this policy shall precedent to their rights under this policy,give the Company notice in be construed; writing as soon as practicable of any claim made and shall give the Company such information and cooperation as it may reasonably 4) For any damages arising from bodily injury, sickness, mental require. anguish, disease or death of any person, or for damages to or 3) For the purpose of the above clauses notice to the designee named destruction of any tangible property including loss of use thereof; under Item 6 of the Declarations shall constitute notice to the INSUR- EDS. 5) For false arrest,libel,slander,defamation of character,invasion of 4) In the event of any claim occurring hereunder, notice to the privacy,wrongful eviction,assault or battery; Company shall be given to the person or firm(s) shown under Item 7 of 6)For strikes,riots or civil commotion; the Declarations. Notice shall be deemed to be received if sent by 7) Based upon or attributable to the rendering or failure to render any pre-paid mail properly addressed. opinion,treatment,consultation or service if such opinion,treatment, CONDITIONS consultation or service was rendered or was not rendered while such 1. ACTION AGAINST COMPANY. No action shall lie against the INSUREDS were engaged in any activity for which they received Company unAGAI acondit Pprecedent Noaction oshall lie the compensation from any source other than the PUBLIC ENTITY named p y in Item 1 of the Declarations and/or were gratuitously engaged other have fully complied with all the terms of this policy.In the event of the than by specific direction of the PUBLIC ENTITY named in Item 1 of the bankruptcy or insolvency of the INSUREDS,the Company shall not be Declarations; relieved of the payment of such indemnity hereunder as would have been payable but for such bankruptcy or insolvency. 8) For which the INSUREDS are entitled to indemnity and/or payment 2, ASSIGNMENT. Assignment of interest under this policy shall not by reason of having given notice of any circumstances which might give bind the Company until its consent is endorsed hereon. rise to a claim under any policy or policies the term of which has expired prior to the inception date of this policy; 3.CANCELLATION.This policy may be cancelled by the INSUREDS at any time by written notice or by surrender of this policy.This policy may 9) Based upon or arising out of any INSUREDS activities in a fiduciary also be cancelled by or on behalf of the Company by delivery to the capacity with respect to any employee benefit plan or any self- INSUREDS or by mailing to the INSUREDS by registered,certified or insurance fund; other first class mail,at the INSUREDS address shown in this policy, written notice stating when,not less than sixty(60)days thereafter,the 10) For claims, demands or actions seeking relief or redress in any cancellation shall become effective.The mailing of such notice aforesaid form other than money damages,nor for any fees,c(,sts or expenses shall be sufficient proof of notice and this policy shall terminate at the which the INSURED may become obligated to pay as the result of an date and hour specified in such notice. adverse judgement for declaratory relief or injunctive rolief; however, If this policy shall be cancelled by the INSUREDS,the Company shall the Company will afford defense to the INSURED for such actions, retain the customary short rate proportion of the premium hereon. claims,suits or demands where compensatory damages are requested Payment or tender of any unearned premium by the Company shall not (other suits arising out of detention facilities regularly used to detain be a condition precedent to the effectiveness of cancellation but such individuals for periods exceeding 72 hours)if not otherwise excluded; payment shall be made as soon as practicable.If the period of limitation 11) For any damages arising from inverse condemnation, adverse relating to the giving of notice is prohibited or made void by any law possession or dedication by adverse use; controlling the construction thereof such period shall be deemed to be amended so as to be equal to the minimum period of limitation by such 12) Arising from the willful and wanton violation of any statute, law' ordinance or regulation committed by or with the knowledge or consent 4. CHANGES. Notice to any agent or knowledge possessed by any of any INSURED;however,the Company will provide a defense to the agent or by any other person shall not effect a waiver or a change in any INSUREDS for lawsuits containing those allegations. part of this policy or stop the Company from asserting any right under DEFINITIONS the terms of this policy, nor shall the terms of this policy be waived or changed,except by endorsement issued to form a part of this policy. Whenever used in this policy,the following words have these meanings: 5.CONFLICTING STATUTES.Terms of this policy which are in conflict INSURED-means: with the statutes of those states wherein certain provisions and 1) The PUBLIC ENTITY named in Item 1 of the Declarations; coverages of this policy are not permitted are hereby amended to cover only those provisions and coverages as apply and conform to such 2) All persons who were, now are or shall be lawfully elected or statutes. lawfully appointed officials and members of the PUBLIC ENTITY; 6.PUBLIC ENTITY AUTHORIZATION CLAUSE.By acceptance of this 3) Members of commissions,boards or other units operating by and policy,the PUBLIC ENTITY named in Item 1 of the Declarations agrees under the jurisdiction of such PUBLIC ENTITY and within apportion- to act on behalf of all INSUREDS with respect to the giving and ment of the total operating budget indicated in the application form, receiving of notice of claim or cancellation,the payment of premiums, provided that the insurance afforded shall not extend to any of the that may become due under this policy and the INSUREDS agree that following boards,commissions or units unless specifically endorsed the PUBLIC ENTITY shall act on their behalf. hereon: Schools, airports, transit authorities, hospitals, municipally 7. SUBROGATION CLAUSE. In the event of any payment under this owned gas or electric companies or housing authorities; policy,the Company shall be subrogated to the extent of such payment 4) All employees and all persons who perform a service on a volunteer to all rights of recovery therefore,and the INSUREDS shall execute all basis for the PUBLIC ENTITY and under its direction and control and papers required and shall do everything that may be necessary to PO-J-1 (1-83)Page 2 of 3 secure and preserve such rights including the execution of such (3) the BODILY INJURY or PROPERTY DAMAGE arises out of fhe documents necessary to enable the Company effectively to bring suit in furnishing by an INSURED of services, materials, parts or the name of the INSUREDS. equipment in connection with the planning,construction,mainte- 8.SEVERABILITY CLAUSE.It is agreed that the written proposal,copy nance,operation or use of any NUCLEAR FACILITY,but if such facility is located within the United States of America, its of which is attached hereto,and the Declarations are the basis of this policy and areto be considered as incorporated in and constituting part territories possessions or Canada,this exclusion (3) applies of the policy.As respect: the particulars and statements contained in only PROPERTY DAMAGE to such NUCLEAR FACILITY and the written proposal and the Exclusions set forth herein,this policy shall any property threat. be construed as a separate agreement with each INSURED.Nothing in 11. As used in this endorsement: this paragraph shall be construed to increase the Company's maximum "HAZARDOUS PROPERTIES" include radioactive, toxic or explo- liability as set forth in Item 3 of the Declarations. sive properties; NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT "NUCLEAR MATERIAL"means SOURCE MATERIAL,SPECIALNU- (Broad Form) CLEAR MATERIAL or BY-PRODUCT MATERIAL; This endorsement modifies the provisions of this policy relating to ALL "SOURCE MATERIAL", "SPECIAL NUCLEAR MATERIAL", and AUTOMOBILE LIABILITY, GENERAL LIABILITY AND MEDICAL "BY-PRODUCT MATERIAL" have the meanings given them in the PAYMENTS INSURANCE OTHER THAN FAMILY AUTOMOBILE, Atomic Energy Act of 1954 or in any law amendatory thereof; SPECIAL PACKAGE AUTOMOBILE,COMPREHENSIVE PERSONAL "SPENT FUEL"means any fuel element or fuel component,solid or AND FARMER'S COMPREHENSIVE PERSONAL INSURANCE. liquid,which has been used or exposed to radiation in a NUCLEAR It is agreed that: REACTOR; 1. This policy does not apply: "WASTE" means any waste material (a) containing by-product A. Under any Liability Coverage, to BODILY INJURY or PROPERTY material otherthan the tailings orwastes produced by the extraction DAMAGE or concetration of uranium or thorium from any ore processed primarily for its SOURCE MATERIAL content,and(b)resulting form (1) with respect to which an INSURED under this policy is also an the operation by any person or organization of any NUCLEAR insured under a nuclear energy liability policy issued by Nuclear FACILITY included under the first two paragraphs of the definition Energy Liability Insurance Association, Mutual Atomic Energy of NUCLEAR FACILITY; Liability Underwriters or Nuclear Insurance Association of Cana- da or would be an insured under any such policy but for its "NUCLEAR FACILITY"means termination upon exhaustion of its limit of liability;or (a) any NUCLEAR REACTOR, (2) resulting from the HAZARDOUS PROPERTIES of NUCLEAR MATERIAL and with respect to which(a)any person or organiza- (b) any equipment or device designed or used fo, (1)separating the tion is required to maintain financial protection pursuant to the isotopes of uranium or plutonium, (2) processing or utilizing Atomic Energy Act of 1954, or any law amendatory thereof,of SPENT FUEL,or(3)handling,processing or packaging WASTE, (b)the INSURED is,or had this policy not been issued would be, (c) any equipment or device used for the processing,fabricating or entitled to indemnity from the United States of America,or any alloying of SPECIAL NUCLEAR MATERIAL if at any time the agency thereof,under any agreement entered into by the United total amount of such material in the custody of the INSURED at States of America, or any agency thereof, with any person or the premises where such equipment or device is located consists organization. of or contains more than 25 grams of plutonium or uranium 233 or B. Under any Medical Payments Coverage,or under any Supplemen- any combination thereof,ormorethan 250 grams of uranium 235, tary Payments provision Telating to first aid, to expenses incurred (d) any structure, basin,excavation, premises or place prepared or with respect to BODILY INJURY resulting from the HAZARDOUS PROPERTIES of NUCLEAR MATERIAL and arising out of the used for the storage or disposal of WASTE, operation of a NUCLEAR FACILITY by any person or organization. and includes the site on which any of the foregoing is located, all C. Under any Liability Coverage, to BODILY INJURY or PROPERTY operations conducted on"-h site and all premises used for such DAMAGE resulting from the HAZARDOUS PROPERTIES of NU- operations; CLEAR MATERIAL,if (1) the NUCLEAR MATERIAL (a) is at any NUCLEAR FACILITY "NUCLEAR REACTOR" means any appartus designed or used to owned by,oroperated by or on behalf of,an INSURED or(b)has sustain nuclear fission in a self-supporting chain reaction or to been discharged or dispersed therefrom; contain a critical mass of fissionable material; (2) the NUCLEAR MATERIAL is contained in SPENT FUEL or WASTE at anytime!possessed,handled,used,processed,stored "PROPERTY DAMAGE"includes all forms of radioactive contamina- transported,or disposed of by or on behalf of an INSURED;or tion of property. IN WITNESS WHEREOF,the Company has caused this policy to be executed and attested,but this policy shall not be valid unless countersigned by a duly authorized representative of the Company. ->w ,its a Secretary President PO-J-1 (1-83)Page 3 of 3 I PUBLIC EMPLOYEES BLANKET BOND Contihrnted Insures ( nce Revised to May, 1958 I Company organized 1853 80 MAIDEN LANE, NEW YORK, N.Y. 10038 F BND 22529 95 DECLARATIONS BOND No. fi BOND 4685 rrYPrinted in U.S.A. Item Name of Obligee: r (A Stock Company, herein called the Surety) 3 Item Name of Insured: 2. Town of Southho'l$, New York a The Continental 4u uwwe Companies Item Bond Period: from the beginning of 12:01 AM January 1, 1985 until January 1, 1988 3• (MONTH. DAY. YEAR) to 12 o'clock night on the effective date of the cancelation or termination of this Bond as an entirety. Item Table of Limits of Liability: 4• Insuring Agreement 1 Honesty Blanket Bond Coverage $ nil Insuring Agreement 2 Honesty Blanket Position Bond Coverage $ nil Insuring Agreement 3 Faithful Performance Blanket Bond Coverage $ nil Insuring Agreement 4 Faithful Performance Blanket Position Bond Coverage $ 25,000. Item The liability of the Surety is subject to the terms of the following riders attached hereto: S. SR 5938, SR 5661. Item The Obligee and the Insured by the acceptance of this Bond give notice to Surety terminating 6• or canceling prior bond(s) No.(s) such termination or cancelation to be effective as of the time this Bond becomes effective. Y 1 STYPE &.SONS, INC. = MAIN ROAD 1VIATTITUCK, N. Y 11962 HONEc 516.- 298-84� `- Secretary --_ =- Executive Vice President Branch New York 11 Office W Countersigned this 23rd-day of January, 1985 Generalo Agent Stype & Sons O 81 453 060 U Th:�o Continen Insura Company Agent or P.O. Box 63 Broker 1 Ma i t u k, New York 1-19-52 By Ss 5655 Address as Buckley, Atto ey Printed in U.S.A. The Surety, in consideration of the payment of the premium, and subject to the Declarations made a part hereof, the General Agreement, Conditions and Limitations and other terms of this Bond, agrees, in accordance with such of the Insuring Agreements hereof as are specifically designated by the insertion of an amount of indemnity in the Table of Limits of Liability, to indemnify the Obligee for the use and benefit of the Insured for: INSURING AGREEMENTS Honesty Blanket Bond Coverage 1. Loss sustained by the Insured through any fraudulent or dishonest act or acts committed by any of the Employees, acting alone or in collusion with others, during the Bond Period, to an amount not exceeding in the aggregate the amount stated in the Table of Limits of Liability applicable to this Insuring Agreement 1. Honesty Blanket Position Bond Coverage 2. Loss sustained by the Insured through any fraudulent or dishonest act or acts committed by any of the Employees acting alone or in collusion with others, during the Bond Period, the amount of indemnity on each of such Employees being the amount stated in the Table of Limits of Liability applicable to this Insuring Agreement 2. Faithful Performance Blanket Bond Coverage 3. Loss caused to the Insured through the failure of any of the Employees, acting alone or in collusion with others, to perform faithfully his duties or to account properly for all monies and property received by virtue of his position or employment during the Bond Period to an amount not exceeding in the aggregate the amount stated in the Table of Limits of Liability applicable to this Insuring Agreement 3. Faithful Performance Blanket Position Bond Coverage 4. Loss caused to the Insured through the failure of any of the Employees, acting alone or in collusion with others, to perform faithfully his duties or to account properly for all monies and property received\by virtue of his position or employment during the Bond Period, the amount of indemnity on each of such Employees being the amount stated in the Table of Limits of Liability applicable to this Insuring Agreement 4. GENERAL AGREEMENT Loss Under Prior Bond If the coverage of an Insuring Agreement of this Bond is substituted for any prior bond carried by the Insured or by any pred- ecessor in interest of the Insured which prior bond is terminated, canceled or allowed to expire as of the time of such substitution, the Surety agrees that such Insuring Agreement applies to loss sustained by, or caused to, the Insured, as the case may be, prior to or during the Bond Period, provided that such loss is discovered after the beginning of the Bond Period and prior to the expiration of three years from the cancelation of this Bond as an entirety and that such loss would have been recoverable by the Insured or such predecessor under such prior bond except for the fact that the time within which to bring suit, action or proceeding of any kind thereunder had expired, and provided further: (1) the indemnity afforded by this General Agreement shall be a part of and not in addition to the amount of coverage afforded by the applicable Insuring Agreement of this Bond; and (2) such loss would have been covered under such Insuring Agreement had such Insuring Agreement with its agreements, con- ditions and limitations as of the time of such substitution been in force when the acts or defaults causing such loss were committed; and (3) recovery under such Insuring Agreement on account of such loss shall in no event exceed the amount which would have been recoverable under such Insuring Agreement in the amount for which it is written as of the time of such substitution, had such Insuring Agreement been in force when such acts or defaults were committed, or the amount which would have been recoverable under such prior bond had such prior bond continued in force until the discovery of such loss if the latter amount be smaller. THE FOREGOING INSURING AGREEMENTS AND GENERAL AGREEMENT ARE SUBJECT TO THE FOLLOWING CONDITIONS AND LIMITATIONS: DEFINITIONS causing such loss, the Insured shall nevertheless have the Section 1. The following terms, as used in this Bond, shall benefit of such Insuring Agreement provided that the evidence have the respective meanings stated in this Section: submitted reasonably establishes that the loss was in fact "Employee" as used in Insuring Agreements 1 and 2 caused by such Employee through such acts or defaults and means a person while in the employ of the Insured during provided, further, that regardless of the number of such Em- the Bond Period who is not required by law to give bond ployees concerned or implicated in such loss, the aggregate conditioned for the faithful performance of his duties and liability of the Surety for any such less shall not exceed the who is a member of the staff or personnel of the Insured amount stated in Item 4 of the Declarations applicable to such but does not mean any Treasurer or Tax Collector by what- Insuring Agreement. ever title known. EXCLUSION "Employee" as used in Insuring Agreements 3 and 4 Section 3. This Bond does not cover any loss sustained by, means a person while in the employ of the Insured during or caused to; the Insured under circumstances whereby and to the Bond Period who is not required by law to furnish the amount which the Obligee or the Insured voluntarily under- an Individual Bond to qualify for office and who is a member takes or is obligated by law to exonerate or indemnify any of of the staff or personnel of the Insured but does not mean the Employees against liability incurred by them in the perform- any Treasurer or Tax Collector by whatever title known. ante of their duties. UNIDENTIFIABLE EMPLOYEE LIMITS OF LIABILITY Section 2. In case a loss is alleged to have been caused Section 4. Indemnification by the Surety for any loss under to the Insured through acts or defaults by an Employee cov- Insuring Agreement 1 or 3 shall not reduce the Surety's liability ered under an applicable Insuring Agreement of this Bond, for other losses under the applicable Insuring Agreement, while such Insuring Agreement is in full force and effect and whenever sustained; provided, however, that the Surety's total the Insured shall be unable to designate the specific Employee liability under each su6lnsuring Agreement for-any loss caused RIDER To be attached to and form part of Bond No. BND 225 29 95 Obligee . Town of Southhold f Insured Town of Southhold It is agreed that: 1. The attached bond is amended by deleting the first two paragraphs under Section 1 and by substituting in lieu thereof the following: DEFINITION Section 1. "Employee" as used in Insuring Agreements 1, 21, 3, and 4 means a person while in the employ of the Insured during the Bond Period who is a member of the staff or personnel of the Insured. 2. This rider is effective as of 12:01 A.M. on the 1st. day of • January, 1985 NEW YORK RIDER FOR M WITH PUBLIC EhTLOYEES OR PUBLIC SCHOOL SYS`TM El-ML0YEES BLANKCT BOND, WHEN ISSUED IN THE STA`T`E OF NEW YORK - DELETES EXCLUSION OF TREASURERS OR TAX COLLECTORS BY MIA=,R TITLE YT011-7I1 OR ANY OFFICER, CLERK OR EISPLOYEE REQUIRED BY LAW TO EY.ECUTE OR FILE AN 101VIDUAL OFFICIAL UIiDERMI IIG. SR 5938 • RIDER 1 To be attached to and form part of Bond No. BND 225 29 95 Obligee Town of Southhold Insured Town of Southhold It is agreed that: 1. Additional indemnity, in accordance with the terms of such of the Insuring Agreements in force under the attached bond as are specifically designated opposite the following positions, respectively, is granted by this rider on Employees performing the duties of such positions, to the amount set opposite the names of such positions, respectively. 2. The liability of the Surety under this rider on account of any one Employee in any one or more of such positions (in the original or an increased or decreased amount) shall not exceed the largest single amount of indemnity on any one position occupied by such Employee. 3. No losses shall be recoverable under this rider unless caused by an Employee who has been iden- tified as having caused such loss, anything to the contrary in said bond or this rider notwithstanding. Total Number Amount of Position Location Insuring of Employees Additional Agreement in each Indemnity on Position each Employee Supervisor Town of Southhold IV 1 190,000. Deputy Supervisor Town of Southhold IV 1 i 190,000. Tax Receiver Town of Southhold IV 1 75,000. i Town Clerk Town of Southhold IV 1 50,000. I I � I I I 4. This rider is effective as of 12:01 A.M. on the 1st. of January, 1985. ADDITIONAL INDEMNITY RIDER FOR USE WITH PUBLIC EMPLOYEES BLANKET BOND AND PUBLIC SCHOOL SYSTEM EMPLOYEES BLANKET BOND, TO PROVIDE ADDITIONAL INDEMNITY COVERAGE. REVISED TO MAY, 1958. SR 5661 Printed in U.S.A. 2'. PUBLIC EMPLOYEES BLANKET BOND a ®c1c The Continental Insurance Companies GENERAL OFFICES 80 Maiden Lane, New York, New York 10038 DEPARTMENTAL OFFICES Buckeye Department . . . . . . . . . . . 1 111 East Broad Street, Columbus, Ohio 43216 Eastern Department . • • • . 80 Maiden Lane, New York, New York 10038 a Foreign Department 80 Maiden Lane, New York, New York 10038 { s Northeastern Department . . . . . . . . . . 291 Glen Street, Glens Falls, New York 12801 i Pacific Department . . . . . . . . . . . . 160 Pine Street, San Francisco, California 94111 Southeastern Department . . . . . . . . . 161 Peachtree Street, N.E., Atlanta, Georgia 30303 Southwestern Department . . . . . . . . . . 1 810 Commerce Street, Dallas, Texas 75201 Western Department . . . . • . . . . . . 360 West Jackson Boulevard, Chicago, Illinois 60606 Branch and Field Offices in all Principal Cities by any Employee or in which such Employee is concerned or (a) Immediately upon discovery by the Obligee or the Insured implicated is limited to the applicable amount of indemnity of any act on the part of such Employee which would specified in the Table of Limits of Liability. constitute a liability of the Surety under the applicable Insuring Agreement covering such Employee; Indemnification by the Surety for any loss under Insuring (b) Upon the death, resignation or removal of such Em- Agreement 2 or 4 shall not reduce the Surety's liability for ployee; or other losses under the applicable Insuring Agreement, when- ever sustained; provided, however, the Surety's total liability (c) At 12 o'clock night upon the effective date specified under each such Insuring Agreement as to each Employee is in a written notice mailed to the Obligee and the In- limited to the applicable amount of indemnity specified in the sured. Such date shall be not less than thirty-days after Table of Limits of Liability. the date of mailing. The mailing by the Surety of Regardless of the number of notice as aforesaid to the Obligee and the Insured shall g years this Bond shall continue be sufficient proof of notice. Delivery of such written in force and the number of premiums which shall be payable notice by the Surety shall be equivalent to mailing. or paid, the limit of the Surety's liability as specified in the This Bond may be canceled by the Obligee or the Insured by Table of Limits of Liability shall not be cumulative from year mailing to the Surety written notice stating when thereafter the to year or period to period. cancelation shall be effective. This Bond may be canceled by the Surety by mailing to the Obligee and the Insured written LIMIT OF LIABILITY UNDER THIS BOND notice stating when, not less than thirty days thereafter, such AND ANY PRIOR BOND cancelation shall be effective. The mailing of notice as afore- Section 5.. With respect to loss under Insuring Agreement said shall be sufficent proof of notice. Delivery of such written 1 or 3 caused by any Employee or in which such Employee is notice either by the Obligee or the Insured or by the Surety concerned or implicated or which is chargeable to such Em- shall be equivalent to mailing. If the Obligee or the Insured ployee as provided in Section 2 of this Bond and with respect cancels, earned premium shall be computed in accordance with to loss under Insuring Agreement 2 or 4 caused by any Em- the customary short rate table and procedure. If the Surety ployee or which is chargeable to such Employee at provided in cancels, earned premium shall be computed pro rata. Premium Section 2 of this Bond and with respect to loss under any adjustments may be made at the time cancelation is effective Insuring Agreement which occurs partly during the Bond Period or as soon as practicable aftei cancelation becomes effective, and partly during the period of other bonds issued by the Surety but payment or tender of unearned premium is not a condition to the Insured or to any predecessor in interest of the Insured of cancelation. and terminated or canceled or allowed to expire and in which the If any of the cancelation provisions set forth in either or period specified therein for bringing suit, action or proceeding both of the foregoing paragraphs of this Section are prohibited of any kind, or if no such period is specified therein, then within or made void by any law controlling the construction cf this the period prescribed by the applicable statute of limitations, has Bond, such provisions to the extent they are so prohibited not expired at the time such loss thereunder is discovered, or made void shall be deemed to be nullified and of no effect. the total liability of the Surety under this Bond and under such other bonds shall not exceed, in the aggregate, the amount LEGAL PROCEEDINGS carried under the applicable Insuring Agreement of this Bond Section 7. No suit, action or proceeding of any kind to on such loss or the amount available to the Insured under such recover on account of loss under this Bond shall be brought other bonds, as limited by the terms and conditions thereof, after the expiration of three years from the cancelation of this for any such loss if the latter amount be larger. Bond as an entirety provided, however, that if such limitation CANCELATION for bringing suit, action or proceeding is prohibited or made void by any law controlling the construction of this Bond, such Section 6. This Bond shall be deemed canceled as to any limitation shall be deemed to be ,amended so as to be equal Employee: to the minimum period of the limitation permitted by such law. In witness whereof, the Surety has caused this Bond to be executed on the Declarations page. .Insurance s W Z 1 06 October 21, 1986 TOWN OF SO OLD Town of Southold Main Road Southold, NY 11971 Attention: Town Board Dear Town Board Members: In response to your request during the Town Board meeting on October 6, 1986. 1) The Loss History for the Public Officials, Police Professional, Business Automobile and Package policies are attached. 2) The Business Auto and Package policy premiums for the term January 1, 1987 to January 1, 1988 could be increase 250. The Public Officials and Police Professional premiums for the renewal term can not be determined as this time. We will advise the Town Board as soon as the renewal premiums become known to us. Very truly yours, aA/u,Valentine W. Stype, Jr. President VWS/jm 4OVE5570^,' W 6E� Main Road Mattituck, N.Y. 11952 z r� '^�•h^ TELEPHONE:(516)298-8481 N = t9' GRANCE AG6 .ax• ,J.a. _ .a. � -aw y�'t:--' '� � - $+tib, =`�.t-e'S'1? .� #- •yYi�7"`, < .�-.Y�'+..7ef•4'S' - ��+ � r r. �.a _ _ �,;p •� .sy''�1��t"� rc.�i1.ee f, �. ..� S e gr $i'4,-{F s nr+}�7 ..jl{?,,t`� +e,�T� _ - � � '��+•3`,,.�''(�'°'rcT �•.M<..,.�� �, t'►r"S'�-'d"L L}''�.1. ."'L•_!'"'� .•P.'�,e'�'`xil�� w -.,4K Y. ; a, ....z a. -'� _ a:. "• "'t�, s- 4 rP YZt ,..♦ - 2 ::-9• irt. ty�.fit t�""' / ,.y�`�"� �' :F -fa•�. �Cy,: i �.•t res, �a�: -. v�I A ' "�'�e -r-13. � x+�'f•�`)`�'��� ..r.1��� '���+.4„tSti ..,_ !�a"..1+y. ,. � � �-•� � r - r -- mat- "`' - „ Tn - ''r r'^,S- ;.v..'�+r; •4-. ..-< - . s'n `U" -, -?ses'._.•,f.�_ .a,- •;"�7+' `w. - POLICY TO CLAIMS INi?LlIRYl-- PwK46 FQSE ENTER THDLDTOWN OF, t� ;rrY NUPi :F-R F'UC'5c-?SC13 INIRET.' SUU , " *-, ISS i nTE SeATUS Ari TC TAA PAID T 0 T A RF-SE.P.�°F5 _k)c IJ001 5 43 02/21/86 CLOSED 008 V--tCo!-a O h ot)00i-3tr2184 ;bac tcc-O" �►� 0025475. 12/14/65 -` 'r:-lT'.�t`D 018 }—C C0 On .$)Uto028336 07/3L!56_. +l-CSED 01 c^ X00002$565 -." � 08/04/86 LDy�13 Ual }-� t� all s � .,�.i - :�y~ J�' N+ �'.: +L�:�. ..4._' ... - �.r .t-,- . .art.Jr+ar�. M•.d+P'..^k...^?R"�N+Y»l,r:......«....:a- ..._� _ r - -'F1 NISC PF'2 BILLING PF3 _ ENDORSEMENTS PF4 NAMESADDRESSES -'F5 ,ITEM PFS -DRIVERS PFT LOSSES PFIS EXIT 'F9 NEXT 15 LOSSES PFIO PREM- SIDE LOSSES 15-IN NO MORE CLAIMS FOR THIS POLICY VSTE:Se9aion •ctiv� wk 15191 299.0461 VAL STYPE & SONS. INC. 'y `� 111SURANCE � CONSULTANTS ' y-. -f -�:` f •:t v :; r F r Ar MAIN ROAD .y�M MATTITUCK.N.Y.11952 VAL W.STYPE JR. t ♦ r'':+( �`�.1':'t.a �..st � Val.'�'�`�,',���.51 W'yUktS iS,+ • .'��j.�'T ��.''`SgA �- r- 117. � . POLICY TO CLAIMS INQUIRY PWK48 /LEASE ENTER 'OLICY NUMBER PLO600275 INSURED SOUTHOLD, TOWN OF P. D. CLAIM NUMBER LOSS DATE STATUS ADJD TOTAL RESERVES 0000025424 05/30/86 CLOSED 0184��o�.Ezo"~ :j7-C) Cl 0000026234 03/24/86 CLOSED 031 4-k 0000031083 06/01/86 CLOSED 018 1�e c8 \ �A ��*` -J y~(�~�»~ «/ ^-.� �--.--�/ ����v�� o�^�� / � -T PF1 MISC PF2 BILLING PF3 ENDORSEMENTS PF4 NAMES & ADDRESSES PF5 ITEM PF6 DRIVERS PF7 LOSSES PF16 EXIT PF9 NEXT 15 LOSSES PF10 PREM SIDE LOSSES }15-IN NO MORE CLAIMS FOR THIS POLICY VSTE:Session active "UL1LY EXPERIENCF REPORT DATE 06/20/86 1 PAGE 2 REQUES-fOR-GINA S P° -R5C po\2CAJ POLICY NUMBER 002394469 POLICY YEAR 1985 INSURED SOUTHOLD9TOWN CONSOLIDATED AGT. 015115 j, -- FF F -DAT f3A -i2Wt - --$iIANC# ----- --- -- ---- - --- - 1 NEW 01-01-85 01-01-86 06-01-86 06-02-86 5931 NOT IN USE KA 15115 STYPE & SONS 1 73 MELVILLE PRNT 91 LMT PO LMT AUDIT EST-RPM M W/C G/L A/L APO I/4 'PRP FIRP OTH MD C W/C G/L A/L APD I/M PRP BUR OTH ---- - --- - A iqt�•---- - f?5$0-- ---- 0549 -IF"At a PREMIUM AND LOSS SUMMARY #4**** �__ - _ � E _-it> �E�f�►RE�1 T—_.-AtisJ-PtE►M Sgf EA�?9�t-- _ RFT - 32 * 51 .260 4. 824- 46,436 O 344 1 .803 134,644 13tS9791 294.6 33 # 279179 2.460 299639 0 39993 93 4,086 13.8 —0- 53 0 53 A 4,501 49501 0 62 A 7,834 7s 8 34 0 GRAND T 90,892 29364 889528 0 49337 1 ,896 134,644 140987E 159al .— __-.__.—,_------------- -_ _—__--- ------___ ..�.�...+....� �, •f-#-BET-AI-L�*�-_ _- ------- ___ - - __ _ __ _ _ _ _ _- -------_ __ LOCN PS CLAIM NO ACC-OT CLAIMANT NAME AS ML SL * PAID LOSSES PAID EXP RESERVES TOTAL INC i 8888 97 31-259127-00 010285 KREIGER WELL PUMP85 31 33 35 1 1 .012.00 1,012.00 ,�'T�46Eg2-GATE VALyf=s ----- _._-------_ ___ f 888$3 97 31-?49558-00 011535 COCKERHILL EDYTHE81 31 32 31 1 55.00 55.00 CLMT TRIPPED*FELL OVER SLAB OF CEMENT 788_35 ---1 v nnn 22'w7$f3r3`s- - - -- ---- - CLMT ALLEGES INJURY DUE TO NEGLIGENCE OF INSD 8889 97 31-251991-00 020385 DIACHUN RONALD 81 31 32 31 1 CWP ARREST*MALICIOUSSECUTION*ASSAWLY 88133 97 31-250005-00 020685 BORRILL DAVID 85 31 33 35 1 19128.02 19128.02 8888 97 31-2.50005-00 020685 9ORRILL DAVID 85 31 33 35 1 1 .534.38 53.00 1 .587.38 _ E,DW4.R-O- A N IN S n VE H CLEARING SO4OW G r n-cs-vc -moi- --� �__- H - 3 8881 97 31-250927-00 031385 GORIER VIRGINIA 81 31 32 31 1 CWP CLMT TRIPPED*FELL ON SIDEWALK — __ — -----$99fl--��-3! P_5P244 00 0444Pr -zi GVD-M#RTE-- A!}-31-33-35--4 45*911- --- - ------- 95.Oa- CLMT TRIPPED OVER RAISED SIDEWALK FELL*SUSTAINED INJURY 8899 97 31-253982-00 051185 BAINPRIDGE KEITH 81 31 32 31 1 9.00 162 171 .00 T--ALL EGES INJURY A-GE --E-OF l N S^ - ---- ---- -- ---- - - - - 8889 97 31-253163-00 061685 KOSSMANN PATRICIA8S 31 33 35 1 3.50 3.50 8888 97 31-253162-00 061685 KOSSMANN PATRICIA85 31 33 35 1 36.75 36.75 3-9$-$tsl - -223.921- ---- IV STUCK IN FLOOD AREA 8888 97 31-254499-00 070485 SOYLE ROBERT 81 31 32 31 1 75.489 75.489.00 �ftE-RO BERT 8i-3 i -32--3zi 26v-205 25v205e - 8888 97 31-254499-02 070485 BOYLE RICHARD 81 31 32 31 1 25,205 259205.00 CLMT HAD AMPUTATION OF PART OF LEG DUE TO B$3ATING ACCID CLMT WALKED INTO CHARCOAL FIRE PIT 8988 97 31-257750-00 092785 ERICSON A C 85 31 33 35 1 CWP HURR EAftf-C--AifSEFO--TOW-N--"EE -W I P FS--TV-O*E-LL-!NG 8888 97 31-258766-00 100185 LEVERETT JACK 81 31 32 31 1 5.50 5,050 59055/650 CLMT DIED AS A RESULT OF CAR ACCIDENT ALLFGES TOWN AT F 32--3I 00 CLMT ALLEGES EGES SHE TRIPPED ON SIDEWALK 8888 97 31-259694-00 120?85 RAYNOR DAVID 85 31 33 35 1 CWP FROM NEW V 1 CNA INSURANCE TIME 23.27.. POLICY EXPERIENCE REPORT DATE 06/20/ PAGE REQUESTOP-GINA S POLICY NUMBER 002394469 POLICY YEAR 1995 INSURED SOUTHOLD9TCWN CONSOLIDATED AGT. 015115 k LOCH PS CLAIM NO ACC-OT CLAIMANT NAME AS ML SL PAID LOSSES PAID EXP RESERVES TOTAL INC 8888 97 31-259127-00 010285 KREIGER WELL PUMP85 31 33 35 1 10012000 1*012000 GATE YALYES 8888 97 _31-p49558-00 011535 COCKEPHILL EDYTHE81 31 32 31 1 155000 55000 CLMT TRIPPED*FELL OVER SLAB OF CEMENT 88890 97 at-P516Ri 00 DEBORAH81 31 32 31 1 88- 35 1,9000 CLMT ALLEGES INJURY DUE TO NEGLIGENCE OF INSD 8889 97 31-251991-00 020385 DIACHUN RONALD 81 31 32 31 1 CWP FALSE-+'RRE-ST*MALlG;()U6 PROSLECUT l0N*"5AUlLT-_ -- 88A8 97 31-250005-00 020685 BORRILL DAVID es 31 33 35 1 14128002 1 *128o02 8889 97 31-250005-00 020685 9nRRILL DAVID 65 31 33 35 1 1 ,534.38 53000 1 ,587*38 EDW-A;?-0,- ANIN-0 "Ell -4 -4-ING SNOW GOLLIDE-0 WITM CLAtT­49H 888%1 97 31-250927-00 031385 GOHIER VIRGINIA 81 31 32 31 1 CWP CLMT TRIPPED*FELL ON SIDEWALK -MAP!E 8 9 95.-" CLMT TRIPPED OVER RAISED SIDEWALK FELL*SUSTAINED INJURY 8898 97 31-253982-00 051185 SAINPRIDGE KEITH 81 31 32 31 1 9000 162 171000 lGENCE OF lN69 8839 97 31-25316.3-00 061685 KOSSMANN PATRICIASS 31 33 35 1 3050 3050 8883 97 31-253163-00 061685 KOSSMANN PATRICTA85 31 33 35 1 36075 36.75 9 M 97 31-29311 3-00-061699 KeSSMANN P T-P+C f A 4 55 31 3-3 3S 1 223 i IV STUCK IN FLOOD AREA 8888 97 31-254499-00 0704893 ROYLE ROBERT 81 31 32 31 t 75.489 759489000 -4 3e 97 i- ei 0-704 5 BOYLE ROBERT 83--31 92 3i 1 2-69906 - 2 5 9 2 0 5 e 00---- 8888 97 31-254499-02 070485 BOYLE RICHARD al 31 32 31 1 25*205 - 259205*00 CLMT HAD AMPUTATION OF PART OF LEG DUE TO 8f)ATING ACCID 31 2543ti 00 071985 FOSTER GH#tRl=ES si ai 32 3i i 2-533 2,633000 CLMT WALKED INTO CHARCOAL FIRE PIT 8988 97 31-257750-00 092785 ERICSON A C 85 31 33 35 1 CWP -- TE TO FALL D*ELL-1 NG 8888 97 31-258766-00 100185 LEVERETT JACK 81 311 32 31 1 - 5050 59050 50055050 CLMT 'DIED AS A RESULT OF CAP ACCIDENT ALLEGES TOWN AT F 80 CLMT ALLEGFS SHE TRYPPED ON SIDEWALK 8888 97 31-259694-00 120?35 RAYNOR DAVID 85 31 33 35 1 CI1P 4 CNA INSURANCE TIME 23o27­ POLICY EXPERIENCE REPORT DATE 06/20/ PAGE REOUESTOP-GINA S POLICY NUMBER 002394469 POLICY YEAR 1995 INSURED SOUTHOLD,TCWN CONSOLIDATED AGT* 015115 Et:Af 04 DETAIL. LOCN PS CLAIM NO ACC-DT CLAIMANT NAME AS ML SL PAID LOSSES PAID EXP RESERVES TOTAL INC E s V-"298-5 134v-b411 -136 v 790 0 m 85 TOTAL ALL 33 LOSSES 39992*61 93025 4*085*86 TOTAL ALL LIAR LOSSES 4*336o61 IV896*10 134.644 1409876*71 CC I ENT CCUNT 8888 97 31-250253-00 020995 SOUTHOLD TOWNSHIP20 31 62 30 1 CWP UP LOS T­CaN - --- ------- TOTAL ALL FIRE LOSSES .00 000 ACCIDENT COUNT I GRAND TOTAL ALL 16 4*336*61 10996* 10 1349644 140*876*71 NA INSURANCEI :. I = �Yo_ PnLTCY FW0FRl=NCr REDIPT DATE 08f21/SS C4%�� PAGE �EOUFSTOR-OlLFK -Di-icy mumqEp 007027571 - POLICY YEAR 1985 TmsuRED SnUTMnLD*T0WN CINSOLIDATED AGT* 015115 p7me n= CT71= nATP PYO JATP FVL. nATI= P(IN DATF 000T ACCOUNT Nn AGENT qQANCH 01-01-0c; 11-01-46 OR-01 -R6 4011 MIT IM 'JSP 019;115%TYD= G SONS 1 730 M-,"-LVtLLE PONT RT LMT Pn LMT AfJr)IT FST-RDA V WIC G/L A/L. ADn T/M PP93 RQP OTH Mr) C 111C G/L A/L RP13 I/" MRP qUQ OTH ANN* 0500 0-,00 FINAL 042908 n97 OIRS 20 MP=MTUM AMn LIC;S SUMMARY LTNF7 Al'c, lFrl/3qFM A U 0 c M STr'l/FAPN PPF 0;:rT AIJ/nYV Pn OATI LnsSFS r'Alr) PFSFPVFS TOTAL INC L/P 19,_045 ?732 0 1910n0 33 19,033 74.3 35 # 1'),9q4 los I I's f)9'9 0 1 ,907 165 1 *972 17*8 AUT? T 309929 397 31. 321 0 159807 1 Qi 179005 54,03 -4 ts A a,--;-,JR 4,559 0 -47 9 ?I C; 8,215 n all 57 495 5.0 '3HY I T 19 773 1 2 97 445 309 Q A N 71 7'1--03,7'1? 3911, 44* 194 0 17, 45 255 l7v500 39o7 CLAIM nETATL rLAIM Nn ACC-11 CLATMA4T NAMIF A-, WL SL * MATrW LMSSFS 0ATr) EXP QFSFpVFS TOTAL INC PIPA9 97 01jjq5 RAp7Ar r.pnpG= 31 35 3? 1 1911>104R 50.00 19371 .49 !'RA TG '-,R(-I--',4T V=H 'qK-T() rOLLTDFO WTrm YNt'll VF4 9Aql 97 141745 KnCH =LT7ARPTH 31 35 33 1 65*00 65900 ASMR Q7 041715 KLIPM JASON 31 34 31 1 CWP RIA4 q? 31-?51501-03 041-15 KOCH ELIZARFTH 71 34 33 1 151000000 32.So 15*032*50 iA,;nN KLVFH ? rpf)ssFr) IN ronNT nF VFm I CAUSTMG CnLLTSY 9qA9 47 11 ;)4-nl 0701 R9 Lcc jnHN 31 39 37 1 50000 114*954 rHT=STPP ',-NTNSI VPH, RACKING UP STPUCK r-LM-r Vc7H 8RQ9 97 31-l'9P141-nn 17'>3R5 PLASKV L 31 1 1 ")1?0*63 220.63 CLMT ALLFGFS QnCK 'PlrLL OF= TMST,) VFH RQOK17 WINDSHIFLO TITAL ALL 14 L.nss,=-s 15*000000 32.50 15,032950 T r%TAL ALL 35 L,ry S s;=1; 1 ,R06,69A-15 0 19971069 T"TAL ALL AUT7 L ISS7S 16*816069 197.5n 170004*19 ACCTIFNT CnONT 4 8944 07 11-151901-00 041745 sniJTMILD TOWN IF "'tl 37 33 1 418*45 56.x+0 494.95 JA"N KSVFH P CqnSSFO IN FONT nF VEM I CAUSING cnLLYSt TITAL ALL 16 LISS F S .no *00 TOTAL ALL 17 Lf)SSI=S 438*45 56.50 494095 TnTAL ALL P4Y n LOSSES 4140495 56.50 494095 ACCTjF=MT CnUNr I GRAMn TOTAL ALL CS 179245414 25+1. 00 179499014 4 i I 3 P[1LTrY 4'1M91=R O{�?077si73 OnL•ICY YEAR 1985 iNS�)RFr� SOUTHOLD,TOWN CONSOLttfA*E[) AGTe 0151145 _ I� QFN. n= FFF DATE FXQ GATE FVL nATF RUN DATE PRPT ACCnUNT NO AGENT BRANCH w ?07757' 01-n t-R6 n 1-nT'q� nA-01 -q6 07-a7_gF 4011 40T TN USF AA O1S11SSTYPF E SONS 1 730 MFLVTLLF '�� PR*!T MY LMT On LMT AUnI T EST-RPM M W/C G1L A/L APD I/M PRP IRO OTN NO C WIC GA- A/L ADD I/M PRP BUR OT" i ANN• 0500 056740 093 059 70 flRFM i M --- • [ 1 AN7 LtiSS SUMM44Y LINT A/S nFr3/:)RrM Alin n9FM STD/r-APN PQ- ca PT AnJ/DTV nl DAYn LOSSFS DAII RESERVE'S TnTAL INC t/R ---- ------- --? - A �n•7 71> 179717 p 35 A 1 �5,6s7 9.710 O 1 .770 [93 199453 -- 20.2 i -- --- ! AUTn T 47,019 ?7, 4107 n 1 .770 143 1.963 7.2 3fi A 6, n45 3,,106 O 691 691 1 9e5 37 A 1'�• iA6 5,94?_ _. "3Hv 7 T 1 f+. 231 9,468 621 i 671 1 1.5 1031? 19312 13.9 I _ GRAM TO 63927•,!► 36,$395 0 3•18? 39275 8.9 nr� -LA1M DETATL �_tzN S CLAIM NP ACC-IT CLAIMANT NAME' AS ML SL * PAID LOSSFS PAID EXP RESERVES TOTAL INC �3P8q 97 �sl_7Fq(11�-orJ 01 OR96 GnLnSNT TH 3l 35 33 1 9<D1.73 60.50 _ 1 •A5Ze23 � ANn?FW C TNSI VFH COLLYIED WTTH CLMT VPH MDS_H_`RS SfnTT _101 105 33 1 29?047 f%9000 360.40 7IGM1141D HFINSn SNnWoLnW STRUCK t'ARKFD CLMT VEH --- 3gRR 97 31-?.5+?09q-00 02?c;g6 TUTHILL JFFFREY 31 35 '13 1 -- ---- - oAUL Fnr- MT STCMJCK i'VSn yFH 64.50 64.50 RgRl 97 31- - 62S41-n0 Of• l O q6 WINTER HAQar1R F[SHP 11 35 :'i 1 243.54 i. J F!HCLMT VPH w TNICHT'ELI nAM AGICn 9Y POCK FALL 1NG OFF [N5 24 3.54 TnTAL ALL 34. LISSFS .00 0 00 TOTAL ALL 35 LISSFS 1 .527.67 193.00 1.720.67 TOTAL ALL AUTO! Lnss=s r) NT nI 1.527.b7 193.00 19720.67 _----�A�C C JNT ,` I 98Rq Q7 00--105777-a7 032486 TNSn 11 37 30 1 97.50 RR.19 97 87.50 00--?,?77-fiR 13248!5 INS1� _31 37 in 1 34ri.ISN 9345.$14 flL TCF IN pURSlJYT cTR+Jr.•K INTFNTIONALLY Pv OTHER VFH - i 3881 97 00--25777-73 04?1 X36 SnUTHDLD TOWN 011- 1#7 31 37 33 l 197.43 Ist7.43 IV 41T nV Rg4q 07 1410946 SOUTHQLn TOWN pOL TC 31 35 33 1 590.79 690.79 TV HIT nFFP TITAL ALL 3fi LCSSFS 540.79 ,OA TOTAL ALL 37 LOSSFS 6Q0.7Q fit 6.T8 .00 6 TnTAL ALL PHY '7 LDSSFS ?6.781 .311 .57 .00 ACCTnFNT COUNT 3 1.311.57 97 00--25277-59 n221 RF MATTT T(.)CK GLASS m 31 3c; 33 i ?41 .9q STONF RnnKc WTNn*)W 241 .98 TnTAL ALL 34 LnSS=S TOTAL ALL 35 LnSSFS 241.89 .00 241 *apt TnTAL ALL AUTn LISSFS 241.99 .00 241.93 ACCI7FNT COUNT ' t P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $ 5000 Carrier: Policy Period: Premium Payment Plan: Comments : B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Policy Period: Premium Payment Plan: Comments : C. Comprehensive General Liability a. First dollar coverage: b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: � r t C. Comprehensive General Liability Rating basis : Carrier: Premium Payment Plan: Comments: D. Automobile Insurance Limits - Rate per vehicle: Carrier: Policy Period: Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 Carrier: Policy Period: Premium Payment Plan: Comments : F. Umbrella Liability First $ 5,000,000: Next $ 5,000,000: Rating Basis: Carrier: � c F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage - Deductible $ 500 Premium: Carrier: Policy Period: Comments: H. Public Employee Blanket Bond Premium: Carrier: Policy Period: Comments: r PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible: Name of Agent/Broker Street or P.O. Box City, State, and Zip Name of Person Completing Quotation Signature Title i Date: � r P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $ 5000 _ Carrier: Policy Period: Premium Payment Plan: Comments : B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Policy Period: Premium Payment Plan: Comments : C. Comprehensive General Liability a. First dollar coverage: b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: l C. Comprehensive General Liability Rating basis: Carrier: Premium Payment Plan: Comments : D. Automobile Insurance Limits - Rate per vehicle: Carrier: Policy Period: Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 Carrier: Policy Period: Premium Payment Plan: Comments : F. Umbrella Liability First $ 5,000,000: Next $ 5,000,000: Rating Basis : Carrier: F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage - Deductible $ 500 Premium: Carrier: Policy Period: Comments: H. - Public Employee Blanket Bond Premium: Carrier: Policy Period: Comments: - PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible.- Name eductible:Name of Agent/Broker Street or P.O. Box City, State, and Zip Name of Person Completing Quotation Signature Title �- Date: