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Home My WebLink AboutFlorida Municipal Insurance Trust Application -2002 10 01 . APPLICATION TO FLORIDA MUNICIPAL INSURANCE TRUST . GOVERNMENT APPLICANT: Citv of Winter Serinas ACCOUNT NUMBER: FMIT 0648 TYPE OF GOVERNMENTAL ENTITY: Municipality ADDRESS: 1126 East State Road 434 Winter Serinas FI 32708 FEDERAL EMPLOYER IDENTIFICATION NUMBER: .5 ~ - \ e>~ <0 3 C:.Y o NOTIFICATION TO DEPARTMENT OF COMMERCE OFFICIALS AUTHORIZED TO EXECUTE CONTRACTS: N,me' (>..~.....\",. ). "".\..~ ~ II. N.me: ~ TOe: c.. -' y c-.-.. .....-.=.. 'i".r- TOe' _ - PRIOR INSURANCE COVERAGE CARRIED BY: ~ M A ( C' ~ r ~ 5" j L p <:. I- "'\ ) Applicant hereby makes application with the Trust for continuing membership for liability, property, allied lines, automobile physical damage, workers' compensation, employers' liability, medical, dental, short-term disability, and/or life coverage, to be effective 12:01 a.m. October 1, 2002 and, if accepted by the Trust's duly authorized representative, does hereby constitute and appoint the Florida League of Cities, Inc., to act as Administrator of said Trust and to act as Applicant's agent-in-fact in all matters relating to its participation in said Trust and agent-in-fact to the extent any such coverage is placed with the Trust. Applicant, by execution of this Agreement, further agrees: (a) That, by this reference, the terms and provisions of the Agreement and Declaration of Trust creating the Florida Municipal Insurance Trust, as may be amended periodically by its Board of Trustees, a copy of which Applicant hereby acknowledges receipt, is hereby adopted, approved, ratified, and confirmed by Applicant; and further, Applicant will accept, assume, abide by and be bound by the provisions and obligations set forth therein; (b) That Applicant will pay all premiums on or before the date the same shall become due and, in the event Applicant fails to do so, will pay any reasonable late penalties and charges arising therefrom and all costs of collection thereof, including reasonable attomey's fees; (c) That Applicant, as long as it remains a member of the Trust; will abide by the rules and regulations adopted by the Trust's Board and will conform its conduct to the terms of any agreements entered into by the Board to administer the Trust; (d) That Applicant, in the event of any changes in the Applicant's corporate or business structure, or if any locations are to be added or deleted from any coverage provided by the Trust, will notify the Trust immediately; and that Applicant further understands that, if workers' compensation coverage or employers' liability coverage is provided by the Trust, the failure to provide said notice within thirty (30) days of any such change may result in the assessment of a civil penalty not to exceed $100 for each failure; (e) That should either the Applicant or the Trust desire to cancel coverage, it will give written notice to the other at least forty-five (45) days prior to cancellation; (f) That, should Applicant default hereunder, Applicant agrees to save and hold harmless the Trust and the Trust's Board from any and all damages, causes of action, claims, delinquency or expenses; including reasonable attorney's fees, which would have otherwise been incurred by the Trust or the Board hereunder absent such default on the part of the Applicant; (g) That, if workers' compensation or employers' liability coverage is placed with the Trust, Applicant will accept and be bound by the provisions of the Florida Workers' Compensation Act, that coverage arising from this Application shall be for Florida operations only, and that the Wage Declaration Schedule (Form No.-> and/or Renewal Certificates, when completed and retumed to Applicant by the Trust, shall become a part of this agreement; and (h) That, if medical, dental, short-term disability, and/or life coverage is placed with the Trust, the probationary period for new employees shall be: ( ) 30 days ( ) 60 days ( ) 90 days ( ) other WITNESSES TO SIGNATURE I. CihL of Wiote.r Sorino.s l' Ronaia w. ~c emore Name 01 Applicant _ If rnuJAllj <JYJ$- I~ , Authoriied Offleer Andrea Lorenzo-Luaces Name 1126 East State Road 434, Winter Springs, Florida Address 32708 c_ Andrea Lorenzo-Luaces Name Date 1126 East State Road,434, Winter Springs, Florida Address 32708 BY: (10/96) AdministratorlTrustee BINDER OF COVERAGE NAME AND ADDRESS OF DESIGNATED MEMBER Ms. Louise Frangoul City of Winter Springs 11 26 East State Road 434 Winter Springs FI 32708 EFFECTIVE DATE EXPIRES AGREEMENT NUMBER: 12:01 am 10/1/02 12:00 midnight 12/31/02 FMIT 0648 NAME AND ADDRESS OF ADMINISTRATOR Florida League of Cities, Inc. Public Risk Services P.O. Box 530065 Orlando, Florida 32853-0065 COVERAGE PROVIDED BY: THIS BINDER IS A TEMPORARY CONTRACT OF COVERAGE, SUBJECT TO THE CONDITIONS SHOWN BELOW. FLORIDA MUNICIPAL INSURANCE TRUST TYPE OF COVERAGE - LIABILITY General Liability 181 Comprehensive General Liability, Bodily Injury, Property Damage and Personal Injury 181 Errors and Omissions Liability 181 Supplemental Employment Practices 181 Employee Benefits Program Administration Liability 181 Medical Attendants'/Medical Directors' Malpractice Liability 181 Broad Form Property Damage 181 Law Enforcement Liability 181 Underground, Explosion & Collapse Hazard Limits of Liability * Combined Single Limit Deductible Stoploss $25,000 Automobile Liability 181 Automobile Liability 181 Leased Automobile Liability o 181 Medical Payments $N/A 181 Personal Injury Protection Uninsured Motorists Protection $N/A LImits of Liabirlty * Combined Single Limit Deductible Stoploss $25,000 Automobile/Equipment - Deductible 181 Physical Damage $1 ,000 - Comprehensive - Auto TYPE OF COVERAGE - PROPERTY 181 Miscellaneous 181 Inland Marine 181 Electronic Data Processing 181 Bond o 181 Buildings o Basic Form 181 Special Form 181 Personal Property o Basic Form 181 Special Form 181 Agreed Amount 181 Deductible $1 ,000 181 Coinsurance 100% 181 Blanket o Specific 181 Replacement Cost o Actual Cash Value LImits of LIability on File with Administrator TYPE OF COVERAGE - WORKERS' COMPENSATION 181 Statutory Workers' Compensation 181 Employers Liability $1,000,000 Each Accident $1,000,000 By Disease $1,000,000 Aggregate By Disease o Deductible N/A o SPECIAL CONDITIONS/OTHER COVERAGES $1 ,000 - Collision - Auto Per Schedule - Miscellaneous Equipment * $2,000,000 Combined Single Limit CONDITIONS The Trust binds the kind!s) of coverage stipulated above. This coverage is subject to the terms, conditions and limitations of the Agreement in current use by the Trust. This binder may be cancelled by the member by surrender of this binder or by written notice to the Trust stating when cancellation will be effective. This binder may be cancelled by the Trust by notice to the member in accordance with the conditions of the Agreement. This binder is cancelled when replaced by an Agreement. If this binder is not replaced by an Agreement, the Trust is entitled to charge a premium for the binder according to the rules and rates in use by the Trust. ~~ ~,~ ,IRJ::: nJ::: .-. FMIT-BINDER 11 0/961 Seotember 25, 2002 nll.TJ::: AGREEMENT NO. FMIT #0648 FLORIDA MUNICIPAL INSURANCE TRUST NAMED INSURED City of Winter Springs OPTION FORM 1. PERSONAL INJURY PROTECTION IX! The member acknowledges and understands that the agreement identified above will provide the full no-fault Personal Injury Protection coverage required by the Florida Reparations Reform Act, as amended. 2. Deductible Amount Applicable to Personal Injury Protection - Optional (select only one) D D D $250 $500 $1,000 D $2,000 3. D Coverage reduced by "Medicare" Program (42 USC 1395) and by Military benefits - Optional 4. D Work loss does not apply - Optional 5. No Deductible Applicable to Personal Injury Protection - Optional IX! No Deductible THE MEMBER HAS READ THE ABOVE APPLICATION & DECLARES THAT MEMBER HEREBY ELECTS THE OPTIONS MARKED ABOVE AND REQUESTS THEY BE MADE A PART OF THE AGREEMENT ABOVE. 10/01/2002 Date FMIT PIP 1002 ;i'-;::;!"tl..~ ., FLORIDA MUNICIPAL INSURANCE TRUST UNINSURED MOTORISTS I UNDERINSURED MOTORISTS SELECTION FORM THIS FORM REQUIRES YOU TO MAKE A CHOICE REGARDING UNINSURED MOTORISTSI UNDERINSURED MOTORISTS COVERAGE, WHICH PROTECTS YOU AND YOUR EMPLOYEES. YOU MAY REJECT, INCREASE, DECREASE OR MAINTAIN LIMITS EQUAL TO YOUR BODILY INJURY LIABILITY LIMITS. PLEASE READ CAREFULLY. AGREEMENT NO. FMIT #0648 DESIGNATED MEMBER City of Winter Springs SELECTION FORM CHECK, SIGN & DATE FOR ONLY ONE OPTION IX] UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - REJECTION: I/We REJECT Uninsured I Underinsured Motorists coverage and request that such coverage be eliminated from the Agreement, all renewals, and any other provisions which extends, changes, supersedes or replaces this agreement. o UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - INCREASED LIMITS: I/We accept the offer of INCREASED limits for Uninsured I Underinsured Motorists in the Combined Single Limit amount of bodily injury each accident. o Limit(s) LOWER than the Iimit(s) of the agreement for bodily injury liability, but not less than the Financial Responsibility minimum Iimit(s) required by law. Limit o Limit(s) EQUAL to the limit(s) of the agreement limit(s) for bodily injury liability. Limit: d,----r A~ S;9;'turf< 10/01/2002 Date FMIT UM 1002 0 Administration/ Marketing 0 Risk Control t! Underwriting Property & Casualty Health Post Office Box 530065 125 East Colonial Drive Orlando, FL 32853-0065 800-445-6248 407-425-9142 Suncom 344-0725 Fax 407-425-9378 0 Health Claims Post Office Box 538140 Orlando, FL 32853-8140 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 0 Workers' Compensation Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 0 Property & Uability Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 FLORIDA LEAGUE OF CITIES, INC. PUBUC RISK SERVICES TO: Member FROM: Administrator 0: Florida Municipal Insurance Trust (FMIT) Property Statement of Values for the 2002/2003 DATE: October 1, 2002 Attached is a current Statement of Values for the locations that we have on file for your property coverage. The amounts listed represent the property values at the coinsurance listed. In order to maintain Blanket Coverage, the Statement of Values must be renewed annually. Information on the attached Statement of Values should be reviewed for accuracy. Please make any changes on the original and initial the change. When the form is correct, please sign and date Page 2 where indicated and return the completed form to the Orlando office within 30 days of receipt. If the construction is left blank, please fill in the type of construction, as we do not have that information. Failure to provide accurate property values will result in your being paid less than the full amount in the event of a property loss. This is called a coinsurance penalty and is described on page 10 of 13 of the Building and Personal Property Coverage form (CPOO 10 10 00). If you have any questions, please feel free to call your Rating Manager, Margaret Gross, ext. 306. Florida Municipal Insurance Trust FLORIDA MUNICIPAL INSURANCE TRUST MEMBER'S STATEMENT OF VALUES MUNICIPAL PROPERTY Member City of Winter Sprinqs FMIT # 0648 Headquarters Address 1126 East State Rd. 434 Winter Springs, FL 32708 Form of Coverage [Xl o Agreed Amount applies to Items Replacement Cost applies to Items Coinsurance o 90% [Xl 100% Blanket Rate Effective Causes of loss for which rates are requested: Basic o o Other (Specify) Other (Specify) ) o [Xl Special Basic Coverage may apply to specified locations. Refer to the Schedule of Property Locations. This statement of values form must be flied annually. MEMBER: All values submitted are accurate to the best of my knowledge and belief. Authorized Signature I I, s ! -::.~ I Date PROP-STMTVAL (1/93) 09/25/2002 Member'sP'roperty Schedule City of Winter Springs, FMIT #0648 10/0112002 - 10/0112003 Locatlon# Address OccuDancy Construction Cause of ~~I Cause of Pers Loc Bid LOSS LOss Efrml 001 001 1126 E. State Rd 434, WS Winter City Hall CompIex- City Hall Fire Resistive Special Form $2,662,717 Special Form $1,105,907 Springs,FL 001 002 1126 E. State Rd 434, WS Winter Gas Tank & Pump Non-Combustible Special Form $16,306 $0 Springs,FL 001 003 1126 E. State Rd 434, WS Winter Appex Utility Building Joisted Masonry Special Form $53,550 Special Form $52,500 Springs,FL 002 001 102 Moss Road, WS Winter Springs,FL Fire Station #24 - Fire House Fire Resistive Special Form $540,855 Special Form $138,100 002 002 102 Moss Road, WS Winter Springs,FL Antenna & Radio Tower Non-Combustible Special Form $2,285 $0 003 001 850 Northem Way, WS Winter Springs,FL Fire Station #26 - Fire House Joisted Masonry Special Form $400,336 Special Form $36,800 004 001 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - ConcesslonslP&R Joisted Masonry Special Form $309,472 Special Form $12,900 Office 004 002 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Maintenance Garage Non-Combustible Special Form $139,901 Special Form $84,000 004 003 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 22 Concrete Ught Non-Combustible Special Form $64,738 $0 Poles 004 004 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 152 Ballfield Non-Combustible Special Form $103,542 $0 Ughls 004 005 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 38 Single FIxt, Non-Combustible Special Form $47,242 $0 Site Ughting 004 006 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 11 Double Filet, Non-Combustible Special Form $14,998 $0 Site Ughting 004 007 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Irrigation Sys & Non-Combustible Special Form $119,023 $0 Pumps 004 008 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - New Soccer Cone Joisted Masonry Special Form $220,000 $0 StlRestrm 005 001 Torcaso Winter Springs,FL Torcaso Park - New Restrooms Joisted Masonry Special Form $127,000 $0 006 001 Moss Winter Springs,FL Moss Park - New Restrooms Joisted Masonry Special Form $120,000 $0 007 001 Trolwood Winter Springs,FL Trolwood Park - existing restrooms Joisted Masonry Special Form $84,000 $0 008 001 400 N. Edgemon Ave., WS Winter Senior Center Joisted Masonry Special Form $265,173 Special Form $59,000 Springs,FI: 008 002 400 N. Edgemon Ave., WS Winter Civic Center Joisted Masonry Special Form $192,441 Special Form $42,000 Springs,FI: 009 001 300 Moss Road, WS Winter Springs,FL Police Complex - Police Station Fire Resistive Special Form $1,186,069 Special Form $493,000 Page 1 of 4 09125/2002 Member'sF'roperty Schedule City of Winter Springs, FMIT #0648 10/01/2002 -10/01/2003 Locatlon# Address Occuoancy Construction Cause of ~ Cause of Pers LOSS Loss ~ Lac Bid ~ 010 001 110 N. flamingo Ave. Winter Sprlngs,FL Public Works - Garage Joisted Masonry Special Form $154,530 Special Form $38,053 010 002 100 N. Flamingo Ave. Winter Sprlngs,FL Public Works - Utility Office Joisted Masonry Special Form $71,556 Special Form $80,000 011 001 N. 1st Street Winter Springs,FL Public Works - Storage Joisted Masonry Special Form $16,438 $0 012 001 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Digesters Fire Resistive Special Form $2,480,844 $0 Sprlngs,FL 012 002 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Chlroine Fire Resistive Special Form $219,300 Special Form $94,700 Sprlngs,FL Contact 012 003 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Filters Fire Resistive Special Form $37,026 Special Form $9,300 Sprlngs,FL 012 005 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Aerator Fire Resistive Special Form $128,214 Special Form $25,000 Springs,FL 012 006 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Plant Ops Fire Resistive Special Form $61,812 Special Form $200,000 Springs,FL 012 007 1560 Winter Springs Blvd, WS Winter East Wastewaler Plant #1 - Lift Station Non-Combustible Special Form $112,455 $0 Springs,FL 012 008 1560 Wlnler Springs Blvd, WS Wlnler East Wastewater Plant #1 - Reclaim Fire Resistive Special Form $481,134 $0 Springs,FL Water Tank 013 001 Sheoah Blvd, WS Wlnler Springs,FL Waler Plant #2'" Pump House Non-Combustible Special Form $138,433 $0 013 002 Sheoah Blvd, WS Winter Sprlngs,FL Waler Plant #2 - LP Gas Tank Non-Combustible Special Form $914 $0 013 003 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Ground Level Tank Non-Combustible Special Form $238,663 $0 013 004 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Hydropneumatic Tank Non-Combustible Special Form $46,868 $0 013 005 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Water Well Non-Combustible Special Form $20,397 $0 013 006 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Well #6 Water Plant 2 Non-Combustible Special Form $174,962 $0 013 007 Sheoah Blvd, WS Winter Springs,FL Waler Plant #2 - Uft Station Non-Combustible Special Form $129,753 $0 013 008 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $97,654 $0 014 001 1000 W SR 434, WS Winter Springs,FL West Wastewater Plant #2 - Water Plant Fire Resistive Special Form $1,985,480 $0 015 001 Bahama Rd, WS Winter Springs,FL Water Plant #3 - LP Gas Tank Non-Combustible Special Form $914 $0 015 002 Bahama Rd, WS Wlnler Springs,FL Water Plant #3 - Ground Level Tank Non-Combustible Special Form $238,663 $0 015 003 Bahama Rd, WS Winter Springs,FL Waler Plant #3 - Water Well Non-Combustible Special Form $19,789 $0 Page 2 of 4 09/2512002 Member's ~toperty Schedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/0112003 Locatlon# Address OCCUDancv Construction Cause of ~ Cause of Pers Loc Bid Loss Loss b'iml 015 004 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Plant Fire Resistive Special Form $336,362 $0 015 005 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Chlorinator Building Fire Resistive Special Form $66,309 $0 016 001 851 Northern Way Winter Springs,FL Water Plant #1 - E. Water Plant Op. Bldg Are Resistive Special Form $128,n5 Special Form $75,000 016 002 851 Northern Way Winter Springs,FL Water Plant #1 - Chlorine Handling Fire Resistive Special Form $63,257 $0 Facility 016 003 851 Northem Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0 016 004 851 Northem Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0 017 001 Indian Ridge Seminole Winter Springs,FL UftStatlon Non-Cornbustible Special Form $85,898 $0 018 001 David Street Winter Springs,FL Uft Station Non-Combustible Special Form $76,104 $0 019 001 Hacienda Village Winter Springs,FL Uft Station Non-Combustible Special Form $58,473 $0 020 001 Tanglewood Drive Winter Springs,FL Uft Station Non-Combustible Special Form $91,7n $0 021 001 S. Edgemon Ave Winter Springs,FL Uft Station & Fence Non-Combustible Special Form $343,598 $0 022 001 Panama Circle Winter Springs,FL Uft Station Non-Combustible Special Form $63,446 $0 )23 001 Alton & Mockingbird Winter Springs,FL Uft Station Non-Combustible Special Form $89,667 $0 )24 001 E. ofWetiand 1000's Winter Springs,FL Uft Station Non-Combustible Special Form $53,045 $0 )25 001 Club Drive Winter Springs,FL Uft Station Non-Combustible Special Form $56,228 $0 )26 001 Dolphin Road Winter Springs,FL Uft Station Non-Combustible Special Form $56,228 $0 )27 001 Papaya Lane Winter Springs,FL Uft Station Non-Combustlble Special Form $33,462 $0 l28 001 Sybllwood Circle Winter Springs,FL Uft Station Non-Cornbustlble Special Form $26,989 $0 129 001 Tuscany Place Winter Springs,FL Uft Station Non-Combustible Special Form $34,095 $0 130 001 Winter Springs Blvd. Winter Springs,FL Uft Station Non-Cornbustible Special Form $50,605 $0 131 001 Northem Way Winter Springs,FL Uft Station Non-Combustlble Special Form $28,500 $0 132 001 Wood Duck Drive Winter Springs,FL Uft Station Non-Combustible Special Form $41,046 $0 133 001 Seneca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $65,224 $0 134 001 Seheca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $46,107 $0 '35 001 Trotwood Blvd Winter Springs,FL Uft Station Non-Cornbustible Special Form $44,982 $0 Page 3 of 4 09125/2002 Member's t-'roperty Schedule City of Winter Springs, FMIT #0648 10/0112002 - 10/0112003 Locatlon# Loe Bid Address Occuoanev Construction Cause of LOSS ~~ft Cause of Loss Pers rr~G 036 037 038 039 040 041 042 001 Seneca Blvd & Chaise Winter Springs,FL 001 Shepard Rd. Winter Springs,FL 001 Cheny Creek Circle Winter Springs,FL 001 VlStawllla Drive Winter Springs,FL 001 Nandlna Terrace Winter Springs,FL 001 Winter Springs Blvd Winter Springs,FL 001 Various Winter Springs,FL Uft Station Uft Station Uft Station Uft Station Uft Station Oak Forest Wall Tuscawllla Ughting and Beautification ImprovementS Non-Combustlble Non-Combustlble Non-Combustlble Non-Combustible Non-Combustible JoIsted Masonry Non-Combustlble Special Form Special Form Special Form Special Form Special Form Special Form Special Form $45,955 $46,589 $57,674 $45,010 $49,802 $500,000 $2,000,000 $18,687,980 $0 $0 $0 $0 $0 $0 $0 $2,546,260 Total: Page 4 of 4 0912512002 --- .y:' I'LOlUDA YUlUotl'u. U.UlWJCII mUST FtC' 09-1 (ReviSed 2/97) APPLICATION I'OR DaUG-.... wouPLAcZPltIMlUW cUD:tT'1'aOGMH <::1 ty . ofWint.rS~r,inC}Js tl'MtT 64a ~ Name of Member: Date ProgrciD\ Implemented: . July. ~, 1,'996 2002/2003 1. TESTING: Drug testing has been conducted in the following areas: 181 181 Job applications 181 181 Routine fitness for duty Follow-up to Eltnployeehlsistance Program Reasonable suspicion 181 11. NOTICE 01' ~""SJjl\UG a$"PfG POlalCY: II Show not;J.ce of drug testing on vacancy announcements 181 181 181 Copy ~o all employees prior to te'sting ~.l Posted onenaploy.r's premises Copy to job applicants pdor to testing General notieegiven 60 days prior to testing Copies av.ilable in pe.tt'sonnel office or other su,ttableloeations. No notice r.qu!red because the employer had a d1;'ug testing pro<}ram in place prior to July 1,1990 . 1m HIA XII. BJ)UCATION: 181 181 lV. A. B. Resource file on Providers II l!:ducatiOJ1 ' Employee ASAJistance Prog.1:aIn 1Wm 01' .M&DXCAL UVl&W Ol'l':tc&a: D..O.1'.stop'MeClieal Review. Officer, JockSneedon, ~L9484S. .'. O'81'f. ,OtlandQ,. .!$32,8$7.. (407). 857-5573 ~ .. He..1tbCare Adrni..nj.,st:rationLab or United' States Services Ce2ttifiec:i taboratoJ:Y: Rameof approved Agen.cY.for . Department of Health . and H:I1ma." ~erican Medical ~orato~ies ) . Phone #: ( 407 )857-81$8 C. Address: 8549 parkline~lvd., O):f~~' "l'J.; 32$09 ALJo. I~HUST . ~L:J:_ 1I1'tH IN 0.. 1'0_ a~G:t"1'O!l 'tBJl. CNlD1:T. SPECIAL NoTB: ) '/' . Any person who kn~winqly and with intent to injure, defraud, or de~eix~vany ins~rer files a statement of claim .or an application containing !ii>lete, or rrddeading informatioi;l is guilty of a felony of the tbird<ie9re. November lZ,2002 Date a1 City of Winter Spdngs Member Name . .",J Mayor . Ti t.t~ ii. :; i>. TH~ ABOVE SIGNED CERTIFltS THAT THIS !NFO~TIOt.r ;(SA rPit1E ANn FAC'+UlUi D'E.PICTION OF THEIR CURRENT PROGRAM. ' , *Appli ation must be signed by an ele<;:tedoff.:l.cial or t November 12, 2002 Date - - '. FLORIDA MUNICIPAL INSURANCE TRUST APPLlCAnON FOR EMPLOYER WORKPLACE SAFETY PROGRAM PREMIUM CREDIT Member Name: Contact Person: Policy #: C~ of Winter Springs Ms. Louise Franghoul FMIT 648 Telephone: 407-327~1800 Effective Date of Policy: October 1, 2002 I am submitting a copy of my wor1q)lace safety program that meets the requirements of the Florida Occupational Safety and Health Ad, Chapter 93-415, 552-74, Laws of Florida, and Rule 381-17 of the Florida Administrative Code. I certify that this safety program has been implemented in my wor1q)lace and is being maintained as submitted to my carrier. This is to certify that my workplace safety program meets or exceeds the following provisions as provided for in R\Jle 381-17: 1) ", Management Commitment to safety 2) Safety Committee 3) Safety and Health and Training 4) Safety Rules, Policy and Procedures Requirements The workplace safety program and application I am submitting for the purpose of obtaining a premium credit do not contain any misleading or untrue information. I am aware that I may .be subjed to an on-site inspection by the Florida Department of Labor and Employment Security, Dlvislof) of Safety, or my carrier, for the purpose of validating the accuracy of this information. 5) 6) 7) Accident Prevention First-Aid Procedures Record Keeping I am aware that if I knowingly and willfully falsify or conceal a material fad, make a false, flditious or fraudulent statement,or representation; or make or use any false document knowing the document to contain any false, flditious or fraudulent entry or statement to my carrier or workers compensation Insurance under Chapter 442, Florida statutes, I will be guilty of a misdemeanor of the second degree, punishable as provided In sections 775.082 or 775.083, Florida Statutes, and will be subjed further to a penalty in the amount of $500 a day, not to exceed $50,000 for each occurrence; and I am also aware that if I, In any matter within. the jurisdiction of the division, knowingly and willfully falsify or conceal a material fad, make any false, flditious, or fraudulent statement or representation, or make or use any false document, knowing the same to contain any'false, fictitious, or fraudulent entry, that I commit a misdemeanor of the second degree, punishable as provided In sections 775.082 or 775.083, Florida Statutes. Moreover, I understand that an employer Who commits such an act will be subjed further to a penalty in the amount of $500 a day,not to exceed $50,000 for each occurrence. Any person who knowingly and with intent to Injure, defraud,or deceive any Insurer files a statement of claim or an application containing any false, Incomplete, or misleading information is guilty of a felony of the third degree. Effedive date of premium credit October 1 , 2002 City of Winter Springs Member Name / / - 8 s--~ 0 ~ Date ;e~iJ1tl~ . . *Eleded Official or Other Official ~~ mu be signed by an eleded official or other official. (If )d"d- . s Signature D~ ANDREA LORENZO-LUACES C 831831 : May 0, 2003 1-8QO:3.NOl'AlW fi", l'Il*1lly8elYlca& ~ Co. ~;iy of . j,J,~t.r fi~tjS . lo u ;S~ Fr.IJ~ D I.f. J PHONE: '10732.. 7./fp{) In anIet ID assure that your safely and heallh pagram meets the requirements d the Slalie. d Florida, Oepertment d Labor Md Employment Secwlty, 0Msi0n d s.tety, SlIfety pagl1lm guidelines, the fallawjng plOIIisions should be in pllIce: ... . 1, MAIWIEMUT COIIIMITM8NT AND INVOLVEMIJlT: ~ 11 & 12 d 381-17.008 ComplJ,nce Publication PlIIt II). ...... you issued and communicatlld ID lIll employees a mll!!D policy stel8ment? . XYES a NO Comments: Does your policy atIllIrMnt cont:elne tile followlng: ... A clev viM d menegement's comm~ ID uIety? Comments: b. Managemenl'S position on safety fundlng7 Comments: Co Employee's rights when wafk ill considelwd UftlIlIfe7 .. Comments: d. OIsciplinely procedU18S lot violation d SlIfety Nles7 Comments: e. Does your safely pollc:y ....ign and communicatlt in writing the A1Sponsibility for the implementation d )'OUt'SlIfIlly pagram1 )(YES a NO rYES a NO ~YES aNO )llYES aNO )(YES 000 Comments: f. Does your SlIfllly pagram indicatlt how rnanegement ill adIveIy per1lcipetlng in: s.fety committHs, SlIfety education and lIIIining, and establishment of safety NI.., policies and ~7 )( YES a NO Comments: 2. 8AI'In"Y c:..-, ....a: (Pages.12lhrough 14 of 381-17.006 Compliance Publlc:alion Part II), Rule 381-17 specifically IlddAISses the requi_ of tile SlIfllly commitllM med....p for your paogram. HINe you edcIIessed the following: .. The fonmdlon of ~ sahity commibe7 Jl{YES a NO Comm-= b. Assured that your commibe is made up d botII menagement and em~7 )(YES aNO Comments: Co Assured that thel8lio d thill commilllle ill such that employees have an eql!al number d, or ~ rep~tIves tIIen tile emp\0yer7 a YES Ale. . AI'<c.. . -f,..y~ ~1) "'c(:v~/~ -#J,J r..+,g Scheduled meetings, ~ quaaterty? ~ YES a NO ~ Comments: d. Comments: eo Assuntd that I8Cl>RIs of meetings .,. recorded and maintained for at 1_ "'.... ~1 )(Yes a. NO Comments: f. EstabIlshed paocedUIWS for inspections ID ~uata tile ---- d your ~1 a YES. /J(NO. 0 I ..J. .Comments: ~_ ."..., r JilcuJ.J ~A.su~e~f~ ""S 14.!. "",:,~~l reu,.d 41 "'~;~ea4lf.. g. Established paocedures lot ilMlSligating all accidents,. safety relallld incidents, iII.- and f1Italities7 )(YES a NO Comm-= h. Established pIOC8dures lor evaluating and recommending im~ ID employee's ac:cidenl and illness preYlIlIlion in tile ~7 )('rr.._ JiI' ' Comments: established and communicated procedures for training committee m1J"beas and ..-ring that this lIIIining ill acc:ompllshed7 J Com_: Cl/r,.-e""-+!VCAr1J1~ CJ1.J&.I/v A (/ -Ir~1 ~ I J ~c.cb",?,hjk~ j. establishing paocedures ll:l 8SlIU1e minutes of !!! committee meetings are communialllld 110 !!! employees7 a YES Comments: Ne.. ~/I) W/)/L d:lyl~~ lIoN -I~ ~~ /~t'lJcei1i'v,;'tJ aYES J!NO J(NO AND HEALTH TftAlNING: ("-lIes 14 & 15 al38I-17.008 Compl__ Publication Part II). . . Haw ~ Implen\elacl Alety and hnllh IIUring Ill_Includes at. minimum Ill. folklwing: a. Safety orientation on Nlas, policlas and ptaeadur-. )( YeS 0 NO ,I I I l Comments: b. Job specillc pn)ceduras tot ... new employeas? AC YeS Comments: ONO c. Job sDe9ific trainina lor employaa before lIley are aalgnad lhair job !uk? )fi(YES ONO Comments: d. Comments: Periodic retainin9a1 employeeS on ~ safety Nlas, pollcIas, and plOClldurw? )(yes ONe 4. I'lIlST AID 1'ft00000RU: (Pages 15 & 18 al38l-17.008 CompllallCll Publlcallon Part 11). Haw you ..mbllshed First Aid PfOC8du/eS far first aid and medical saMces lIl81 includes 81. minimum tile lollowiilg: .. AVIIllablllty aI .pproved First Aid Kits, ar Fim Aid facilities III all employees? )Q YES ONe Comments: b. Comments: Fim. Aid training lor employees in Ilne witlllIle poIIential hazanl allIlait warkplace .nd ltIair ~ envinlnmant? "'YeS ONe c.. POlIting of emelgeflCy t8tephane numbers .nd lIleleaehlng olllOlSily undenIlIood procedures? ll(YeS ONe Comments: 50 ACCIDENT INVIISTlGATlON: (Pao-18 lhlough 18 at 381-17.008 Compliance Publication Part II). Haw you established. pIOCadUI1l requiring lIla investigallon of tile fallowing: .. AccIdents: )I YeS 0 Na Comments: II. Injuries: )( YeS ONa Comments: c. Occupllllonal disaaes: ~YeS ONa Comments: d. AI1I all allIle .bove farms and reconIa l1IVlawad by lIle safety commillM? Comments: . Dt'Arf~ t f'~N,s.e~IIO-}'lie.J .. Con lIle safety commiIIM inillllta racommandatlons baed on lIla aboVII? Comments: ~YES ONO ~YES ONO t.IUICORDKEEP1NG 'ROC1!DUR&S: (Page 18 al38I-17.008 CompllallCll Publication Part II). Have you: .. established rec:ordIcHping pftlCadunls III contnIl and maintain all accident and injury .-ds? ~YeS ONa Comments: b.. Mad. pnMsions 1D _re .n reconIa are retained far 1Il_ years? ,,-YES ONO Comments: II~ n. ....m ....... beloW an __ ,..,u tIIat _ lie ......Ill.... 1. DIvtslo. fit SaMy, Lot .... .....ry ", Oeea........ hIIartas, D.......... ---- Z. ........ of h1jary (LEa I'ORM DWC-11 7. 8AI'IETY RULliS, I'OUCIES AND I'ftOCEDURBS: (p.lIe 18 ol381-17 Complillnce Publication Part II. 1. HaVe you developed . safety m.nual containing .11 wotkplace safety Nles, policies. and pIOClIdures? Comments: "ves ONO 2. Is tile above manual updated wilen changes in tile ~ ar woik envi.....ment occurs? )q YES 0 NO Comments: -f'.t!Co;,f:e; -1-0 J}~",,-j,,,,~1Ir1 3. 00 lIle above safety Nles includ. bolh general and job specific NIes? ~ YES Q NO . J Comments: SON1Co d~A,...j~41 J':e.t.):f,~ rV&J ~~c. ~n-lA;"'~/l 1-1- JI......nd...,J 9'I!/I;t~:Y CV/~dl;' c.../- ;J~~~e~-I , J.. re of "- CompIring tills Fonn: """-- ~_~. · /l. X~.. .... p.r...c;,."e-t .~t-(/ / er J~/' 11 /~ . 1"'\ 3 0 Administration/ Marketing 0 Risk Control if Underwriting Property & Casualty Health Post Office Box 530065 125 East Colonial Drive Orlando, FL 32853-0065 800-445-6248 407-425-9142 Suncom 344-0725 Fax 407-425-9378 0 Health Claims Post Office Box 538140 Orlando, FL 32853-8140 800-756-3042 407 -245-0725 Suncom 344-0725 Fax 407-425-9378 0 Workers' Compensation Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 0 Property & Liability Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 FLORIDA LEAGUE OF CITIES, INC. PUBLIC RISK SERVICES October 28, 2002 Ms. Louise Franghoul Director of Finance City of Winter Springs 1126 East State Road 434 Winter Springs, FL 32708 Re: Position Schedule Bond 103940482 Dear Ms. Franghoul: Attached please find your Position Schedule Bond as requested. The Bond is for your files. As this policy is continuous in nature, only an annual billing will be issued each year at renewal. If you have any questions, please do not hesitate to contact me. ~ Valerie M. Morrison UndelWriting Assistant VMM/vmm Enclosure Florida Municipal Insurance Trust ',',lPf: I" A Name Position Employed at Amount of Guarantee Premium . 1 Finance Director City of Winter Springs $100,000 $591.00 10/01/02 S-1560-B (08-99) "'11'~~ rf.. . , '- ~ ~ . FORMS SCHEDULE FLC UNDERWRITING NOV 1 2 2002 RECEIVED Named Insured: CITY OF WINTER SPRINGS Policy No:FPL 8084255 Effective 12:01 A.M. November 9. 2002 END # Form Name Form Numberl Edition Date DECLARATIONS PAGE 56100 7/93 1 COVERED LOCATIONS 60298 5/94 2 CANCELLATION/NON-RENEWAL 76105 5/00 3 INDEPENDENT COUNSEL 59048 11/93) 4 CROSS LIABILITY EXCLUSION 58052 7/93) 5 EXTENDED REPORTING ENDORSEMENT 74623 11/99 6 OTHER INSURANCE ENDORSEMENT 74622 11/99 7 STORAGE TANK ENHANCEMENT ENDORSEMENT 74553 11/99 8 DATE RECOGNITION ENDORSEMENT 70632 5/98) 9 PER LOCATION LIMITS OF LIABILITY 60300 5/94) NOTICE OF LOSS/NOTICE OF CLAIM N/A POLICY TERMS & CONDITIONS 56101 (7/93) ~- ~---~~--:-- 0(' '" , - .,. COMMERCE AND INDUSTRY INSURANCE COMPANY 70 PINE STREET NEW YORK, N.Y. 10270 STORAGE TANK THIRD-PARTY LIABILITY, CORRECTIVE ACTION AND CLEANUP POLICY NOTICE: THIS IS A CLAIMS-MADE AND REPORTED POLICY. AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE AMOUNT AND ALSO SHALL REDUCE THE SEPARATE LIMIT OF LIABILITY AVAILABLE TO PAY LEGAL DEFENSE COSTS COVERED BY THIS INSURANCE. PLEASE READ CAREFULLY POLICY NUMBER: FPL8084255 REN/NEW: R DECLARATIONS Item 1: NAMED INSURED ADDRESS CITY OF WINTER SPRINGS 1126 SR 434 EAST WINTER SPRINGS, FL 32708 Item 2: POLICY PERIOD: FROM November 9, 2002 TO November 9, 2003 12:01 a.m. standard time at the address of the named insured shown above Item 3: LIMIT OF LIABILITY, up to $1,000,000 $1,000,000 Each Incident Aggregate Limit Item 4: DEDUCTIBLE $10,000 Each Claim Item 5: COVERED LOCATION(s): See Covered Location(s) Endorsement. Item 6: COVERED UNDERGROUND STORAGE TANK SYSTEM(s) AND OR ABOVEGROUND STORAGE TANK(s): See Covered Location(s) Endorsement. Item 7: RETROACTIVE DATE: November 9, 1995 Item 8: POLICY PREMIUM $1,405 Broker: Morefar Marketing, Inc. 501 Carr Road Wilmington, DE 19809 p,.w ,,~,,-~ AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 56100(7/93) >F:lTJ["Y:~'~ pl" --",- ,.... -.~----------~ .. ,. . r' ENDORSEMENT NO.1 . This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY COVERED LOCATIONS UNDERGROUND STORAGE TANKS AND ABOVEGROUND STORAGE TANKS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY It is hereby agreed that Item 5 of the Declarations, Covered Location(s), and Item 6 of the Declarations, Covered Underground Storage System(s) and Aboveground Storage Tank(s), shall include only the following: .SEE ATTACHED APPENDIX- A SCHEDULED LIST OF SITESITANKS. All other terms, conditions and exclusion remain the same. j2~ "~~a_~, AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 60298(5/94) ( t t APPENDIX A-LIST OF SCHEDULED SITESIT ANKS APPENDIX TO ENDORSEMENT #1 FORM# 60298(5/94) NAME INSURED: CITY OF WINTER SPRINGS POLlCY#: FPLBOB4255 EFFECTIVE: 11-9-02 SCHEDULED LOCA TIONS LOCA TION# 1 TANK CAPACITY AST/UST CONTENT INSTALL DA TE WINTER SPRINGS, CITY PUBLIC TANK#1 1000 AST DIESEL 1995 WORKS 1 ST ST & N FLAMINGO AVE WINTER SPRINGS, FL DEP#8520773 RETRO DATE:11/9/95 LOCA TION# 2 TANK CAPACITY AST/UST CONTENT INSTALL DATE WINTER SPRINGS, CITY POLICE TANK#1 10000 UST UNLEADED GAS 1985 DEPT 1126 SR 434 E TANK#2 1000 UST FUEL-GENERATOR 1985 WINTER SPRINGS, FL DEP#8731664 RETRO DATE:11/9/95 LOCA nON# 3 TANK CAPACITY AST/UST CONTENT INSTALL DA TE WINTER SPRINGS CITY LIFT TANK#1 2000 UST FUEL-GENERATOR 1989 STAT. #7 EDGEMON AVE WINTER SPRINGS, FL DEP#8944283 RETRO DATE:11/9/95 LOCA TION# 4 TANK CAPACITY AST/UST CONTENT INSTALL DA TE WINTER SPRINGS CITY WATER TANK#1 2000 AST FUEL-GENERATOR 1996 & SEWER 851 NORTHERN WAY WINTER SPRINGS, FL DEP#9045575 RETRO DATE:11/9/95 :Jl'l'''''~ LOtATION# 5 TANK CAPACITY AS T/UST CONTENT INSTALL DA TE WINTER SPRINGS CITY WATER TANK#1 1000 UST FUEL-GENERATOR 1987 & SEWER 1000 W SR434 WINTER SPRINGS, FL DEP#9300098 RETRO DATE:11/9/95 LOCA T10N# 6 TANK CAPACITY AST/UST CONTENT INSTALL DA TE WINTER SPRINGS CITY WRF TANK#1 2000 AST FUEL-GENERATOR 1996 1560 WINTER SPRINGS BLVD WINTER SPRINGS, FL DEP#9601163 RETRO DATE:11/9/95 LOCA TION# 7 TANK CAPACITY AST/UST CONTENT INSTALL DATE WINTER SPRINGS CITY PUBLIC TANK#1 750 AST FUEL-GENERATOR 1997 SAFETY 300 N MOSS RD WINTER SPRINGS, FL DEP#9701186 RETRO DATE:11/9/95 >-,,-'~. '- f AMENDATORY ENDORSEMENT NO: 2 This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY FLORIDA CANCELLATION/NONRENEWAL ENDORSEMENT Wherever used in this endorsement: 1) "we", "us", "our", and "Insurer" mean the insurance company which issued this policy; and 2) "you", "your", "named Insured", "First Named Insured", and "Insured" mean the Named Corporation, Named Organization, Named Sponsor, Named Insured, or Insured stated in the declarations page; and 3) "Other Insured(s)" means all other persons or entities afforded coverage under the policy. It is hereby agreed and understood that the cancellation provision of this policy is to be deleted in its entirety and to be replaced with the following: A. The Insured shown in the Declarations may cancel this policy by mailing or delivering to the Insurer advance written notice of cancellation. B.1. Cancellation for Policies in Effect Ninety (90) Days or Less If this policy has been in effect ninety (90) days or less the Insurer may cancel this policy by mailing or delivering to the Insured written notice of cancellation, accompanied by the reasons for cancellation, at least: a) Ten (10) days before the effective date of cancellation if the Insurer cancels for nonpayment of premium; or b) Twenty (20) days before the effective date of cancellation if the Insurer cancels for any other reason, except the Insurer may cancel immediately if there has been: 1. A material misstatement or misrepresentation; or 2. A failure to comply with underwriting requirements established by the Insurer. B.2. Cancellation for Policies in Effect for More Than Ninety (90) Days. If this policy has been in effect for more than ninety (90) days the Insurer may cancel this policy only for one or more of the following reasons: a) Nonpayment of premium; b) The policy was obtained by a material misstatement; c) There has been a failure to comply with underwriting requirements established by us within ninety (90) days of the effective date of coverage; d) There has been a substantial change in the risk covered by the policy; or e) The cancellation is for all insureds under such policies for a given class of insureds. 76105(5/00) ,~ i If the Insurer cancels this policy for any of these reasons, the Insurer will mail or deliver to the First Named Insured written notice of cancellation, accompanied by the reasons for cancellation at least: 1. Ten (10) days before the effective date of cancellation if cancellation is for the reason stated in 2(a) above; or 2. Forty-five (45) days before the effective date of cancellation if cancellation is for the reasons stated in 2(b), (c), (d) or (e) above. The following is added. C.1. Non-Renewal a). If the Insurer decides not to renew this policy the Insurer will mail or deliver to the Insured written notice of nonrenewal, accompanied by the reason for nonrenewal, at least forty-five (45) days prior to the expiration of this policy. b). Any notice of nonrenewal will be mailed or delivered to the Insured's last mailing address known to the Insurer. If notice is mailed, proof of mailing will be sufficient proof of notice. C.2. Renewal a) The Insurer shall give the named insured at least forty-five(45) days' advance written notice of the renewal premium. All other terms, conditions and exclusions remain the same. p,.,l", ,,~~~-~ AUTHORIZED REPRESENTATIVE Or countersignature (where required by law) 76105(5/00) 7'';Sji2~(:'i.~~'/'': ENDORSEMENT NO.3 This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY INDEPENDENT COUNSEL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In the event the INSURED is entitled by law to select independent counsel to defend the INSURED at the Company's expense, the attorney fees and all other litigation expenses the Company must pay to that counsel are limited to the rates the Company actually pays to counsel the Company retains in the ordinary course of business in the defense of similar claims or suits in the community where the claim arose or is being defended. Additionally, the Company may exercise the right to require that such counsel have certain minimum qualifications with respect to their competency including experience in defending claims or suits similar to the one pending against the INSURED and to require such counsel to have errors and omissions insurance coverage. As respects any such counsel, the INSURED agrees that counsel will timely respond to the Company's requests for information regarding the claim or suit. Furthermore, the INSURED may at anytime, by its signed consent, freely and fully waive its right to select independent counsel. All other terms, conditions and exclusions remain the same. fZ,6.I "4.~rt~ AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 59048(11/93) - ---_.__.----.~- ENDORSEMENT NO.4 This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY CROSS LIABILITY EXCLUSION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that this insurance does not apply to any Claims made by any Insured against any other person or entity who is also an Insured under this policy. f1,6.1 ".i:.~6_~, AUTHORIZED REPRESENTATIVE 58052(07/93) ~~- -t>Y.'::~<;f:~ ENDORSEMENT NO. #5 This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY EXTENDED REPORTING PERIOD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 1. It is agreed that Section VI. EXTENDED REPORTING PERIOD, is deleted in its entirety and replaced with the following: VI. EXTENDED REPORTING PERIOD The Named Insured shall be entitled to an Automatic Extended Reporting Period, and be entitled to purchase an Optional Extended Reporting Period upon termination of coverage as defined in paragraph B of this Section. Neither the Automatic nor the Optional Extended Reporting Period shall reinstate or increase the limit of liability shown in Item 3 of the Declarations as applicable to the "Aggregate Limit" of this Policy. A. Automatic Extended Reporting Period Provided that the Named Insured has not purchased any other insurance to replace this insurance which applies to a Claim otherwise covered hereunder, the Named Insured shall have the right to a period of sixty (60) days following the effective date of such termination of coverage in which to provide written notice to the Company of Claims first made and reported within the Automatic Extended Reporting Period. A Claim first made and reported within the Automatic Extended Reporting Period will be deemed to have been made on the last day of the Policy Period, provided that the Claim arises from a Pollution Condition that commenced before the end of the Policy Period and is otherwise covered by this Policy. No part of the Automatic Extended Reporting Period shall apply if the Optional Extended Reporting Period is purchased. B. Optional Extended Reporting Period The Named Insured shall be entitled to purchase an Optional Extended Reporting Period upon termination of coverage as defined herein as follows: 1. A Claim under which is first made and reported during the Optional Extended Reporting Period, if purchased in accordance with the provisions contained in Paragraph 2 below, will be deemed to have been made and reported on the last day of the Policy Period if the Claim arises from a Pollution Condition which commenced on or after the Retroactive Date shown in the Declarations and before the end of the Policy Period. 2. The Company shall issue an endorsement providing an Optional Extended Reporting Period of up to forty (40) months from the date of the termination of coverage hereunder for all locations designated in Item 5 of the Declarations if the Policy is cancelled or non renewed, or any specific location listed in the Declarations, if coverage for that specific location is terminated during the Policy Period. The Named Insured must: a. make a written request for such endorsement which the Company receives within thirty (30) days after termination of coverage as defined below; and 74623(11/99) ~..1'i:1';; b. pay the additional premium when due. If that additional premium is paid when due, the Optional Extended Reporting Period may not be canceled, provided that all other terms and conditions of the Policy are met. 3. Termination of coverage occurs: a. At the time of cancellation or nonrenewal of this Policy by the Named Insured or by the Company; or b. At the time of the deletion of a listed location in the Declarations from this Policy by the Company at the Insured's written request, but solely with respect to such location; 4. The Optional Extended Reporting Period is available to the Named Insured for not more than 100% of the Policy premium. 2. For purposes of coverage under this Endorsement, the following definition is added to Section III. DEFINITIONS: Extended Reporting Period means either the automatic additional period of time or the optional additional period of time, whichever is applicable, in which to report Claims following termination of coverage, as described in Section VI. of this Policy. All other terms, conditions and exclusions shall remain the same. fl,.t", "~~fr~^ AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 74623(11/99) "T-ii11 ,~----------:------; --jfi~ ENDORSEMENT NO. #6 . This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY AMENDMENT TO OTHER INSURANCE CONDITION ENDORSEMENT (THIS INSURANCE IS EXCESS OVER STATE TANK FUNDS) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY It is hereby agreed that Section VIII, CONDITIONS, Paragraph I is deleted in its entirety and replaced with the following: I. Other Insurance - Where other insurance, or funds from any Tank Fund, is available to the Named Insured for Losses or for costs for Corrective Action or Cleanup covered under the terms and conditions of the Policy, the Company's obligation to the Insured shall be as follows: 1. This insurance shall apply as excess insurance over any other valid insurance, whether collectible or not, be it primary or excess. This excess insurance shall in no way be increased or expanded as a result of the receivership, insolvency, or inability to pay of any insurer with respect to both the duty to indemnify and the duty to defend. 2. Where this insurance is excess over any other valid insurance, the Company will pay only its share of the amount of Loss and covered costs for Corrective Action or Cleanup, if any, that exceeds the total amount of all such valid insurance, whether collectible or not. 3. This insurance shall also apply as excess insurance over any Tank Fund, provided that in the event of the receivership, insolvency, or inability to pay of any state fund or program, this insurance shall act as primary insurance. The Insured shall promptly upon request of the Company provide the Company with copies of all policies potentially applicable against the liability covered by this Policy. For purposes of this endorsement, the following definition applies: Tank Fund means any state storage tank trust fund, state administered insurance program, restoration (corrective action) funding for storage tanks whose owners qualify for reimbursement, or any self insurance fund established for the purpose of funding Corrective Action or Cleanup for Pollution Conditions from Underground Storage Tank Systems or Aboveground Storage Tanks. All other terms, conditions and exclusions shall remain the same. f1~Jt~,,~~ AUTHORIZED EPRESENTATIVE or countersignature (where required by law) 7 4622( 11/99) ~ ENDORSEMENT NO. #7 This endorsement, effective 12:01 AM, November 9,2002 . Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY STORAGE TANK THIRD PARTY LIABILITY. CORRECTIVE ACTION AND CLEANUP BROADENING ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY It is hereby agreed that the Policy is amended as follows. 1. Section I, INSURING AGREEMENT, Coverage D: DEFENSE is deleted in its entirety and replaced with the following: COVERAGE D: DEFENSE. The Company shall have the right and the duty to defend the Insured against any Claim under Coverages A, B or C provided such coverage has been purchased. The Company's duty to defend or continue defending any such Claim shall cease when the "Aggregate Limif' as described in Section V. LIMITS OF LIABILITY AND DEDUCTIBLE, has been exhausted by the payment of Loss or costs for Corrective Action or Cleanup. 2. Section II, CLAIM PROVISIONS, paragraph A is deleted in its entirety and replaced with the following: A. It is a condition precedent to coverage under this Policy that: 1. NOTICE OF CLAIM: Coverage A.: In the event of a Claim under Coverage A., the Insured shall give the Company's representative as identified in this paragraph written notice as soon as possible after receipt of the Claim by the Insured. Coverage B.: In the event that a Pollution Condition has taken place which the Insured has verified as a Confirmed Release, the Insured must submit a Claim under Coverage B., in writing, as soon as possible after verifying the Confirmed Release. Coverage C.: In the event the Insured is issued a Governmental Order requiring Cleanup, the Insured must submit a Claim under Coverage C., in writing, as soon as possible after receipt of the Governmental Order. All Claims under Coverage A., Coverage B. and Coverage C. shall be reported to: Division Attorney - Pollution legal Liability Commerce and Industry Insurance Company 175 Water Street, 1ih Floor New York, New York 10035 & Home Office Senior Supervisor, Pollution legal Liability AIG Technical Services, Inc. Environmental Claims 80 Pine Street New York, New York 10005 or other address(es) as substituted by the Company in writing. 74553(11/99) j 3. Section III. DEFINITIONS, paragraph A. Aboveground Storage Tank; paragraph B. Bodily Injury; paragraph H. Environmental Laws; and paragraph R. Underground Storage Tank are deleted in their entirety and replaced with the following, respectively: A. Aboveground Storage Tank means a stationary device on, within, or under a location designated in Item 5 of the Declarations and that is designated in Item 6 of the Declarations: 1. designed to contain an accumulation of hazardous waste, waste product, petroleum product or any other product, which is constructed primarily of non- earthen materials (e.g., wood, concrete, steel, plastic) which provide structural support; 2. that is situated in such a way that the entire surface area of the tank is completely above the plane of the adjacent surrounding surface and the entire surface area of the tank (including or excluding the tank bottom) is able to be visually inspected; and 3. includes any underground or aboveground piping directly connected to the tank, dispensing system, underground or aboveground ancillary equipment and containment system. B. Bodily Injury means physical injury, or sickness, disease, mental anguish or emotional distress, sustained by any person, including death resulting therefrom. H. Environmental Laws means any applicable federal, state, provincial or local law pursuant to which the Insured has or may have a legal obligation to pay for Corrective Action or Cleanup. R. Underground Storage Tank System means a tank or tanks operated by the Insured, including any connected underground or aboveground piping, dispensing system, underground ancillary equipment and containment system: 1. that are on, within, or under a location designated in Item 5 of the Declarations and that are designated in Item 6 of the Declarations; and 2. that are used solely to contain Regulated Substances. Each tank in an Underground Storage Tank System, including associated underground piping connected to the tank, must have at least ten (10) percent of its volume beneath the surface of the ground. 4. Section IV. EXCLUSIONS, paragraphs A, Band D are deleted in their entirety and replaced with the following, respectively: A. arising from Pollution Conditions existing prior to the inception of this Policy and not disclosed in the application for this Policy, if the Insured knew or reasonably could have expected that such Pollution Conditions could give rise to a Claim, Corrective Action, or Cleanup. B. due to or for any punitive, exemplary or the multiplied portion of multiple damages, or any civil or administrative fines, penalties or assessments, except where such damages, fines, penalties or assessments are insurable by applicable law; or any criminal fines, penalties or assessments. D. arising out of the ownership, maintenance, use, operation, loading or unloading of any automobile, aircraft, watercraft or rolling stock, except that this exclusion does not apply to Claims arising out of the loading or unloading from or to any automobile at locations designated in Item 5 of the Declarations. 74553( 11/99) -~~-- ---- "'" 5. Section IV. EXCLUSIONS, paragraphs F, N., and 0., are deleted in their entirety. 6. Section V. LIMITS OF LIABILITY AND DEDUCTIBLE, is deleted in its entirety and replaced with the following: A. The Company's total liability: 1. for all Losses from Claims first made against the Insured and reported; and 2. for all costs for Corrective Action from Claims first reported by or on behalf of the Insured; and 3. for all costs for Cleanup from Governmental Orders first made against the Insured and reported by or on behalf of the Insured as a Claim in writing to the Company during the Policy Period and including the Extended Reporting Period, if applicable, shall not exceed the limit of liability shown in Item 3 as applicable to the "Aggregate Limit". The purchase by the Named Insured of an Extended Reporting Period, pursuant to Section V. of this Policy, shall not serve to reinstate or increase the "Aggregate Limit" limit of liability. B. Subject to Paragraph A. above, this Policy is to pay any Loss, or any costs as a result of any Corrective Action or Cleanup. in excess of the deductible amount shown in Item 4 of the Declarations, up to but not exceeding the limit of liability shown in Item 3 of the Declarations as applicable to the "Each Incident" limit of liability. However, regardless of the number of Claims, claimants, or Insureds, the total liability of the Company for all Claims, during one or more policy periods, resulting either in Loss, or in costs for Corrective Action or Cleanup, or in any combination thereof, and arising out of the same, interrelated, associated, repeated, or continuous Pollution Conditions, shall be considered one incident, subject to the "Each Incident" limit of liability shown in Item 3 of the Declarations of the Policy in effect when the first such Claim was made and reported to the Company. Such Claims shall be deemed first reported to the Company during the policy period in which the first such Claim was first reported to the Company or an affiliate. C. For each Claim under Coverage A., Coverage B. or Coverage C., or under any combination of Coverage A., Coverage B. and or Coverage C., one deductible amount as shown in Item 4 of the Declarations shall apply collectively to the "Each Incident" limit of liability shown in Item 3 of the Declarations. However, the deductible amount does not reduce either the "Each Incident" limit of liability or the "Aggregate Limit", unless the Insured fails to reimburse the deductible amount. Such costs within the deductible amount are to be assumed by the Insured, and any payment of such costs by the Company is subject to prompt reimbursement by the Insured. 7. Reference in Item 3 of the Declarations page to "Aggregate Defense Expense Limit" is deleted. All other terms, conditions and exclusions shall remain the same. f1,.(", II 4.~~-~ AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 74553(11/99) For use with Storage Tank Third-Party Liability, Corrective Action and Cleanup Policy Form No. 56101(7/93) or 56099(7/93) Endorsement NO.8 This endorsement, effective 12:01 AM, November 9,2002 Forms a part of policy No. FPl8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY DATE RECOGNITION ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUllY. THIS ENDORSEMENT MODIFIES INSURANCE UNDER THE FOllOWING: Cleanup Cost Cap Insurance Contractors Operations and Professional Services Environmental Insurance Contractors Pollution Liability Professional Services Environmental Insurance Agriculture Cooperative PLL PLL for the Horticulture Industry Owner's Protective Environmental Insurance Automobile Dealer's PLL Secured Creditor Impaired Property PLL Select Storage Tank Third Party Liability, Corrective Action and Cleanup Policy Commercial General Liability and PLL Commercial General Liability and Professional Liability Supplemental Environmental Automobile Liability Coverages under this Policy do not apply to any damages, claims, loss, costs, expenses, bodily injury, property damage, personal injury, advertising injury arising from: A. Any actual or alleged failure, malfunction or inadequacy of: (1) Any of the following, whether belonging to any Insured or to others: (a) Computer hardware, including microprocessors; (b) Computer application software; (c) Computer operating systems and related software; (d) Computer networks; (e) Microprocessors (computer chips) not part of any computer system; or (f) Any other computerized or electronic equipment or components; or (2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in Paragraph A(1 )(a)-(f) of this endorsement due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond. B. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in Paragraph A. of this endorsement. 70632(5/98) -~,~-~- ;..;."';;': Such damages, claims, loss, costs, expenses, bodily injury, property damage, personal injury, advertising injury are excluded regardless of any other cause or event that contributes concurrently or in any sequence to the damages, claims, loss, costs, expenses, bodily injury, property damage, personal injury, advertising injury. We will not pay for repair, replacement or modification of any items in Paragraph A(1 )(a)-(1) and Paragraph B. of this endorsement to correct any deficiencies or change any features. All other terms, conditions and exclusions remain the same. f1,.,/,,1 ".!:.~a_~. AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 70632(5/98) '~$ ENDORSEMENT #9 I , This endorsement, effective 12:01 AM November 9, 2002 Forms a part of policy No. FPL8084255 Issued to: CITY OF WINTER SPRINGS By: COMMERCE & INDUSTRY INSURANCE COMPANY Per Location Limits of Liability. Defense Expense Limits and Deductibles Endorsement In consideration of the premium charged, it is hereby agreed that Section V. of the policy jacket, "Limit of Liability and Deductible," is deleted in its entirety and replaced with the following: V. LIMIT OF LIABILITY AND DEDUCTIBLE A. The Company's total liability arising from Pollution Conditions at anyone location designated in the Declarations: 1. for all covered Losses from Claims first made against the Insured and reported; and 2. for all covered costs for Corrective Action from Claims first reported by or on behalf of the Insured; and 3. for all covered costs for Cleanup from Governmental Orders first made against the Insured and reported by or on behalf of the Insured as a Claim in writing to the Company during the Policy Period and including the Extended Reporting Period, if applicable, shall not exceed the limit of liability shown below as applicable to the "Aggregate Limit" for each such location. The purchase by the Named Insured of an Extended Reporting Period, pursuant to Section VI. of this Policy, shall not serve to reinstate or increase the "Aggregate Limit" limit of liability applicable to any and all locations designated in the Declarations. B. Subject to Paragraph A. above, this Policy is to pay any Loss, or any costs as a result of any Corrective Action or Cleanup, arising from Pollution Conditions at anyone location, in excess of the applicable deductible amount shown below, up to but not exceeding the limit of liability shown below as applicable to the "Each Incident" limit of liability for each such location. However, regardless of the number of Claims, claimants, or Insureds, the total liability of the Company for all Claims, during one or more policy periods, resulting either in Loss, or in costs for Corrective Action or Cleanup, or in any combination thereof, and arising out of the same, interrelated, associated, repeated, or continuous Pollution Conditions, shall be considered one incident, subject to the "Each Incident" limit of liability and "Aggregate Defense Expense Limit" of liability shown in Item 3 of the Declarations of the policy in effect when the first such Claim was made and reported to the Company. Such Claims shall be deemed first reported to the Company during the policy period in which the first such Claim was first reported to the Company or an affiliate. 1of2 60300 (5/94) l r' .. c. '~1~ The most the Company will pay in defending anyone Claim and all Claims under Section I., Coverage D: Defense, is shown below as applicable to the "Aggregate Defense Expense Limit" for each such location. Each payment or reimbursement the Company makes in defending a Claim under Section I., Coverage D: Defense, reduces the "Aggregate Defense Expense Limit" applicable to such location but does not reduce the "Aggregate Limit" shown below applicable to such location. For each Claim under Coverage A., Coverage B. or Coverage C., or under any combination of Coverage A., Coverage B. and or Coverage C., and arising from Pollution Conditions at anyone location designated in the Declarations, one deductible amount shown below as applicable to the location shall apply collectively both to the "Each Incident" limit of liability and to the "Aggregate Defense Expense Limit" shown below as applicable to that location. However, the deductible amount does not reduce either the "Each Incident" limit of liability or the "Aggregate Defense Expense Limit", unless the Insured fails to reimburse the deductible amount. Such costs within the deductible amount are to be assumed by the Insured, and any payment of such costs by the Company is subject to prompt reimbursement by the Insured. LOCATIONS: See endorsement #1, covered locations, scheduled sites/tanks. D. Each Incident Aggregate Limit Limit Aggregate Defense Expense Limit Deductible $1,000,000 $1,000,000 (N/A See endorsement #7) $10,000 f1,./,,1 "-I:.~r-~' AUTHORIZED REPRESENTATIVE or countersignature (where required by law) 60300 (5/94) 'f::/. -'!ff"" . , , .,. CERTIFICATE OF INSURANCE NAME: CITY OF WINTER SPRINGS ADDRESS: 1126 SR 434 EAST,WINTER SPRINGS, FL 32708, POLICY NUMBER: FPL8084255 ENDORSEMENT: N/A PERIOD OF COVERAGE: FROM November 9, 2002 TO November 9, 2003 NAME OF INSURER: COMMERCE & INDUSTRY INSURANCE COMPANY ADDRESS OF INSURER: 70 PINE STREET, NEW YORK, NY, 10270 NAME OF INSURED: CITY OF WINTER SPRINGS ADDRESS OF INSURED: See item 1, Certification, below CERTIFICATION 1. COMMERCE & INDUSTRY INSURANCE COMPANY, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): Covered Location(s): * SEE ENDORSEMENT #1, COVERED LOCATIONS, OF POLICY INDICATED ABOVE Forcorrective action and compensating third parties for bodily injury and property damage caused by sudden accidental releases and non-sudden accidental releases, in accordance with and subject to the limits of liability, exclusions, conditions and other terms of the policy arising from operating the underground storage tank(s) identified above. The limits of liability are $1,000,000 each loss $1,000,000 total for all losses exclusive of legal defense costs which are subject to a separate aggregate under the policy. This coverage is provided under Policy Number FPL8084255 The effective date of said policy is November 9, 2002. The insurer further certifies the following with respect tot he insurance described in Paragraph 1: a. Bankruptcy or insolvency of the insured shall not relieve the insurer of its obligations under the policy to which this certificate applies. b. The insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or damaged third party with a right of reimbursement by the insured for any such payment made by the insurer. c. Whenever requested by a Director of an implementing agency, the insurer agrees to fumish to the Director a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the insurer, except for non-payment of premium and misrepresentation by the insured, will be effective only upon written notice and only after the expiration of sixty (60) days after a copy of such written notice is received by the insured. Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of ten (10) days after a copy of such written notice is received by the insured. .. , I . e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability, and exclusions of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97 (b) (2) and that the insurer is licensed to transact the business of insurance in one or more states. f1,.,1", If ~~6_~ Authorized Representative of Insurer Florida Petroleum Liability Insurance Program Administrators, Inc. P.O. BOX 1947 COCOA, FL 32923-1947 .. , ' -4 NOTICE OF LOSSINOTICE OF CLAIM STORAGE TANK AIG Technical Services, Inc. Environmental Claims 80 Pine Street - 6th Floor New York, NY 10005 Attention: Manager, Pollution Insurance Fax #: (212) 344-2761 If Notice of Loss/Notice of Claim is sent by fax, please also provide notice by mail. Any person who knowinaly files a statement of claim containina any false or misleadina information is subiect to criminal and civil penalties. DATE OF NOTICE: INSURED: CITY OF WINTER SPRINGS 1126 SR 434 EAST WINTER SPRINGS. FL 32708* Telephone: Contact: BROKER: Morefar Marketing Inc. 501 Carr Road Wilmington, DE 19809 POLICY INFORMATION: Policy No.: FPL8084255 Effective Date: November 9, 2002 Limit of Liability: $1,000,000 Each Loss $1,000,000 Total all Losses Self-Insured Retention/Deductible: $10,000 Expiration Date: November 9, 2003 LOSS INFORMATION: Insured Location: Date and Description of Loss: Date Claim Notice Received: Date of Claim: Company/Person Filing Suit: t ~. 1 . v COMMERCE AND INDUSTRY INSURANCE COMPANY (a Stock Company, herein called the Company) 70 PINE STREET NEW YORK, NEW YORK 10270 STORAGE TANK THIRD-PARTY LIABILITY CORRECTIVE ACTION AND CLEANUP POLICY NOTICE This policy has certain provisions and requirements unique to it and may be different from other policies the Named Insured may have purchased. This is a Claims-Made-and-Reported policy with respect to third party off-site liability coverage and cleanup coverage for aboveground storage tanks, and a Release-Reported form with respect to corrective action coverage for underground storage tanks. This policy is site-specific: only scheduled tanks at scheduled locations are covered. Please read the entire policy carefully to determine the Insured's rights, duties, and what is and is not covered. Various provisions throughout this policy restrict or exclude coverage. Defined terms appear in bold face type. In consideration of the payment of the premium, in reliance upon the statements in the Declarations and Application made part hereof and subject to all the terms of this Policy, the Company agrees with the Named Insured as follows: I. INSURING AGREEMENT COVERAGE A: THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE. Subject to the applicable limits of liability and the deductible, the Company agrees to pay Loss on behalf of the Insured that the Insured is legally obligated to pay as a result of Claims first made against the Insured and reported to the Company, in writing, during the Policy Period or during the Extended Reporting Period if applicable, for Pollution Conditions Emanating From the locations designated in Item 5 of the Declarations which result beyond the boundaries of such locations in Bodily Injury or Property Damage. The Pollution Conditions must be unexpected and unintended from the standpoint of the Insured and must commence on or after the Retroactive Date shown in Item 7 of the Declarations. COVERAGE B: CORRECTIVE ACTION DUE TO UNDERGROUND STORAGE TANK. RELEASES. Subject to the applicable limits of liability and the deductible, the Company agrees to pay on behalf of the Insured reasonable and necessary costs that the Insured is legally obligated to pay for Corrective Action due to ConfIrmed Releases resulting from Pollution Conditions from an Underground Storage Tank System which are unexpected and unintended from the standpoint of the Insured. The Pollution Conditions must commence on or after the Retroactive Date shown in Item 7 of the Declarations. Claims reporting a ConfIrmed Release must be first reported to the Company, in writing, during the Policy Period or during the Extended Reporting Period, if applicable. COVERAGE C: CLEANUP DUE TO ABOVEGROUND STORAGE TANK. RELEASES. Subject to the applicable limits of liability and the deductible, the Company agrees to pay on behalf of the Insured reasonable and necessary costs that the Insured is legally obligated to pay for Cleanup of Pollution Conditions from an Aboveground Storage Tank, as a result of a Governmental Order. The Pollution Conditions must be unexpected and unintended from the standpoint of the Insured and must commence on or after the Retroactive Date shown in Item 7 of the Declarations. During the Policy Period, or during the Extended Reporting Period, if applicable, both the Governmental Order must first issue against the Named Insured and the Claim reporting the Governmental Order must be first reported to the Company, in writing. 56101(7/93) 1 1" t . ;" \ "-"'~, ,. "-;";-II':~~, ,:(,";:;'f.I1W-;';"'-:G'\-~'1 '\'_';'" ~' 2. When a Claim under Coverage A., Coverage B. or Coverage C. has been made, the Insured must forward to the Company as soon as practicable after receipt, or receipt by its representative or agent, of the following: a. All technical reports, laboratory data, field notes or any other documents generated by or on behalf of the Insured to investigate or abate a Pollution Condition or to implement Corrective Action or Cleanup. For Claims under Coverage B., the Insured shall also forward documentation of the release detection tests or procedures, such as system tightness tests or site checks, undertaken to investigate a suspected Pollution Condition and verify that a Confirmed Release has taken place. b. All correspondence between the Insured and any third party claimant, including but not limited to any Implementing Agency; c. All demands, summons, notices or other processes or papers from a court oflaw, administrative agency or an investigative body; d. All expert reports, investigations and data collected by experts retained by the Insured whether or not the Insured intends to use the material for any purpose; and e. Any other information developed or discovered by the Insured concerning the Claim whether or not deemed by the Insured to be relevant to the Claim. B. No costs, charges and expenses incurred in the defense, investigation, or adjustment of Claims, proceedings or suits to which Section 1., Coverage D: Defense applies shall be incurred without the Company's consent. No costs of preparing, developing, modifying or implementing a corrective action plan undertaken as part of a covered Corrective Action, shall be incurred without the Company's consent. C. The Insured shall not admit or assume any liabilities or settle any Claims without the Company's consent. D. The Company may at its discretion investigate any Pollution Condition or Confirmed Release and settle any Claim under Coverage A. for Loss or any suit or proceeding under Coverage B. for Corrective Action or under Coverage C. for Cleanup. E. The Insured, on demand of the Company, shall promptly reimburse the Company for any element of the Loss or costs for Corrective Action or Cleanup falling within the Insured's deductible, as described in Section V., LIMIT OF LIABILITY AND DEDucrmLE. F. The Insured shall cooperate with the Company to the fullest extent possible by providing the assistance necessary to adjust, investigate and defend the Claim under Coverage A., Coverage B. and/or Coverage C. The Insured agrees to provide the Company free access to interview any employee, agent, representative or independent contractor of the Insured and to review any of the Insured's documents concerning the Claim. 56101(7/93) 3 . t . , 2. The cleanup, pursuant to a Governmental Order from the Implementing Agency and with the prior written approval of the Company, of a Pollution Condition from one or more Aboveground Storage Tank(s), including the preparation, development, modification and implementation of a corrective action plan, and the monitoring, evaluation and reporting of the results of the implementation of such plan. E. Confirmed Release means a Pollution Condition from an Underground Storage Tank System that has been investigated and confirmed by or on behalf of the Insured utilizing a system tightness check, site check or other procedure approved by the Implementing Agency in accordance with 40 C.F.R. 280.52 or another applicable federal or state regulation or state statute. F. Corrective Action means: 1. Response, abatement, investigative, and removal actions resulting from a Confirmed Release as legally required by Subpart F of the federal underground storage tank regulations, 40 C.F.R. 280.60 through 280.66, and 280.72, or as legally required by other applicable federal regulations or by other applicable regulations promulgated by a state under an underground storage tank program approved by the federal Environmental Protection Agency in accordance with section 9004 of the Resource Conservation and Recovery Act of 1976, as amended; 2. The cleanup, pursuant to a written order from the Implementing Agency and with the prior written approval of the Company, of Regulated Substances in soil or groundwater due to a Confirmed Release, including the preparation, development, modification and implementation of a "corrective action plan" as defined in 40 C.F.R. 280.66, and the monitoring, evaluation and reporting of the results of the implementation of such plan. G. Emanating From means directly and immediately releasing, dispersing or escaping from and originating from an Aboveground Storage Tank or an Underground Storage Tank System that is on or within a location designated in Item 5 of the Declarations. H. Environmental Laws means one or more of the following statutes, any amendments thereto, any regulations promulgated thereunder, and any similar statutes, amendments or regulations of any state or province or political subdivision thereof, of the United States or Canada in effect at the commencement of the Policy Period: Comprehensive Environmental Response Compensation, and Liability Act of 1980 (CERCLA), as amended by the Superfund Amendments and Re authorization Act of 1986 (SARA), 42 U.S.C. 9601-9675; Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976 (RCRA), 42 U.S.C. 6901-6992K; Federal Water Pollution Control Act, 33 U.S.C. 1251-1387. I. Governmental Order means an order, including any governmental directive, lawfully issued against the Insured by an Implementing Agency or other governmental agency or court having jurisdiction over the locations designated in Item 5 of the Declarations and acting under authority granted by Environmental Laws. J. Implementing Agency means the federal Environmental Protection Agency (E.P.A.) or a state or local agency having jurisdiction over the Aboveground Storage Tank(s) pursuant to applicable Environmental Laws, or over the Underground Storage Tank System(s) pursuant to an underground storage tank program approved by the federal E.P.A. in accordance with section 9004 of the Resource Conservation and Recovery Act of 1976, as amended, or other applicable statute. K. Insured means the Named Insured, and any director, officer, partner or employee thereof while acting within the scope ofhis/her duties as such. 56101(7/93) 5 ,;~.;;,~~;:r::'::~;'~-";j:'\~i'~~:-:;::: . . . f I. that are on, within, or under a location designated in Item 5 of the Declarations and that are designated in Item 6 of the Declarations; and 2. that are used solely to contain Regulated Substances. Each tank in an Underground Storage Tank System, including associated underground piping connected to the tank, must have at least ten (10) percent of its volume beneath the surface of the ground. IV. EXCLUSIONS This insurance does not apply to Claims: A. arising from a Pollution Condition existing prior to the inception of this Policy, if any employee of the Named Insured responsible for environmental affairs, control or compliance or any manager, supervisor, officer, director or partner of the Named Insured knew or could have reasonably foreseen that such Pollution Condition could have been expected to give rise to a Claim. This exclusion does not apply to such Pollution Conditions which commenced during the term of a prior storage tank pollution liability policy issued by the Company or an insurance company which is a member company of American International Group, Inc. (hereinafter "affiliate"), provided that: 1. the Insured has maintained storage tank pollution liability insurance with the Company or its affiliate on a successive and uninterrupted basis for the periods succeeding the Pollution Condition; and 2. the Insured made full and complete disclosure of such Pollution Condition on each renewal application for storage tank pollution liability insurance with the Company or its affiliate. However, none of the preceding provisions (i) shall restrict or prevent the Company from exercising its right to cancel or non renew either this Policy or the coverage for a particular Aboveground Storage Tank or Underground Storage Tank System designated in Item 6 of the Declarations; or (ii) shall be deemed to reinstate or increase any of the limits of liability shown in Item 3 of the Declarations. B. for any punitive, exemplary or multiplied damages or statutory assessments, or any civil, administrative or criminal fines or penalties. C. arising from Pollution Conditions based upon or attributable to the Insured's intentional, knowing, willful or deliberate noncompliance with any statute, regulation, ordinance, administrative complaint, notice of violation, notice letter, executive order, or instruction of any governmental agency or body. D. arising out of the ownership, maintenance, use, operation, loading or unloading of any aircraft, watercraft, rolling stock, or automobile or any other land motor vehicle, trailer or semi-trailer designed for travel on public roads including any machinery or apparatus attached thereto. E. for costs, charges or expenses incurred by the Insured for goods supplied by the Insured or services performed by the staff and/or salaried employees of the Insured, or its parent, subsidiary or affiliate, unless such costs, charges or expenses are incurred with the prior written approval of the Company at its sole discretion. 56101(7/93) 7 . . a) with respect to which an Insured under this Policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or b) resulting from the Hazardous Properties of Nuclear Material and with respect to which (i) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (ii) the Insured is, or had this Policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. 2. for Bodily Injury, Property Damage, Corrective Action or Cleanup resulting from the Hazardous Properties of Nuclear Material, if a) the Nuclear Material (i) is at any Nuclear Facility owned by, or operated by or on behalf of, an Insured or (ii) has been discharged or dispersed therefrom; b) the Nuclear Material is contained in Spent Fuel or Waste at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an Insured; or c) the Bodily Injury, Property Damage, Corrective Action or Cleanup arises out of the furnishing by an Insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any Nuclear Facility, but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (c) applies only to Property Damage to such Nuclear Facility and any property thereat. 3. As used in this exclusion: "Hazardous Properties" include radioactive, toxic or explosive properties; "Nuclear Material" means Source Material, Special Nuclear Material or By-Product Material; "Source Material," "Special Nuclear Material," and "By-Product Material" have the meanings given them in the Atomic Energy Act of 1954 or in any law, amendatory thereof; "Spent Fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a Nuclear Reactor; "Waste" means any waste material (a) containing By-Product Material and (b) resulting from the operation by any person or organization of any Nuclear Facility included within the definition of Nuclear Facility under paragraph (a) or (b) thereof; "Nuclear Facility" means (a) any Nuclear Reactor; 56101(7/93) 9 . . ( interrelated, associated, repeated, or continuous Pollution Conditions, shall be considered one incident, subject to the "Each Incident" limit of liability and "Aggregate Defense Expense Limit" of liability shown in Item 3 of the Declarations of the policy in effect when the first such Claim was made and reported to the Company. Such Claims shall be deemed fIrst reported to the Company during the policy period in which the fIrst such Claim was fIrst reported to the Company or an affIliate. C. The most the Company will pay in defending anyone Claim and all Claims under Section I., Coverage D: Defense, is shown in Item 3 of the Declarations as applicable to the "Aggregate Defense Expense Limit". Each payment or reimbursement the Company makes in defending a Claim under Section I., Coverage D: Defense, reduces the "Aggregate Defense Expense Limit" but does not reduce the "Aggregate Limit". D. For each Claim under Coverage A., Coverage B. or Coverage C., or under any combination of Coverage A., Coverage B. and or Coverage C., one deductible amount as shown in Item 4 of the Declarations shall apply collectively both to the "Each Incident" limit of liability and to the "Aggregate Defense Expense Limit" which are shown in Item 3 of the Declarations. However, the deductible amount does not reduce either the "Each Incident" limit of liability or the "Aggregate Defense Expense Limit", unless the Insured fails to reimburse the deductible amount. Such costs within the deductible amount are to be assumed by the Insured, and any payment of such costs by the Company is subject to prompt reimbursement by the Insured. VI. EXTENDED REPORTING PERIOD The Named Insured shall be entitled to purchase an Extended Reporting Period upon termination of coverage as defmed herein. A. A Claim under Coverage A. fIrst made and reported, or a Claim under Coverage B. or Coverage C. fIrst reported, within the Extended Reporting Period if purchased in accordance with the provisions contained in Paragraph B. of this Section, will be deemed to have been made and or reported on the last day of the Policy Period, provided that the Claim arises from a Pollution Condition that commenced on or after the Retroactive Date shown in Item 7 of the Declarations and before the end of the Policy Period. B. The Company shall issue an endorsement providing an Extended Reporting Period of 12 months from termination of coverage hereunder for all covered locations or any specifIc locations listed in Item 5 of the Declarations provided that the Named Insured: 1. makes a written request for such endorsement which the Company receives within 30 days after termination of coverage as defIned herein; and 2. pays the additional premium when due. If that additional premium is paid when due, the Extended Reporting Period may not be canceled, provided that all other terms and conditions of the Policy are met. C. Termination of coverage occurs: 1. At the time of cancellation or nonrenewal of this Policy by the Named Insured or by the Company; or 56101(7/93) 11 :,,_._-._,--c:n"";""'!?",C',.~i':"f.'- "l'~.pji'~~'~~<r'-- . . , D. Action Against Company - No action shall lie against the Company, unless as a condition precedent thereto, there shall have been full compliance with all of the terms of this Policy, nor until the amount of the Insured's obligation to pay shall have been finally determined either by judgment against the Insured after actual trial or by written agreement of the Insured, the claimant and the Company. Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this Policy to the extent of the insurance afforded by this Policy. No person or organization shall have any right under this Policy to join the Company as a party to any action against the Insured to determine the Insured's liability, nor shall the Company be impleaded by the Insured or his legal representative. Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company of any of its obligations hereunder. E. Assignment - This Policy shall not be assigned without the prior written consent of the Company. Assignment of interest under this Policy shall not bind the Company until its consent is endorsed thereon. F. Subrogation - In the event of any payment under this Policy, the Company shall be subrogated to all the Insured's rights of recovery therefor against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The Insured shall do nothing after a Claim to prejudice such rights. Any recovery as a result of subrogation proceedings arising out of a Loss or out of costs for Corrective Action, caused by Pollution Conditions under this Policy after expenses incurred in such subrogation proceeding are deducted by the party bearing the expense shall accrue to the Insured and the Company in proportion to each amount actually paid as a result of judgment, settlement or defense of a Claim for Bodily Injury, Property Damage, Corrective Action, or Cleanup Costs. G. Changes - Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this Policy or estop the Company from asserting any right under 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. H. Sole Agent - The Named Insured first listed in Item 1 of the Declarations shall act on behalf of all other Insureds, if any, for the payment or return of premium, receipt and acceptance of any endorsement issued to form a part of this Policy, giving and receiving notice of cancellation or nonrenewal, and the exercise of the rights provided in the Extended Reporting Period clause. I. Other Insurance - Where other insurance is available to the Named Insured for Losses or for costs for Corrective Actions or Cleanups covered under the terms and conditions of the Policy, the Company's obligation to the Insured shall be as follows: 1. This insurance shall apply as excess insurance over any other valid insurance, whether collectible or not, be it primary or excess. This excess insurance shall in no way be increased or expanded as a result of the receivership, insolvency, or inability to pay of any insurer with respect to both the duty to indemnify and the duty to defend. This also applies to the Insured while acting as a self-insured for any coverage. 2. Where this insurance is excess insurance, the Company will pay only its share of the amount of Loss and costs for Corrective Action or Cleanup, if any, that exceeds the total amount of all such valid insurance, whether collectible or not. The Insured shall promptly upon request of the Company provide the Company with copies of all policies potentially applicable against the liability covered by this Policy. 56101(7/93) 13 .;If TIES FAX NO. 407 317 7181 O~JT'-09-2002 lIED 03:48 PM FLORIDA LEAGUE OF CI 4259378 \, ~ ~33 1293 TO 1407. FPLIPA 321 OCT 08 2002 13:13 FR p, 04 P.A5/14 r"L.llClA255 Eft. 0.18; l1/A102"1~ Ch) CIIAIHDlJ8Tf1y (I....1n OIlled ... Co~."y) T)nll.AN ~"~OATlON!'OR A a.AI~DE POUCY. S''rORME TANI< 11-lJAO PAAl)'"lIASILJ1Y ~F1ECTlVE ACTION AND Ct..EANUP roucY NoncE: PI.EASI! "Haw."...u. QUl!lll0Nfi. ATTACH 4DDI'tIONAlIHIITS 0," P4PI!" IF NEcaUftY, THfG r(JU(~Y PROVIDES OEPfiflfr./.': I:XPI!NSI!S 8I:iPAAA"c fl'~M TliG LIMIT 011 LIABIUTV n-tA'r A1>Pll~ TO LOSS, COAAECTI\IE ACTION AP-lD ClEANII~ C091'a, NOll; THAr A-"OUNTllINCU,.AfD FOA lEGAL D!'F!N9.I! BH,l,U. at:: AF-PUeO AGAINST THE OEDUCllBLE AMOIJNT. 1 Namee 'n~urfJCl; ..oo:Y OP wt~R S~INq8_ 2 Insurad's AddrMli: ~_8ft 4S4 U&. l:ily,"lale, 7jp: JYI.Jm!B~"INGS. &.J27--..!!- PtlIlIlO=-___.__.-___ 401.147-1800 FlVC: 401-327""7" - -..) {::>. r <<-,,-.~\ 3. f'iQaSG ~idO ~ ~y plol for Ilia 'diy, 'f...... lII'ct ~ t.nkI. ~ (""" J \ 4. 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FI'\c:illty I,D, #: 8520'l1~_ Facility Name; PUBLIC WORKS Fncility Adllrats: l~t ST. & N FLAMINGO AVE Faoility Type: .LOCAL GOVERNMENT ~NTEA S~AINGS, FL 32708 Dl~ you (Circle on Opllr2lta tAIl.. thl. fadltty? If not awned, pltllse name ttMa C)wnlr. STORAGE TANK & lOCA liON BCHBDUt.! (Co"'PfeM schIduhl ,.llh symbol. '-'ow ....__..L_~ '--~- 3 4 5 ------ __om. IW!U ______.__........____ -- - --- - ~~.@~l_.___.__.__ ___w, . .-- l~!~~lty~t!t_~___~ .~ ___t~tS .- r~I~Q..a!~.L___.__ ._,,--~-_.. QQDI.cn!!...___.__._ ____p. L~~~p!1..M!!t!;~____ I ,. ~ - 9.~~~p]L~~______ ____--A-__ - .. rim~ kl!3k.Qi!.~19n..._._ __..._---11__._ {\[LQ.lJ!i~~~ID)J.!1!IQ~_ -- _. elQ1U!.1.(l9!.!e~tIOfl M~~.___ __'40__.-._ ----- -- Nr>!I',l'lwk Or,IOCllon - .ClllthlAlI. 171. Ul1ht.dliod Gun""" C. (~lIl<lhol O,,r .,O.Jt 0;01001 1<. K"Q&l:'''b t.. W\I$llI OW Uocld OM ... MItt! 01 P. OIlnMlc aasallno O.l'tl{lIdtl;l A, t\n\ffll\nle (,OftlpllUlld iii. Chlo",,, OOtt1pwnd 1.I-tn. ~lIbslilllOd (CeRCL/IJ IJ. 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'ft"-NfiIJeI MonIlomg 01 daubl....... pl~ Y. 8UCltlon P\Jmo Cheolc Valli' _~'-;r;."-'-::T, FAX NO. 407 317 7181 433 1083 TO 1487~2S937e P. 08 OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITI;~l -,-)M.~~ 1~:14 FR FPLIPA OCT 89 ~I\<.lr;;. oJ . . ., P.09/J4 1.t. &rORACp. rA.NK, l.oc~nON SCHEDULE: Copt.nd Itlallll Iddltltl'llI....(.1f 1'I00000uy. F~.:ility 1.0. ..; 90'5b75 F.c:alty N.",.: .wATER ~ SEWER F<\Clli~ ^ddr8~: &11 NQJi'tH~N WAY P'acflftyType; .1QQ&.GOVEFlNAAM ~~R SPRINQS,~ Do WlIllCl,.:lu Own Operal. L... tlIlI fIofPIy7 n not ...,., pI_ "11118 lhe owner. t.a.YIOH 1OiIDULe: (QOflI.... 8flf1Mulawlllt IIWIlI"'1IoIIa1ll I--_._.m.......____....._ 1----1._ .~ ! 4 1; M~"._._~_.____... ..- - ,,- ~L...._____ .lRT ----- --.--- -- ~.!lL'!P/iC" _...._____ -..!Dt ("-JI.l.BIill'..L~~____._._.._ -..-.... 2IId6 -- - C;\JflI~___.,,_...~_ ._. ~. 1------. - ril'.lL.~~.r.u~.. -L_._ ---- 1--..-- ~~!f.r.gI!!lttklQ.___.__ ..... 1.10 --~ - !a!1ltl.....tc o.lur;lioO "_'___ '--~.- -. 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UST willi SlOCClrldaty Cln.lr1nllIl'll IS, 'nut"", LinINI In E,lTl-Pi CMuftl~1I P(JIllalJon A. a.u Chedc V.t4 M. 1Ip* CenlarNMnllludltt H. ~ ShIlI-DlI O. llthl Fil ,. Lavlllli....O*I. lilj)/\ 1A-tIel AI&ml8 a. 0Ih8t ePMlEP ApptavDd Pftl~ fo\8lhod -"IT bid"; ... II... e-AltueUaQ I(. Concnlrl, 8vnhlle ......I!ar. _. a. Ollw 15"""DEP 1Pfll\':lq(f ncDldIrj r:o/U~1t ,",1m 2.DlI1itaIth PIaIna CanatQ.....n" Uao'4rl:lll U.StIII Co fU(g/uo ~.,M. Doub/e wllfld ~. AQpllll/ld 8~ MIlIJrllll 2. ou., EPAIDF.P Mpl'01lld ~"" Malo... D. ~mel Pl'lllaalhl. CoaUng Eo CJP lIft1t\.~ .~lld8 tJI h'4IrMlld curflnt l'lI,lIt La." o..Ioc;tlP<l H. OI'llUIlIIWIlar Uonllnrlng w.n. I. Inl8rl111111 Woniroring O. VJ90r "OIIIIor~ We'. a. VltlltllncoecnGl\ll 0/ I<9T gyl6el!lll Z. Olh.r EPAJO!!p ApplOlled D. 8POO II.." . ~ F. '"beltlillal Sp.... . Ouuble Wlllled T8I1" ... ....1UlI1 Tlr4t aavg~O . US,. Ii. SllllllfOlllMnlllty R8Ctlncllillllan'SIR)IUS'ra) L .l\.tornllHo TI\I1< Qauglrog Syt"" lUST,) II, l"leIVrJlial M~lon~ 01 A9T rink 8clIIDll'l T. AllI'UlllT_""',. T..t ...I\h Jrrz-I!llY (~.l !IIIf1llll..,1t ~UqQ Q. El8Dtl'llnic Lin. LNk tlIfeclar I'IIIIh I'low ~lDIr J. /nhntlliall\4orilclltl"Q . Piping ,.lter s.. ~maJ MonlIO"1'(I It MIIdlanletll Un, Leak o..lot Sysllm (US K. 1""IWi'1Ia1 Monhlll1nll or dal,jbl. ..IIV ~1I'l~ V. Sulllion P\Il'l\P OlecJc Va"'. .$ 'i 10 . OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITIES IPA 321 OCT ~0 2002 13:1~ FR FPL FAX NO. 407 317 7181 ~33 1893 TO 14074258378 P. 09 P.1B/14 U. tiTO""GE 'rANI( l.lOGAnQN SC1ieDU~ Copv anli -tta.---'1 Mllluanal.heots II neoauwy. F!lellitv 1.0.' :.~jQ faoility Name: ~TfP. &. SewER f,\(:\lily Ar.ldl'll~: J.Q.l!!..1Y fJA -i34 FaoKity Type: LOCAl GQ~ERNMEIq Y.l!mA 8P1UNus. JIlL ~ 0/1 you (Cli'tJo 0....... ...... 'hi. tlllll/lIVt II nol"",1Id, pl_ n_ .hI owner. OCATJON $C>>fIDUU (0uMp'-'w1Chld\lll W"ft IJftlbo'e b.low --...L 2 3 4 !S - --"--- -. .-..--- 1----..- ----....." UeT -- -_...._~ 1U1 - - .-...-................-...-- _J.!!1l2._. ---- _0_- ------_. G \--- M~._~.,_ I .~._. "!!.Il___.._ - .~.!l.__._.__.. ...----- ----.. er~!';l~ -...--- --- - .;Q~:~l=i-...~--.-l.-- '!'l1CU__ WlTMV___ .ollll.'!~_ 1)LMJdJ~..t:h:o..l9J;1 .~!J)~.~.b8.!. ~if<1!ln ~ ~.k DollGEL ~ 8. UnI..dood GUt,l~l" (:.. o.a~ha/ o..r.,a.,H. OJ.tel I<.KeI'Cl&8l11 "" W.u.11I 0tV UlIlltI on M. "U81 OU J'. Ollrleria GaalOU(ld 0. "..I/cld. n A~~.~ompou~~ S. Ctllnljn. ~Clul\d T. Hu. 31b&w"" ICEPlCLAl \1. MI"",aj Addu V. Orlr*! "I bunk"" '(., ol1u IN. ""~'b'lKI """"illo X. L(l1lll. !l6IrlllOllM-l1MQ Go (ItMr. (t.l8ncily O. Now I uOa Olf r. ,WQA3 F. .lnl Fu.l 7~9Jf1V991 I.Ii,lt "'-MhtuiJlQD C.SI.MI I:. '1)e1'1l1ul f. f'flP CI..s SiN' X. t;onMlt Y.~,. :I. Olher EPNDF.P AJlpfWott c. ea.... JlIClIlIdiDn SlIlrinct.l ~ H-C.~Pr~,,- IlI'flre....d OlJtlWnl I. tIollbll Wlijed(DW) . SIf\Qlo M.!8rW A, ~ W.\IM (OW). D4IlI ""alllffal J. (OW)Syn1tlUc LJ~8t In Tank tonalnlclion V. (tIW)Pipe\M6 U!1" lMVl t.e.:Nodarv ConIalnlTlelll I. rmlNl Ur\lrIo STI. STl.P3 Q8rfJIIMIIIIl PMtat;Il~ ".Ii' Clwok Va~ W. SpI. Colll.lll'rNlll Bu6k40, N. Flow Shul-olf O. '\1aI1l ",. P. ~t GlUClll', HlcfIl.4-iet AJI/TNI Q. OINt l!PAIOEP Ioporavlld Pro~1\ M-Ittod 1',,"11 u..1t o.lect\llrl N. GlOllnIIwllltlf MDllIltlrinO Weill 10. fntlllllllal AloniIor'IrlQ a. VlrI;1Qr Manlltllll'G WlIVa Q.. VIlli. IIlICel:4lone fIf A9T Sy,Iema Z. om.. a>M:Ja,. ~ n SPoc P.." .An t. Int-.IIII,1 Space . Double W.lllld'Tl1Il( ... ""1ft..., T ank o.~ - UST t. SlaIiItkl.lln<iII'Ila.y AaconaIllatla/l (SJA)(lJST.) L. AuIo".l,b T;aNl GluD"1o SYll~ IUSTa) ...lnloralllblll4ol1l\cril'tg Qf ABT 'rank Bollom T. All..... Ti;ht\"llM teel IlI/Ih I~lm. (~'l " <<lID .u1' n1~ &.,-- pa""lI\w.lll\l1 1(, CMCtlle, 8~lheIJa "'1'lrIII, ~_ I.. OlNr EPAiDEI" ~id ItOCIlIdary IlOn"~ IVMInI %. 0i1tlE1I/ttI PI""'" ~1UI_1"" ......dal ft. Sill' c. FblI'gIllt ".,M. Double _bed N. ~1'll\I.d !ylllhl1ill M.IoI1~1 Z. Ol'-r ~PAIDEP JIflprcwOd Piping Alaltl1al D. !"xNmlll ProflClfllll Coaling E CJP....1tl ~.., anode or ~~ CIJITInt .e.IaJ.aa I Mil rwwtII'lI! a. el~ Unel.1k ~Dl;lllr *Ih II. !'t"lllo/f J. Int"tillll Met\ilDrIng . rillllll Fnl8r I. ~JnlI Monilolfro ... M8d1.~ Une L..ak o.l.~IOf' S'yolam (US K. Inter-till., Manllomg II' cIoubl.. wall pilW'G V. Suction p.,,1Y\) Child< Val~e . . .. FAX NO. 407 317 7181 ~33 1~93 TO 14B74259378 P. 10 OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITIES IPA 321 OCT 09 2002 13:1~ FR FPL . P.11/14 14. a'rOAAGI:i TANK.. LOCATION ICHEDUlE: C'..oP\' and .tt.d1_IIlIlRlI ~hMl.1f ,....~. FGciltty \.0. . : $1:101 1 ~ ______ FIltll1lty Name: CllY WAF FDr.illty Add,e.: ~rJ!lt.SDMD. Blvd Faoill!y Typo: LOCAL GOVERNMENT ~I~ ~P~8. Fl 3~oe OJlllral. "-- .111. fdlV1l1 nlll-nM. ,_ nantlltw ollflur. ST~AQIi T"NK 01:4110N 1ICtt1!DUL. (Calll,letelC'-dlllt w"h aWll1lo1s below ~ . 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SulQle W.lwl R. Doubt.. Wall6d (OW}. Clulll MIII.lilll J. (O~1c Llniot In nnk CPflIlf\lllllar, V. (0Wlf'jpe1a.. lJST with 81WlOndllIV Ooftllllrlrnent .. \tlf8INl Llnlno STl. 3'r10f'3 QwrfjlllCalll ~UDIJ A. stll ~ VaMI N. !\JID contalMlOllt eUclea. ... JIlow StwJf.A/' O.~'/III! ~. ~l o.UgIIi, HI~ ~I All""' O. Ollw f1PAIDI!P ~roV1ld Prol9ation Mit'ad o\5'r' a11dll1l .. nU. CDft&~ J(. QoI'lOnIltI, S)t1l1wric MIIIt"t1. ~1Y8 So Ollw F.PMlJ!P ~roved --ndliry oonllllnnwtlllyAlllm Z. Dirt/E.WI P!aIlIf en~~IlII/1ft "'''M! B.JlDeI C. Fbtrglul F.,Iof. Doutllll wI,1ld H. ~l'llVed Synlf1llic: Ma141<4t1 2. Olher EPJJDEp ~nNod ~'"'" M~...I D.. ElltemN ProlKllole Coalir\g E Clfllofth NOrlrJclll llIOde or Imp_It QJrT'lIr1\ PIDI"17 \JIol~ bioi......., Q. E1lCt1on1a Un. Latlk Deltclor wiltl F'cw ShulOlf 01. InCantUIIII ""'r4lOring . PlPina fl'MLlIr e. ~I r.tanltaring )t. Mechanical U,.,. lalt o.I8tlor SI/Ifam (US K. Inllt,.1tl1l Mgnlltll'lnO 01 doul* waf ~ \" 8ucl\1on Pump Chllck VaIv. bIlI/LIII" ~I~ N. af'l'lu"""'.I~ 14onllOll/l9 Wille ~. 1rt!.rsIiUII MOn/IPring O. VflPOt Monaorirlg Wello 0, \I1l\.loi1llnllpllC'lfana D/ NiT S~ms 1. Other EIDAJOEP AlJl)lDVefl D. spec Pili" . AST' F. Inl4ltlltial $pliCA - DouIll, W.~ link M. MAnual TiNl a.ug;,q . UST I. _UlloIlllMII10'Y Rec,ollllllllllcn rslR>/US'Tf) 1- A111om1~Ta,*QaugJng 8ptern (USTs, It. In""Utill Mo,,'\OIil'lQ of AST Tlnk Ilollolll T. i\rftlal T tghtr,e.. T ~l wjl/lIIl'Jtr!~ (U8TI) 11/lJ OC~-09-2002 WED 03:51 PH FLORIDA LEAGUE OF CITIES A 321 OCT 09 2n~2 13:15 FR FPLIP .,. FAX NO. 407 317 7181 433 1093 TO 1407425937e P. 11 P.12/14 14. StORACE TANK.. LOCA'1l0N actIaaul.l!: Copy end .lWh addlHDNllltlMlA ""--A'Y. r.';lciJlIV 1.0. * : mtta_ F~oMy Nllme: PUBLIC SAFETY BUI~OJt'JG F!lc:llily Addl'6tc: $l...fl1'4 MOSS AO _ FAdIl~ Type: LOCAL GOY;8NMEN1' .W!NTt!Ft Sf1illL~~8 -~ (Clre~"'/, Own Opt..... LM.. u.. flldlll", Wool own.. pi.. ..1M the owner. lTJ'OltA<il'!"'.,.. c"n~ kHEO~ (ComJII.w laMdul. willi .ynlbal. .Iaw >-_.L_ ~ ~ . [, -- '.. ~ -- Tit1llt__________.___ .__ -- -- Lt!rL~.:L-.____ _..__ _ .&lrr . - ~.Qa.lA.Y~_ _"'__~ - 1.7 - ~~'.ffiI1Ill!!l& __...... ._. ,,~__ I-_~.- -,-- C'oCl\(!!!!!!.... _______. 1-____.9_ - !I~~t!Il!IY~M~l!i!1tL._ ~_L. - ~-~"!!.!t!;1i!:l.!L_.___.... -- :...--._. Tl!lltl..l~~l!_._______ ~ y...JL '--- YiLrnIJlQ_U~n le!l[l"I!lll1lI.~ ---.- -- f!&1U~~~!11!..___ --.-... . Plpll1a lll'~ Pelucllon CAnIenll ~. IJt1ladod G6fll'l111'>ll c..~lWuhaI 1\.I'.,Cii.,It, Olll."l k. KIIfOM>I11 L Wa,.. o.v lIJjol1I1 011 fl. f lJ4Il 0tI P. G1i1nar'c Ga.lllln. O. "NlioCkl R. ,,",mol~a OClITl&)tMJnd l. L:l'rlorlne ClO/Yll"C'lJr.d' 'r. HitL .tW5lanoe (CatOLA) u. MIri..,lr MIla v. GTll40a 6&8 bunkllr '0' Oil~ \V, l'abc1llUl'lI-l)a.., au.Jlli~ :to ""loCI. ~Irn~-Gall<) Z. Ollw, I&lihfy O. NlIW/lJrbe Ojl F., ....VGNJ F. .hI1 FUIIl --..-----.-., JIJIlItCto....1hu:11lUl 0. filM r.. l'iblIlQiIlu F. ~'flP CladSllll1 t. C:~I" 'Y. (IIrQ~"""", l. 0CIw !PAlDEI'> .App/ewd Q. CIIIIhodic PrlHeGl..n Il~OI1l1dal Anode H. CllhOrlIo PIllIlati'arl . 1~1'II'1IIId Cu"IIft/ r. DIIutM Wlllllld(OW) . Sillolt "'."1' 11. 0cdlIa Wlllld (DW). Dull 1.(......, .J. {LlW)Synlhllia l.ir<<11I TlInk ~1011 V. (DWjPip.e... US'! ltiilfl SoloOondary Conla""",,1 s. Inlo"" li"~ll ST/. STI~ 7-111&"(t~JlJfJ'l g..rflll1ft..11I PMt.lIllRI\ A. lid o..ctt Vallie M. 6p11 CtJo1talN'llnllt1Jckat N. "low Sllll~rt O. 'naht Fill P.l.J.otql Gaugtc. foIlgh IllVIf Alarm. Q. omlr !PAmeP Ap(>rv>tld PI'dhtab'\lf\ M8Ihod "SIT nDrIn. & .... C'afttL'luellal:l IC. COftOfM.. Synl~ MeloorMl, a11~ s. Olhfr EPNOEP IllPl1lVld IeQOtIdlry DOtIIai"",~ 1}'t11llTl Z. DirTt'EaIln PlalnD CDftllfT"'lUgn y.lVJaI .. Sloel C. ~rgllt.. '.,U. Doubl1 ~16d N. AjJproYOd 8ynlheliC Malerial Z. 0111., EPN!)f;p Ajlp~d I'/p(.... M.lIItlar D. IiJtOlnIl ProtllCli~8 Co1lirla Eo OfF' with ..~iJfllt.1 Mode 01' lmpreK1ld au,,",nt I'lplna luk rw-II~ Q. IfllCll'Onlc Une LAk o..l~Qr \Mth P'/bwt SllurO/f J. lnt_HIIlIMortIIoMll . I''Plng FJllDr t. l!l(tIIft'\lIIl(onilolf~ H. MechllliClll Ul18 i..Nk DIItctOr S}.otlem (US IC. I/!\allflllll a.r~,h; '" doubl. w.A plp10g V. Su=tion PU/YVl Chedc VaJlfE Ink 1....It rw-Ua" N. Gooun.18r MCIr\Ilonf1(l W... Il. ''''.rll\!;., MonIIomll o. V.pef ~llnllorinCl WtlJI Q. VlRuiIlnl'l*lJans of ..aT S Ylw"". Z. 00.. EPM'l!p Approvea D. sPec PI8lt -ItS( fT, tnlwlliltal Spacl . Doub,. Walled T AIIk M. ~Inual Tank ailUOi~. \.1ST 8. Slallallr..r If'IVWItotV ~rDllallGtl (Sll'I)rUS1il) L. AulDl7IIlle Tank Gtlll'Qing Syst..., (Ugr I) ft. ~ra"~11 Mollllorintl 01 AST Tank Iollam Y. Arnual T'IclhIroe.. 'rltll w/tn I~Qo!Y (llST.l r 1. /6 'v: TIES FAX NO, 407 317 7181 OC~ -09-2002 WED 03: 51 PM FLORIDA LEAGUE OF C I 433 I B93 TO 14974259378 IrA 321 oCT 03 2002 13: 15 r:1~ FPL '. 15. Ne there any lankg at this location fh8t Wel'& not incfuded in (he Tank Schedule? ( ) Yes ~ If yoa, pleaKQ cfe8crib~. P. 12 P. 13/ '.1 ", - -....-.----....-.-....---.. -.._- ._.~~,._----..__..-- ------..... ---------.... -- --.--..-----.......----.---...........----------. 16. Do you use an outsidA COl'lflactQr or firm for compliance management servIces? This Includes, but Is not limited to, equipmttnf InspectJon rtnd monitoring, proper state 8nd local Jf!bulafory paperwori< completIon, and filing, POOling OBLiges and monlt1/y mOl,lforing reports for you? ( ) Y8$ (L-rNo- If ~e9, plea.so gIve the nama 3nd phone #, of the firm you uae. _ ___. -~.__.._---_.._--_....,"'........._-_.-- ...-------- 17. t)o you L'a. a rtJl1'lote monitoring system, with an outsIde vendor who raceWE!s an alarm when B release occurs ~nl1l$ I'Asponsiblt1 fur notifying the approprlale parties? ( ) Ye. (l).HO . If Yttl. plessQ glvQ Ihp. Mine of that vendor. 18'-~:y pIo~:~::~::::;~. any lanks WithIn tho ".xl yea.-? ( I Vos (~' If )fG.lI, list wl'uitn and why Ihe removal Dr replseemenl ,. to occur. ..-..-......-..---..----.---....- --, ---..-- 19. Do. ~ currently n;;lV$ pOilu lion liability ln~ur::1f1CO Coverage for ttll~ tanks ~pplJed for on this application? (~.5 ( ) No If <<>, pie... list hal.... the nom. .f th. "",,Ior, ..pIrlng premium, oxplr,(! deducti"'''- retrooctMl dB'" .nd '~I!s of Ililblllty; or attach :.I copy Qf your Current pOlicy declarallons page. ...,. '-' l.s l..s ~ r cr'\ e "'""'"^ \ -~"""---- .....--,.-.-.----.-,...- ---,- LIMITS bESJREO: (eacm InCIL1onVagsfegate) ( ) $fiOO,OOO/$1 million K $1 01/11100/$1 mitl/on ( ) $:> mll/lon/$2 million ( ) OTHER: Qf:DUCT'8lE DESIRED: (otJch ./P&Jant) ( ) $5,000 ( ~10.000 ( ) $25,000 ( ) $50,000 ( ) $100,000 ( ) $250,000 ( ) OTHER;_ For Ot\(jlJctlbl~ $25,000 or sbovo, p/eata/nclude your moal current audited financIal statement. THIt1 APPI.ICATION DOES NOT ClINOTHe APPLICANT TO BUY60R THE COMPANY TO ISSUE THe INSURANce, BUT IT IS AGREE!> THAT TlIIS FOR'" allALL 8E TH~ - OF TlIE C >lTRACf SHOULD A POliCY BE ISSlJ~D, AND IT WILL BE ArrACI~ED TO ANO MACE A PART or- THE POLICY. THE UNOI;RSIGNED APPLICANT OECLARE"SIHAT THE STATEMENTS seT FOR'IlIIN THIS APPLICATION ARE TRUE AND THAT NO MATF.RJAl FAcn; HAV~ 8EEN SUl'PREsseo OR MISSTATEO. THE API't1CANT FURTHER DeClARES THAT IF THe INFORM.\TlOH 8UPPuED ON THIS APPLICATION CHANGES BElWEEN THE DATE OF THIS APPLICATION AND THe lIME WHEN l1ie POLICY IS ISsueo, THE APPLICANT WlLllMMEOIATeLY NOTIFY lHE COMPANY OF SUCH CHANGES, AND THe; COMPANY MAy WITHDRAW OR MOOIFY AfoN OUTST.t.NOING QUOTAltONS ANO/Of{ AUTHC)R/ZA1'ON OR AGREEMFNT'rO BIND THE INSURANCE. } $1 mlllion/$2 mill/on ^ _ Slonaturo of brck~ or 8ge1'1I) 0:'""'\ ~ l~~J.- ~L (Lldenl~umbor 1I~ .Ie) "S~-(oOD11&lf (TIIX to. tI) NOTE; IN SOME ~rA1ES, ANY PERSON WHO I<NOWINGlY ANO WllloIlNTENT TO DEFRAUD ANY INSURANCE COMPANY OR On1F.~ PERSON FILES AN APPLICATION FOR INSURANCE CONTAININO ANY MATE~IAl.LY FAL.sE INFORMATION. OR 14Ei93{12/~H} ~ "t (0 . . ,~-; '~'t:r-' ',' ~~~~-"'_,.W"',~:'" . .... .. OCT-09-2002 WED ~n.n? 13'1~ FR FPLIPA OCT 8H t!l"""c. ., CONCEALS, FOR THE PlII'lPOSC OF MlSl.EADINCl, INFORMA liON CONCEIlNING ANY FACT W\TERIAL THEflF.TO, COMMITS A fRAUDU1.ENT INSl JRANCE ACT, WHICH IS " CRIME. NOllCE 10 AAICONSAs APPUCAtlTS: 'AAY PERSON WHO KNOWINell Y PRESENTS A FAl"" OIl FRIIUDU[J;NT ClAIM FOR PA 'fI.tENT OF A LOsS OR IlENEJ'rr, OIlI<NOWINGt Y PRESl'NTS FALSE INFo_TlON IN AN APPLICATION FOR /NSURAIICE IS GUIL'rY OF A CRIME AND WlY 8E SUBJECT TO FINES AND CONFINEMENT IN PRISON.' NOTICE TO COLORADO APPLICAtlT8: "IT 18 !JNU,WFUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MJSlEAolNG FACTS OJ. INFORW\TION TO AN INSUIlANcE COMpANY FOR THE PURPOSE OF OEFRAUDINCl OR ATTEMPrlNG TO DEFRAUD 1 HE COMpANY. PENAl TIES WlY INClUllE IMPRISONMENT, FINES, DENIAL OF INsURANCE, AND CIIIll DMtACFS. ANY INSUl,^NOE COMPANY OR AGENT OF AN INSURANCE COMpANY WHO KNOWINGLY PROV!OE'$ FAL.'lE. INCDI.IPU:fl;, OR MISLFMING FAc'IS OR INFORMATION TO A POliCYHOLDER OR CLAIMANT FOR THE PURPose OF DEFIlAUDlNG OR A1TEMPTINO TO DEFRAUD THe PoI.ICYHOLDER OR ClAIMANT WITH REGARO TO A SETn.EllENT OR AW.,., PAYABLE PRDI.IIN8URMIcE PkOCceos SHAlL lIE REPOJUED TO TI-Ie COLORADO DIVISION OF INSURANCE WITHIN ,HI:; DEPARTMENT OF RfiGULATORY AGENCIES.. . " , ~;~ ES FAX NO. 407 317 7181 03:51 PM FLORIDA LEAGUE OF CITI321 433 1093 TO 14974259378 P. 13 P.lt4....,4 NOna; To /'LDRIll.<. APPLICANT.: 'ANY PER.ON WHO KNDWINGl Y AND Wlrn INTENT TO INJURE, DS'RAuD, OR DoCEIVE ANY INSURER FilES A STATEMENT OF ClAIM 011 AN APPLICATION CONTAINING ANY FALSE, INCOMPLeTE OR M/$I.c.AOING INFORMATION IS GUll,Y OF A FELONY'~ THe THIRD DEGREE.' NOTlCJ; TO KEImJCKY Al"PI.lCA~",: 'ANY PERSON WHO KNOWINGlY AAO 11Im. I/(TENT TO DEFRAUO ANY INsURANCE CoMPANY OR OTHER PERSON FILES AN APPlJCAnON FOR INSU~HCE CONTAINING MY WlTERIALLY FAl"E INFOAMA TlON, OR CONCEALS FOR THE PURPOSE OF MfSlEJ,DING, INFORWlnON CONCERNING ANY FA~ MATERIAL n-rE"RE 1'0, COMMI rs A FRAUOULENT INSUMNce ACT. WHICH IS A CRfME.. N01'ICE "0 MAl.... APPl.lCANT.: 'IT IS A CRIlIE TO kNOWINGLY PROVIDE FALSE, INCOMPLeTE OR MISlEAOING INFORMAnON TO AN INS"""""", COMPANY FOR mE PURPOsE OF DEFRAUOINO THE COMPANY. PENALTIES MAY INCLUDe IMf->RISONMF:Nr, FINes OR A Of;NIAl. OF INSURANCE BENEFITS." NOTICE "0 MINNESoTA APPLICANT.: 'ANY PERSON WfIO SUBMITS AN APPliCATION OR FilES A ClAIM WITH INTEN r TO OE~ RAlJo OR HelPS COMMit A fRAUD AGNNST AN INSURER IS GUll TV OF A CRIME: NOTICE TD NEW JERBl!Y A~PLICAH18: 'ANv P€RSON WHo INCLUDES MY FAlSe OR MIS[J;ADING INFORMATION ON AN APf'UCATION FOR AN INSURANce POliCY IS SU8J1!CT TO CRIMINAl AND CIVIL PENAlTIES.' NOTICe To NE"" MElCIco APPLICANT.: 'ANY PERsoN WHO KNOWINGLY PRI;SENTs A FALsE OR FRAuDULENT ClAIM FON PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTs FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUlL TV OF A CJllME ANI) MAY SE SUIlJEq TO CIVIl. FINes AND CRIMINAL PENALnss.' NOTICE To NEW YORK ....PLlCANTs: 'Il/<( PeRSON WHo KNoWINOl Y ANO WITH 'NTENT TO 0EFRAUIl ANv INSulW;ce COMPANY OR OTIlEIl PERsoN PI[J;S AN AFFllC.<\lIOH FOR I-RANce OR STATEMENT OF ClAIM CONTAINING ANY MATERIALLY FALSE INFORW\TlON, CONCFALS FOR mE PURPosE OF MISLEADING, INFORMATION CONCEIlNING ANY FACT MA ll3RlAl rnFRETO, CO"1M/TS A FRAUOUlENT INSURANCE ACT, WHICH Is A CRIME AND SHALL ALsO IlE SUIlJF.CT TO A CNlL PENAL TV NOT To EJ(CEED FIVE THOUSAND DOllARs AND TI-IE STATED VAlUE OF THE CLAIM FOR EACH SUCH VIOLATION,. NOTlCJ; TO OINO ....1'I.IcANTs: 'ANY PERsoN WHO, IIIITH lNTENTTo DEFRAUD OR KNOWING IT-iA THE 18 FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FI[J;s A ClAIM CONTAIN/NO A FAlSE OR oeCE/'nVe S"fATEMEN1IS GlJIL1YOF INSURANCE FRAuo: NOTICE To PENNSYlVANIA Al'PUCAllr8: 'AAY PERSON WHO KNOWINGLY AND WITH /NTE~ TO DEFRAUD ANY INSURMIcE COMPANY OR ornER PERsoN ~1l.E" AN AFPlJCATION FOR INSURANce DR STATEMENT OF Cl.AIM CONTAIN/NO ANv MIl TFRIALl Y FAlSo INFORMA "ON OR CONCEAlS FOR THe PURPOSE OF MlSlEJ,DINI3, I""ORMA nON CONCERNiNG ANY ~ACT MAT.IlIAl THEReTO, co~rrs A FMuDULENT INSURANCE ACT. WHICH IS A CRIMe AND ~IJS.1ECl'.S t~U(;H PERSON TO CRIMINAL ANn CIVIL PENAL ile'S.. NOllCE TO VIlIGlNIA ....PlICANT.: 1T IS A CRIME TO KNOWINGLY FROVIDE FALSE, INCOMPLeTE OR MISlEAOING INfORMATION To AN INEUllANce COMPANY FOR ll-IE PlJRPOSE OF DEFRAUDINI3 THE COMPANY. PENAlTIES INCLUDe IMPRISONME~r, FINES ANO DENIAL OF INSUMNCE DENEFITS.. 7-1{j93Cf2195lJ If) 1 10 ** TOTAl PAr.F.ld ** FLORIDA LEAGUE OF CmES SPONSORED INSURANCE PROGRAMS DECLARATIONS I. DESIGNATED MEMBER: City of Winter Springs Address: 1126 East State Road 434 Winter Springs, FL 32708 II. COVERAGE PERIOD From October 1, 2002 to October 1, 2003 12:01 A.M. Standard Time at the address of the Designated Member. III.AGREEMENT NUMBER Florida Municipal Insurance Trust (FMIT) FMIT #0648 IV. COVERAGES INCLUDED General Liability Automobile Property Workers' Compenstation V. ESTIMATED ANNUAL PREMIUM Normal Premium Incentive Credit Expense Constant $ 769,081.00 200.00 $(162,024.00) ~~ Signature of Authorized Representative Net Premium $ 607,257.00 September 25, 2002 Date FLORIDA MUNICIPAL INSURANCE TRUST GENERAL /PROFESSIONAL LIABILITY COVERAGE AGREEMENT DECLARATIONS I. DESIGNATED MEMBER City of Winter Springs Government Description Municipality Agreement No.: FMIT #0648 III. COVERAGE PERIOD From October 1, 2002 to October 1, 2003 the. Designated Member. 12:01 A.M. Standard Time at the address of Premium Payroll: Basis Deductibleffvoe Limit Net Premium $25,000 DSL $2,000,000 $88,654 6,214,440 $25,000DSL $2,000,000 Included N/A $25,000 Included $25,000 DSL $250,000 Included $25,000 DSL $2,000,000 Included $25,000 DSL $2,000,000 Included $25,000 DSL $2,000,000 Included $25,000 DSL $2,000,000 Included $25,000 DSL $2,000,000 Included 58 22 IV. General/Professional Liability 1. General Liability a. Broad Form Property Damage b. Extra Contractual Legal Expense c. Fire Legal Liability d. Medical Attendants'/Medical Directors' Malpractice Liability 2. Errors and Omissions Liability a. Supplemental Employment Practices Liability b. Employee Benefits Program Administration Liability 3. Law Enforcement Full Time with Arrest Powers: Clerical: ( V. This Agreement includes these endorsements and schedules: See Schedule A VI. ESTIMATED ANNUAL PREMIUM Normal Premium Incentive Credit Net Premium Florida Municipal Insurance Trust (FMIT) $96,774 $8,120 $88,654 Florida League of Cities Sponsored Insurance Pr.ograms Since 1977 L THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT. FMIT GL DEC 1002 Original Page 1 of 2 09/25/2002 Form # FMIT IND (10-02) FMIT GC (10-02) FMIT DSL (10-02) FMIT BFPD (10-02) FMIT ECLE (10-02) FMIT FLL (10-02) FMIT MA (10-02) FMIT EO (10-02) FMIT LE (10-02) FMIT SE GL (10-02) FMIT PA EO (10-02) ( ( FMIT GL DEe 1002 FMIT GENERAL/PROFESSIONAL LIABILITY COVERAGES October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List FMIT #0648 Schedule A Description COMMON Indemnity Agreement Coverage Agreement Deductible Stoploss Endorsement Provisions GENERAL LIABILITY Broad Form Property Damage Extra Contractual Legal Expense Fire Legal Liability Medical Attendant's/Medical Directors' Malpractice Liability Errors and Omissions Liability Endorsement Law Enforcement Liablility Endorsement Specific Excess Endorsement - General Liability Prior Acts Endorsement - Errors And Omissions Liability Page 2 of 2 SPECIFIC EXCESS ENDORSEMENT - GENERAL LIABILITY This endorsement, when issued by the Florida Municipal Insurance Trust, does not in any way modify the provisions of the Coverage Agreement. It does extend the monetary limits of liability, as stated in the Limits of Liability in the Declarations, as set forth below: It is agreed that the specificlimits of liability are . $2,000,000 (combined single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section 768.28(5) Florida Statutes or liability imposed pursuant to Federal Law, or to any liability resulting from actions taken outside of the State of Florida where it is. determined by a court of competent jurisdiction that the liability limitations contained in Section 768.28(5), Florida Statutes, are inapplicable, if such liability is covered by the Agreement. The limits provided herein are inclusive of the $100,000 each person and $200,000 each occurrence as set forth in the Declarations of the Agreement and within the Coverage Agreement itself, but in no way exceed $2,000,000 (combined single limit) per occurrence. Exclusion W is amended as follows: To any damages imposed by an act of the legislature, except for claims bills passed by the legislature pursuant to Section 768.28(5), Florida Statutes, against a member, for damages covered under the terms of this Agreement. ( ( FMIT SE GL 1002 Page 1 of 1 FLORIDA MUNICIPAL INSURANCE TRUST PRIOR ACTS ENDORSEMENT ERRORS AND OMISSIONS LIABILITY This Endorsement modifies the Agreement as follows: Agreement Number: FMIT #0648 Designated Member: City of Winter Springs Coverage Period: October 1, 2002 to October 1, 2003 Effective Date of Endorsement: It is noted and agreed that in consideration of the premium charged, coverage for Public Officials Errors & Omissions Liability is retroactively extended for claims that occurred but were not reported to the designated member or to the Florida Municipal Insurance Trust until the effective date of this endorsement, whether or not reported to the prior insurer. No coverage will be provided by this endorsement: ( For any claim or suit first made against the designated member before the effective date of this endorsement, whether or not reported to the prior insurer, or for any occurrence reported to the prior designated member before the effective date of this endorsement. For any occurrence that may create a potential claim that the insured was aware of prior to the effective date of this endorsement and which was not reported to the prior insurer. Limit of Liability: $1,000,000 Combined Single Limit Deductible: $25,000 Retroactive Date: October 1, 1999 Florida League of Cities Sponsored Insurance Programs Since 1977 ( INITIALS: BBarbieri DATE: 12/09/02 FMIT PA EO 1002 FLORIDA MUNICIPAL INSURANCE TRUST COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FORM NAME: General Conditions Endorsement #1 It is noted and agreed the Exclusion Section of the Agreement is amended as follows for this endorsement: A. Exclusion LL is deleted. B. Exclusion MM is amended to read: to damage to Real Property, Business Personal Property and Business Income and Extra Expense arising directly or indirectly out of any loss, damage, claims, injury, cost or legal obligations, or any other sum, or relating to: 1 . Any act of terrorism, or 2. Any action authorized by a governmental authority or agency for the purpose of preventing, terminating, countering or responding to any act of terrorism or for the purpose of preventing or minimizing the consequences of any act or threat ofterrorism. ( ~~. Authorized Representative Signature ( Page 1 of 1 FLORIDA MUNICIPAL INSURANCE TRUST INDEMNITY AGREEMENT THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own selection. These members of the Florida Municipal Insurance Trust, all local government entities, have organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW, THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained, which are given to and accepted by each member hereof to the other, the parties to this instrument covenant, stipulate and agree as follows: RESPONSIBILITIES OF MEMBER Each member of the Trust agrees to abide by the following rules and regulations: I. GENERAL CONDITIONS A. The member agrees the Board of Trustees, the governing body of the Trust, comprised entirely of local elected officials, will set up, operate and enforce its own administrative rules, regulations and by-laws as between the individual members of the Trust and shall otherwise direct the affairs of the Trust; (- B. The member and the Trust agree all members of the Trust hereby agree that the Board may admit as members of this Trust only acceptable employers in the state of Florida who have common governmental interest. The Board or its designee shall be sole judge of whether or not an applicant shall be admitted to membership; C. The member agrees to maintain a reasonable loss prevention program in order to provide the maximum in safety and lawful practices as such may relate to the potential liability assumed by the Trust under this Agreement or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement; D. The member agrees to provide immediate notification of such occurrence to the Trust in the event of an occurrence likely to give rise to a claim within the scope of this Agreement, or any other agreement, certificate, document or other instrument executed by the Trust and the member pursuant to this Agreement; E. The member agrees to promptly make all contributions for coverages arising under this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement at the time and in the manner directed by the Board of Trustees. Said contributions may be reduced by any discount, participation credit, or other contribution reduction program established by the Board of Trustees; F. The member agrees in the event of payment of any loss by the Trust on behalf of the member, the Trust shall be subrogated to the extent of such payment to all the rights of the member against any party or other entity legally responsible for damages resulting from said loss, and in such event, the member hereby agrees, on behalf of itself, its officers, employees, and agents to execute and deliver such instruments and papers as is required, and do whatever else is reasonably necessary, to secure such right to the Trust, and to cooperate with and otherwise assist the Trust as may be necessary to effect any recovery sought by the Trust pursuant to such subrogated rights; ( FMIT IND 1002 Page 1 of 4 ( / (" G. The member agrees the Board of Trustees, its Administrator, and any of their other agents, servants, employees or attomeys, shall be permitted at all reasonable times and upon reasonable notice to inspect the property, work places, plants, works, machinery and appliances covered pursuant to this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and shall be permitted at all reasonable times while the member participates in the Trust, and up to and including two (2) years following the termination of its membership in the Trust, to examine the members' books, vouchers, contracts, documents and records of any and every kind which show or tend to show or verify any loss that may be paid or may have been paid by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, or which show or verify the accuracy of any contribution which is paid or payable by the member pursuant to the terms of this Agreement, or any other agreement, certification, document or any other instrument executed by the Trust and the member pursuant to this Agreement; H. The members hereby delegate to the Board of Trustees the responsibility to contract for handling the administrative and servicing functions of the Trust. The Board may pay a reasonable fee for such, which shall be negotiated from time to time by the Board of Trustees. These fees shall be in consideration of all services and expenses contracted for with the Trust, which services or expenses may include the collecting, disbursing, and accounting for monies collected, counseling with members as to the safety hazards, claims handling and investigations, and legal services, actuarial services and accounting services and for the purpose of providing for excess insurance coverage. Books and records of all contractors employed by the Trust are to be open to inspection by the Board of Trustees or their agents at all reasonable times and as otherwise required by law; I. The member and the Trust agree the administrator, to be appointed by the Board, shall deposit to the account of the Trust, at any bank or banks designated by the Board, all contributions or other monies, as and when collected and said monies shall be disbursed only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules, regulations and by-laws of the Board, and (2) the Agreement between the Board and the administrator; J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of the member any claims, suits or other legal proceedings which may at any time be instituted against the member on account of bodily injury liability, property damage liability, errors and omissions liability, civil rights liability, personal injury liability or any other such liability, monetary or otherwise, to the extent such defense and liability has been assumed by the Trust pursuant to this Agreement or any other agreement, certificate, documents, or other instrument executed by the Trust and the member pursuant to this Agreement, subject to any and all of the definitions, terms, conditions and exclusions contained in said agreements, certificates, documents or other instruments, although such claims, suits, allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed against the member in any such legal proceedings defended by the Trust or the members, all interest accruing after entry of judgement in such proceedings, and all expenses incurred in the investigation, negotiation or defense of such claims, suits, allegations or demands. Such defense shall be subject to the control of the Trust and its Administrator, which may make such investigation and settlement of any such claim, suit, or other legal proceeding, monetary or otherwise, as they deem expedient; K. The member agrees the liability of the Trust is specifically limited to the discharge of the liability of its members assumed pursuant to this Agreement or any other agreement, certificate, document, or any other instrument executed by the member and the Trust pursuant to this Agreement; L. The member agrees the coverage of the Trust does not apply to punitive or exemplary FMIT IND 1002 Page 2 of 4 damages; ( M. The Trust shall operate on a fiscal year from 12:01 a.m. October 1st to 12:01 October 1st of the succeeding year. Application for continuing membership, when approved in writing by the Board or their designee, shall constitute a continuing contract for each succeeding fiscal period unless cancelled by the Board or unless the member shall have resigned or withdrawn from said Trust by written notice; N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees coverage by the Trust for a member under the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of September of each calendar year; O. Except as otherwise provided herein, the member and the Trust agree such member's coverage may be canceled by the Trust or the member at any time upon no less than forty- five (45) days prior written notice by the Board of Trustees or the Administrator to the member and to the Division of Workers' Compensation, if applicable, or by the member to the Trust, stating the date such cancellation shall be effective; however, cancellation by the member after the initial effective date of coverage (October 1), shall be conditioned upon Member's payment of an amount equal to ten (10) percent of the premium that is unearned by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice of cancellation to the member 10 days before the effective date of cancellation; P. The member agrees excess monies remaining after the payment of claims and claim expenses, and after provision has been made for the payment of open claims and outstanding reserves, may be distributed by the Board of Trustees to the members participating in the Trust in such manner as the Trustees shall deem to be equitable; ( a. The member agrees there will be no disbursements out of the reserve fund established by the Trust by way of dividends or distributions of accumulated reserves to members until provision has been made for all obligations against the Trust and except at the discretion of the Board of Trustees; R. The member agrees to permit qualified service providers, including attomeys selected by the Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits, allegations or demands that may result in liability assumed by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust or the member pursuant to this Agreement; S. The member shall make prompt payment of all contributions as required by the Board of Trustees, said contributions to be determined by said Board. The member shall fully cooperate with auditors of the Trust to promptly determine final audited contributions. Any disputes concerning contributions shall be resolved after payment. Any objections concerning the final audited contribution shall be filed within 60 days of billing of the final audited contributions. After that time, the audit shall be considered to be final; T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for late payment of contributions required under this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement; ( U. The member, through the Board of Trustees, does hereby appoint the Administrator of the Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and other documents reasonably necessary to accomplish the purposes and to fulfill the responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses, FMIT IND 1002 Page 3 of 4 ( v. medical expenses, and all other matters required or necessary insofar as they affect the member's liability under federal or Florida law and insofar as such matters are covered pursuant to the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and by the rules and regulations now or hereafter promulgated by the Board of Trustees; The Trust shall determine all questions of the scope of liability coverage, eligibility methods of providing or arranging for benefits, and all other related matters. It shall have full power to construe the provisions of this agreement and the other program documents in the terms used here and therein. Any such determination and any such construction adopted by the Trust in good faith shall be binding upon all parties hereto and the members, provided such determination or such construction is consistent with the laws of the State. The member agrees to abide by all the terms and conditions of this Agreement, the Participation Agreement, the Trust's By-laws, the rules and regulations, and any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to the Agreement; W. The member and the Trust agree the Trust will maintain an excess coverage program and reserve evaluation to protect the financial stability of the Trust in an amount and manner determined by a qualified and independent actuary; X. The member and the Trust agree the Trust will submit to the appropriate governmental agency annually an audited fiscal year-end financial statement prepared by an independent certified public accountant; (~ Y. The member and the Trust agree that any member who formally applies for membership in this Trust and is accepted by the Board of Trustees shall thereupon become a party to the Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions contained therein, and said application shall constitute a counterpart of said Agreement and Declaration of Trust; and Z. Members duties after loss: ( FMIT IND 1002 1. give the Trust prompt written notice of any accident, occurrence or potential claim along with all relevant information concerning the claim. The member shall have a continuing duty to provide to the Trust all relevant information promptly as the member becomes aware of such information; and cooperate fully with the Trust in defense or settlement of claims or opposition to claims bills, and in the enforcement of any right of contribution or indemnity; and forward to the Trust every notice, demand, summons or other process served upon the member relating to any occurrence, and take no further action concerning the occurrence without the approval of the Trust or the servicing agent; and take reasonable steps to prevent additional or cumulative bodily injury, personal injury or property damage from or arising out of the same or similar conditions or circumstances; and not engage in settlement negotiations as to any claim or suit, and the Trust shall have no obligation to pay the amount of any settlement negotiated or agreed upon by a member without prior written approval by the Trust or the servicing agent; and agree to take all reasonable actions, where appropriate, which shall facilitate settlement of claims; and agree to responsible counsel selected by the Trust to defend the claim and agree not to use the designated member's counsel in defense of said action. 2. 3. 4. 5. 6. 7. Page 4 of 4 FLORIDA MUNICIPAL INSURANCE TRUST COVERAGE AGREEMENT In consideration of the payment of the contributions and the covenants and agreements set forth in the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the statements of the APPLICATION, the DECLARATIONS, and all terms, conditions, limits and other provisions of the COVERAGE AGREEMENT, the Trust agrees with the member as to the following: LIMITS OF LIABILITY Regardless of the number of (1) members under this Agreement, (2) persons or organizations who sustain injury or damage, or (3) claims made or suits brought on account of bodily injury, property damage or personal injury, the liability of the Trust is limited as follows: The total liability of the Trust applicable to "each person" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by one person or organization as the result of anyone occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. The total liability of the Trust applicable to "each occurrence" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than one person or organization as the result of anyone occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. ( For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence. DEFENSE AND SETTLEMENT In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers appropriate, any claim or suit demanding money damages covered by this Agreement. The Trust will defend any suit against a member which alleges a claim for money damages covered by this Agreement even if such suit is groundless, false or fraudulent. However, the Trust has no duty to defend a member in any action which on its face alleges facts excluded or not covered by this Agreement. In the event a suit or other action contains allegations which allege damages which the Trust has a duty to defend and other allegations which allege damages or other relief that the Trust does not have a duty to defend, the Trust will defend all allegations subject to the terms, conditions, limits of liability and exclusions of the Agreement; however, undertaking such defense shall not obligate the Trust to pay any judgments, settlements or awards which a member becomes legally obligated to pay for allegations to which coverage does not apply. The Trust's duty to defend ends when applicable Limits of Insurance have been exhausted. ( FMIT GC 1002 Page 1 of 10 ( DEFINITIONS The following definitions apply throughout this Agreement unless modified or excluded: A. Advertising Injury, means injury arising out of an offense committed during the Agreement period occurring in the course of the designated member's advertising activities; if such injury arises out of libel, slander, defamation, violation or right of privacy,'piracy, unfair competition, or infringement of copyright, title, or slogan. B. Agreement Territory, means anywhere in the world. C. Automobile, means a land motor vehicle, trailer or semi-trailer designed for travel on public roads (including any machinery or apparatus attached thereto), but does not include mobile equipment. D. Bodily Injury, means bodily injury, disability, disfigurement, sickness or disease or death resulting from an occurrence and sustained by any person, and any loss, injury or damages sustained by any person because of bodily injury, which occurs during the period of this Agreement. E. Completed Operations Hazard, includes bodily injury and property damage arising out of operations or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs after such operations have been completed or abandoned and occurs away from the premises owned by or rented to the designated member. "Operations" includes materials, parts or equipment furnished in connection therewith. Operations shall be deemed completed at the earliest of the following items: 1. When all operations to be performed by or on behalf of the designated member under the contract have been completed, ( 2. When all operations to be performed by or on behalf of the designated member at the site of the operations have been completed, or 3. When the portion of the work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing an operation for a principal as a part of the same project. Operations which may require further service or maintenance work, or correction, repair or replacement because of any defect or deficiency, but which are otherwise complete shall be deemed complete. The completed operations hazard does not include bodily injury or property damage arising out of operations in connection with the transportation of property, unless the bodily injury or property damage arises out of a condition in or on a vehicle created by the loading or unloading thereof. F. Contractual Liability, means liability expressly assumed under a written contract or agreement; provided, however, that contractual liability shall not be construed as including liability under a warranty of the fitness or quality of the designated member's products or a warranty that work performed by or on behalf of the designated member will be done in a workmanlike manner; and provided, however, that contractual liability shall not be construed as including liability under any hold harmless agreement or agreement to indemnify any non-public or private person, corporation, or entity under any contract or agreement. ( FMIT GC 1002 Page 2 of 10 ( G. Designated Member, means the entity, organization or constitutional officer named in Item I. or V. of the Declarations of this Agreement; designated member does not include employees or agents of that entity or organization. H. Designated Member's Products, means goods or products manufactured, sold, handled, or distributed by the designated member or by others trading under his name, including any container thereof (other than a vehicle), but "designated member's products" shall not include a vending machine or any other property, rented to or located for use of others but not sold. I. Elevator, means any hoisting or lowering device to connect floors or landings, whether or not in service, and all appliances thereof; but does not include an automobile servicing hoist, a material hoist used in alteration, construction or demolition operations, or an inclined conveyor used exclusively for carrying property or a dumbwaiter. J. Employee Benefits Program, means any pension and profit sharing plan; individual retirement account (IRA) plan; salary reduction plan under Internal Revenue Code 401 (k) or Amendments; employee stock subscription plan, savings plan; group plan for life, health, dental, disability, automobile, home owners, or legal services insurance; social security system benefits; workers' compensation and unemployment insurance; travel and vacation plans; or educational tuition reimbursement plans created, administered or endorsed by a member. K. Errors and Omissions, means an actual or alleged error or misstatement or act of omission or neglect or breach of duty including misconduct or official misconduct by the members in their official capacity, individually or collectively, or any matter of claims against them solely by reason of their having served or acted in an official capacity. L. Incidental Contract, means a written (a) lease of premises, (b) easement agreement, except in connection with construction or demolition operations on or adjacent to a railroad, (c) undertaking to indemnify a municipality required by municipal ordinance, except in connection with work for the municipality, (d) sidetrack agreement, or (e) elevator maintenance agreement; but does not include any hold harmless agreement or agreement to indemnify any non-public or private person, corporation, or entity under any contract or agreement. ( M. Incidental Medical Malpractice Injury, means bodily injury arising out of the rendering of or failure to render medical services or treatment by a non-professional during the period of this Agreement, including the following services: 1. medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or 2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. N. Inverse Condemnation, means a cause of action by a property owner to recover the monetary value of property that has been taken by the designated member having the power of eminent domain where no formal exercise of that power has been undertaken and includes any claim alleging lost profits both future and past. O. Member, as used herein means: a. the designated member; b. while acting within the scope of his employment, any officer (except constitutional officers), volunteer, servant, or employee of the designated member, including elected and appointed officials, and members of Boards or Commissions. However, the coverage so provided any officer, servant, or employee does not apply to bodily injury to another officer, servant or employee of the designated member injured in the course of and arising out of his employment. ( FMiT GC 1002 Page 3 of 10 ( ( ( The coverage afforded applies separately to each member against whom claim is made or suit is brought, except with respect to the limits of liability of the Trust; and does not apply to bodily injury or property damage or personal injury liability arising out of the conduct of any partnership or joint venture of which a member is a partner or participaht and which is not specified in this Agreement as a designated member. P. Mobile Equipment, means a land vehicle (including any machinery or apparatus attached thereto), whether or not self propelled, (a) not subject to motor vehicle registration, or (b) maintained for use exclusively on premises owned by or rented to the designated member, including the ways immediately adjoining, or (c) designed for use principally off public roads, or (d) designed or maintained for the sole purpose of affording mobility to equipment of the following types forming an integral part of or permanently attached to such vehicle: power cranes, shovels, loaders, diggers and drills; concrete mixers, graders, scrapers, rollers and other road construction or repair equipment; air compressors, pumps and generators, including spreading, welding and building cleaning equipment; and geophysical exploration and well servicing equipment. Q. Mold, Spores and/or Fungus means any mold, spores and/or fungus of any type of nature whatsoever that can cause or threaten harm to any living organism (including human health or human welfare, or the health or welfare of any animal or plant) or can cause or threaten physical damage, deterioration, loss of use, and/or loss of value or marketability, to any tangible property whatsoever. This includes, but is not limited to, any type(s) of mold, spores and/or fungus that are harmful or potentially harmful to health or welfare (such as Stachybotrys and others), or that are damaging or potentially damaging to tangible property (such as wet or dry rot, mildew and others) or that can otherwise cause or threaten to cause bodily injury, property damage, personal injury or advertising injury or any kind whatsoever. R. Occurrence, means an event or accident, including continuous or repeated exposure to conditions which result in bodily injury, property damage or personal injury and not arising from any form of intentional misconduct. S. Personal Injury, means injury sustained by any person or organization arising out of one or more of the following offenses committed during the term of this Agreement. However, this coverage does not apply to law enforcement operations. 1. False arrest, detention, imprisonment; 2. Wrongful entry or eviction, or other invasion of the right of private occupancy; 3. Publication or utterance: a) of a libel or slander or other defamatory or disparaging material; b) in violation of an individual's right or privacy; or except that publications or utterances in the course of or related to broadcasting, publishing, or telecasting activities conducted by or on behalf of the designated member shall not be deemed personal injury; 4. Assault and battery, not committed by or at the direction of the designated member unless committed for the purpose of protection of persons or property. T. Products Hazard, includes bodily injury and property damage arising out of a designated member's products or reliance upon a presentation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs away from premises owned by or rented to the designated member and atter physical possession of such products has been relinquished to others. FMITGC 1002 Page 4 of 10 U. Property Damage, means (a) physical injury to or destruction of tangible property which occurs during the policy period, including the loss of use thereof at any time resulting there from, or (b) loss of use of tangible property which has not been physically injured or destroyed provided such loss of use is caused by an occurrence during the period of this Agreement. V. Terrorism means activities against persons, organizations or property of any nature: 1. That involve the following or preparation for the following: a. Use or threat of force or violence; b. Commission or threat of a dangerous act; or c. Commission or threat of an act that interferes with or disrupts an electronic, communication, information or mechanical system; and 2. When one or both of the following applies: a. The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or b. It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology. EXCLUSIONS ( This Coverage Agreement does not apply: A. to liability assumed by a designated member under an expressed or implied contract or agreement except an incidental contract or inter-local agreements with other governmental entities; but this exclusion does not apply to an implied warranty of fitness or quality of the designated member's products or an implied warranty that work performed by or on behalf of the designated member will be done in a workmanlike manner; B. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any automobile operated by or rented or loaned to any member; 2. any other automobile operated by any person in the course of his employment by any member; but this exclusion does not apply to the parking of an automobile on premises owned by, rented to or controlled by the designated member or the ways immediately adjoining, if such automobile is not owned by or rented or loaned to any member; 3. any vehicle while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any contest or activity; C. to bodily injury or property damage arising out of: 1. the ownership, maintenance, operation, use, loading or unloading of any mobile equipment while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any such contest or activity; 2. the operation or use of any trailer designed for use therewith; or 3. the ownership, maintenance, operation, or use of a skateboard/skate park facility, in-line skating facility or water theme park; ( D. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any watercraft over twenty six (26) feet in length; 2. any passenger being carried for a consideration while in or upon, entering or alighting from any watercraft; or FMIT GC 1002 Page 5 of 10 3. barge or lighter rented by the designated member to others with respect to which the designated member does not furnish employees to operate and does not have any operating control; 4. any watercraft while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any contest or activity; 5. any watercraft or structure being used as an artificial reef or similar purpose; E. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any aircraft owned or operated by or rented or loaned to any member; 2. any other aircraft operated by any person in the course of his employment by any member; but this exclusion does not apply to aircraft while parked on premises owned by, rented to or controlled by the designated member; F. to any liability arising out of or caused or contributed to by any maintenance, operation, use or control of or responsibility for any airfield, airport, runway, hangar, building or other property or facility designed for, used, connected, associated or affiliated with or in any way related to aviation or aviation activities or operations; provided that liability for services performed or premises located at or on any airfield, airport or aviation facility not directly related to aviation activities or operations, and not covered by any other liability insurance, shall not be excluded from coverage by this exclusion; G. any claim for bodily injury, property damage (including the loss of use thereof), personal injury or advertising injury caused by, contributed to or arising out of the actual or threatened discharge, dispersal, release, or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, electromagnetic radiation, liquids or gases, waste materials or other irritants, pollutants or contaminants into or upon the land, the atmosphere or any course or body of water, whether above or below ground. ( Also, excluded from coverage under this agreement is the process of continued surface and/or subsurface degradation and deterioration of lead based paint that has been applied to any surface of any building whether considered commercial or residential. It is understood and agreed that the intent and effect of this exclusion is to delete from all coverages afforded by this policy any claim, suit, action, judgment, liability, settlement, defense or expenses (including any loss, cost, or expense arising out of any governmental direction, order or request that the member test for, monitor, clean up, remove, contain, treat, detoxify or neutralize pollutants) in any way arising out of such actual or threatened discharge, dispersal, release or escape, whether such results from the member's activities or the activities of others, whether or not such a sudden or gradual, and whether or not such is accidental, intended, foreseeable, fortuitous or inevitable and wherever such happens; H. to bodily injury or property damage due to war, whether or not declared, civil war, insurrection, rebellion and revolution, or to any act or condition incident to any of the foregoing; I. to any obligation for which any member or any carrier as his insurer may be held liable under any workers compensation, employers liability, unemployment compensation or disability benefits law, or under any similar law and including any claims under the Americans with Disabilities Act; J. to bodily injury to any employee of the designated member arising out of and in the course of this employment by the designated member or to any obligation of a member to indemnify another because of damages arising out of such injury; but this exclusion does not apply to liability assumed by the designated member under an incidental contract. This exclusion shall include any liability incurred by a designated member as a result of an alleged wrongful discharge; failure to promote; demotion or transfer of any employee of the designated member; ( K. to property damage to property owned or occupied by, leased, or rented to a designated member; FMIT GC 1002 Page 6 of 10 /' \ L. to property damage to premises alienated by the designated member arising out of such premises or any part thereof; M. to loss of use of tangible property which has not been physically injured or destroyed resulting from a delay in lack of performance by or on behalf of the designated member of any contract or agreement; N. to property damage to the designated member's products arising out of such products or any part of such products; to property damage to work performed by or on behalf of the designated member arising out of the work or any portion thereof, or out of materials, parts or equipment furnished in connection therewith; and to damages claimed for the withdrawal, inspection, repair, replacement, or loss of use of the designated member's products or work completed by or for the designated member or of any property of which such products or work form a part, if such products, work or property are withdrawn from the market or from use because of any known or suspected defect or deficiency therein; o. to any liability from the designated member's completed operations arising out of: 1. loss of sales, customers or profits suffered by a person or entity affected by the actions of the designated member or its agents including any damages sustained by such person or entities by virtue of a business interruption; or 2. loss resulting from theft of any property which at the time of loss is not an integral part of a building or structure including direct loss by pillage and looting occurring during and at the immediate place of a riot or civil commotion; P. to any liability arising in whole, or in part out of 1. any act or omission of a member committed while acting outside the course and scope of his employment, or committed in bad faith with malicious purpose, or in a manner exhibiting wanton and willful disregard of human rights, safety or property; 2. any member obtaining remuneration or financial gain to which the member was not legally entitled; 3. the willful violation of any federal, state or local law, ordinance or regulation committed by or with the knowledge or consent of any member; or 4. official misconduct by any member; ( Q. to any liability arising out of or in any way connected with the operation of the principals of eminent domain, condemnation proceedings, inverse condemnation or takings law, by whatever name called, whether permanent or temporary, including but not limited to, claims arising out of federal, state or local land use, environmental, air, ground or water pollution, or health, safety and welfare laws, ordinances or regulations, claims arising from Ch. 95-181, Laws of Florida, as may be amended from time to time, or claims arising from activities by or on behalf of a member which result in permanent or temporary loss of use or value of property, whether such liability accrues directly against the member, or by virtue of any agreement entered into by or on behalf of the member; however, this exclusion does not apply to bodily injury, property damage or personal injury resulting from a claim against the designated member for inverse condemnation; the limit of inverse condemnation claims is the amount of liability described in the GeneraVProfessional Liability section of the Declarations Page or $1,000,000 aggregate per fund year, whichever is the lesser amount, subject to a deductible of $5,000.00 per occurrence. R. to any liability for injury, sickness, disease, death or destruction due to the rendering of or failure to render any professional service by any doctor, surgeon, dentist, nurse, physician's assistant, paramedic, emergency medical technician or other medical professional of a designated member; ( s. to any liability arising out of or in connection with or caused or contributed to by any failure or inability to supply, in whole or in part, any adequate quantity or quality of power, steam, pressure or fuel; FMIT GC 1002 Page 7 of 10 ( T. to any liability arising out of or caused or contributed to by or connected with any actual or alleged violation of the Employee Retirement Income Security Act of 1974 (Public Law 93-406) or any amendment thereto or any similar provision of any local, state or federal law, statutory or common; U. to any liability arising out of or caused or contributed to by any breakage and/or water overflow of any dam or reservoir; V. to any liability for fines, punitive or exemplary damages; or any non compensatory damages or penalties imposed pursuant to any federal or state anti-trust, civil rights, anti-discrimination, or racketeer influence and corrupt organization (RICO) laws; W. to any damages imposed by special act of the Legislature; X. to loss caused directly or indirectly by nuclear hazard. Nuclear hazard means any nuclear reaction, radiation, a radioactive contamination, all whether controlled or uncontrolled or however caused, or any consequence of any of these; Y. to personal injury arising out of any publication or utterance described in sub-paragraph Q 3 of the definition of Personal Injury contained in the Definition section of this Agreement (a) if the first injurious publication or utterance of the same or similar material by or on behalf of the designated member was made prior to the effective date of this coverage; (b) concerning any organization or business enterprise, or its products or services, made by or at the direction of any member with knowledge of the falsity thereof; Z. to any liability arising out of errors and omissions as defined herein; c~ AA. to bodily injury or property damage for which the designated member or his indemnitee may be held liable; 1. 2. as an entity or organization engaged in manufacturing, distributing, selling or serving alcoholic beverages; or if not so engaged, as an owner or lessor of premises used for such purposes, if such liability is imposed a) by, or because of the violation of, any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any alcoholic beverages; or by reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol or which causes or contributes to the intoxication of any person. b) This exclusion does not apply and coverage is afforded under the Agreement for bodily injury or property damage claims or liability resulting from the providing or serving of alcoholic beverages without charge to the public at functions incidental to a designated member's business or activity otherwise covered under the Agreement or any endorsement to the Agreement; BB. to any claim, demand or action seeking injunctive, declaratory, writ of mandamus, or any other non- monetary relief against a designated member or any of its agents; CC. ( to any liability arising out of any actual or alleged sexual action, abuse, communicable disease or employment related claim, defined for purposes of this exclusion as: 1. sexual action includes, but is not limited to, any verbal or non-verbal communication, behavior or conduct with sexual connotations or purposes, whether for sexual gratification, intimidation, coercion or other purpose, and regardless of whether such action is alleged to be intentional or negligent. 2. abuse shall include, but is not limited to, the negligent or intentional infliction of physical, emotional or psychological injury or harm on any person or persons in the care, custody or control of any member. 3. communicable disease includes but is not limited to Acquired Immune Deficiency Syndrome (AIDS), and any venereal disease. FMIT GC 1002 Page 8 of 10 ( 4. employment related claim includes but is not limited to claims, accusations or charges of negligent or intentional hiring, placement, training or supervision arising from or related to actual or alleged sexual action, or any other type of actual or alleged abuse, or a communicable disease. However, this exclusion does not apply and coverage is afforded under this Agreement to bodily injury or personal injury liability which may accrue against the "Designated Member" as defined within the "Definition" section; 5. DO. to any liability for injury, loss or damage sustained by any person or entities arising from or in anyway involving asbestos or other products containing asbestos or to asbestosis or any other disease including mesothelioma and cancer related to asbestos exposure nor any liability for costs or expenses incurred in removing, cleaning up or nullifying such asbestos product; EE. to any liability arising out of errors and omissions as defined herein or other negligent or wrongful act committed in the administration of any employee benefits program as defined herein, for present or former employees of the designated member; FF. to any liability arising out of or caused by or contributed to or connected with alleged violation of the following: 1. Florida Whistle Blowers Act, Sec. 112.3187, Florida Statutes. 2. Federal "Fair Labor Standards~. 3. Chapter 447, Florida Statutes; GG. any claim requesting return or reimbursement of a special assessment, tax, service charge or fee or any other overpayment to the designated member or member; HH. ( II. to any claim for attorneys' fees or costs for any action not covered by this Agreement; to any damages which accrued or occurred prior to the effective date of this Agreement notwithstanding the date of the occurrence; JJ. advertising injury arising out of: 1. Failure of performance of contract, but this exclusion does not apply to the unauthorized appropriation of ideas upon alleged breach of implied contract, or 2. Infringement of trademark, service mark, or trade name, other than titles or slogans, by use thereof or in connection with goods, products or services sold, offered for sale, or advertised, or 3. Incorrect description or mistake in advertising price of goods, products or services sold, offered for sale or advertised. KK. c Also, with respect to advertising injury: 1. To any member in the business of advertising, broadcasting, or telecasting, or 2. To any injury arising out of any act committed by the member with actual malice. to any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of 1. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond by: a. Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Microprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or b. Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. 2. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in paragraph a. above. FMITGC 1002 Page 9 of 10 ( \ LL. to any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, for which any designated member or member under this agreement may be held liability arising out of the actual or threatened occurrence, growth, release, transmission, migration, dispersal or exposure to mold, spores and/or fungus; 1. Resulting from any actual or threatened exposure to, inhalation, absorption or ingestion of, or physical contact with mold, spores and/or fungus; 2. Resulting from any actual or threatened mold, spores, and/or fungus upon any real property or personal property, product or work, premises, site or location, or any other tangible property, or any designated member or member or any other person(s) or organization(s), located anywhere in the world; 3. Resulting from any loss, cost or expense for any testing, monitoring, clean-up, treatment or removal, or neutralization of mold, spores and/or fungus; MM. to any Bodily Injury Liability Property Damage Liability, Personal Injury Liability and Advertising Injury Liability arising directly or indirectly out of any loss, damage, claims, injury, cost or legal obligations, or any other sum, or relating to: 1. Any act of terrorism, or 2. Any action authorized by a governmental authority or agency for the purpose of preventing, terminating, countering or responding to any act of terrorism or for the purpose of preventing or minimizing the consequences of any act or threat of terrorism. OTHER INSURANCE The coverage afforded by this Agreement is primary, except when stated to apply in excess of or contingent upon the absence of other insurance. When this coverage is primary and the member has other insurance which is stated to be applicable to the loss on an excess or contingent basis, the amount of the ( Trust's liability under this Agreement shall not be reduced by the existence of such other insurance. If all other valid and collectible insurance provides for contribution by equal shares, the Trust shall not be liable for a greater proportion of such loss than would be payable if each party contributes an equal share until the share of each party equals the lowest applicable limit of liability under anyone policy or coverage agreement or the full amount of the loss is paid, and with respect to any amount of loss not so paid the remaining parties then continue to contribute equal shares of the remaining amount of the loss until each such party has paid its limit in full or the full amount of the loss is paid. ( If any such other insurance does not provide for contribution by equal shares, the Trust shall not be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss bears to the total applicable limit of all valid and collectible insurance against such loss. FMIT GC 1002 Page 10 of 10 ( DEDUCTIBLE STOP LOSS ENDORSEMENT PROVISIONS I. Member City of Winter Springs II. Stoploss Coverage Applies 0 A. Workers Compensation & Employers Liability ~ B. General Liability ~ C. Auto Liability 0 D. Property 0 E. Automobile Physical Damage III. Applicable Stoploss Deductible A. Workers Compensation & Employers Liability $ ( B. General Liability $ 25,000 j C. Auto Liability $ 25,000 D. Property $ E. Automobile Physical Damage $ IV. Applicable Deductible Stop loss Amount A. $ 188,303 ( FMIT DSL 1002 Page 1 of 2 The endorsement provides for a limitation on the number of deductibles or amount of loss incurred by a member under a deductible program as offered by the Florida Municipal Insurance Trust. I. IT IS AGREED THAT: A. The Trust's liability to pay claims on behalf of the member under this endorsement applies only to the members deductible amounts as stated in the Declarations and only atter satisfaction of the Deductible Stoploss amount as stated in this endorsement. B. The Trust agrees with the member that the member's obligations under applicable deductible endorsements cease when the member had paid losses within the deductible that exceed: (1) Three (3) times the largest deductible as stated in the Provisions or (2) the Deductible Stoploss Amount, whichever is greater. C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full force and effect, including those with respect to: (1) the Trust's rights and duties in the defense of claims and (2) the member's duties in the event of an accident or occurrence, irrespective of the application of deductible amount or deductible stoploss. D. The member will immediately report in writing: (1) all accidents or incidents which may give rise to liability. (2) all Notice of Claims. (3) all lawsuits involving a claim for damages. E. The Trust shall select and retain all defense attorneys and other service providers as necessary and shall directly control and supervise their activities. All such costs incurred in these services shall be paid by the Trust. F. The deductible amount shall include the amount of any payment resulting from a covered claim in the aggregate up to the deductible amount stated in the declarations. The member's responsibility under the deductible shall continue even though the contract may have been cancelled or expired. G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust and not included in the deductible amount. H. The Trust may settle or defend any claim as it considers appropriate without the member's consent regardless of any deductible amount. I. The Trust is authorized to make reasonable additions, changes, or deletions to these reporting requirements. J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount due within 45 days of the invoice date. Failure to pay this sum will result in the revocation of the member's deductible plan privileges. K. Recoveries shall be applied to the member's deductible until satisfied. L. The Definitions Section of the Trust is amended per this additional definition: (1) Deductible stop loss is coverage which limits a members deductible payment obligations to a certain fixed amount. ( FMIT DSL 1002 Page 2 of 2 ( BROAD FORM PROPERTY DAMAGE I. The Coverage section is amended to include the following additional coverage: As it relates to property damage to property owned, occupied or used by or rented to the member or in the care, custody or control of the member or as to which the member is for any purpose exercising physical control and work performed by or on behalf of the designated member arising out of the work or any portion thereof, or out of materials, parts or equipment furnished in connection therewith. ( ( FMIT BFPD 1002 Page 1 of 1 EXTRA CONTRACTUAL LEGAL EXPENSE I. The Coverage Section is amended to include the following additional coverages: The Trust will reimburse the member seventy five percent (75%) of the legal fees and seventy five percent (75%) of the legal assistant fees incurred by the public officer or officers and reimbursed by the member as a result of an occurrence, up to a maximum of twenty five thousand dollars ($25,000) per occurrence, or one hundred thousand dollars ($100,000) in the aggregate for the Trust year provided: a. the occurrence is not otherwise covered by the Trust; b. the member and the public officer provide the Trust such documentation as is necessary for the Trust to determine the total amount incurred and reimbursed, and the eligibility and legitimacy of the reimbursements; c. in an action, the court finds the member is obliged to reimburse the legal fees and legal assistant fees incurred by the public officer because the conduct that gave rise to the action arose out of or in connection with the performance of the officer's official duties and the action served public purpose; and d. in an ethics proceeding; it is determined the conduct that gave rise to the proceeding arose out of or in connection with the performance of the officer's official duties and the public officer is not found to have committed a breach of the public trust; ( e. coverage is specifically excluded for any occurrence outside the effective dates of this endorsement. II. The Definition Section is amended to include the following additional definitions which shall apply exclusively to this endorsement. "Action" means a criminal or civil judicial proceeding in a court of law, before a judicial officer, in which a public officer or a group of public officers of a member are named party in their personal capacities and in which original subject matter jurisdiction is vested in a county court or circuit court. "Action" includes any appellate proceedings that arise from such judicial proceedings and any administrative proceeding before the Florida Public Employees Relation Commission and Federal Equal Employment Opportunity Commission, but excludes any other state or local administrative proceedings. "Attorney" means a person admitted by the Supreme Court of Florida to practice law in Florida and who is a member in good standing of The Florida Bar. If the member is named a party in the action or the ethics proceedings, "attorney" excludes the person, such as the city attorney, appointed by the member to act as the legal advisor to, and attorney and counselor for, the member and its public officers, such person's deputies or assistants and other employees, and the partners, associates, and other employees of the law firm in which such person is a member. (, "Ethics Proceeding" means any proceeding, including appellate proceedings, designed to dispose of an ethics complaint filed with the Florida Commission on Ethics alleging a public officer or group of public officers of a member has committed a breach of public trust, except any portion of such proceeding prior to the issuance of a "Determination of Investigative Jurisdiction and Order to Investigate." "Legal Assistant" means a person who contributes non-clerical, meaningful legal support to an attorney; who, under the direct supervision and direction of an attorney, engages in legal research, case development or planning, prepares or interprets legal documents, or selects, compiles and uses technical information from references such as digests, FMIT ECLE 1002 Page 1 of 2 encyclopedias, or practice manuals; and who is certified by the National Association of Legal Assistants as a "Certified Legal Assistant." "Legal Assistant Fees" means the fees charged a public officer for the services of a legal assistant. "Legal Fees" means fees charged a public officer by an attorney engaged in the practice of law. "Occurrence" means conduct or a course of conduct by a public officer or group of public officers that culminates in an action or ethics proceeding. "Practice of Law" means legal work performed primarily for the purpose of rendering legal advise or representation to the member's public officers. "Public Officer" means any officer or employee of the member who is required to file financial disclosure pursuant to Sec. 112.3145, Fla. Stat. ( ( ..........,-- FMIT ECLE 1002 Page 2 of 2 FIRE LEGAL LIABILITY FIRE LEGAL LIABILITY - REAL PROPERTY With respect to property damage to structures or portions thereof rented to or leased to the designated member, including fixtures permanently fixed thereto, if such property damage arises out of fire: I. The Coverage section is amended to include the following additional coverage: A. all of the exclusions of the Agreement, other than the Nuclear Energy Liability Exclusion (Broad Form), are deleted and replaced by the following: this coverage does not apply to liability assumed by the member under any contract or agreement. B. the limit of property damage liability as respects this Fire Legal Liability Coverage - Real Property is $250,000 each occurrence unless otherwise stated in the schedule of this endorsement. C. The Fire Legal Liability Coverage - Real Property shall be excess over any valid and collectible property insurance (including any deductible portion thereof), available to the member, such as, but not limit to, Fire, Extended Coverage, Builders' Risk Coverage or Installation Risk Coverage, and the "Other Insurance" Condition of the Agreement is amended accordingly. ( ( FMIT FLL 1002 Page 1 of 1 MEDICAL ATTENDANTS'/MEDICAL DIRECTORS' MALPRACTICE LIABILITY / ( I. The Coverage section is amended to include the following additional coverage: A. It is agreed that the Trust will pay on behalf of the member all sums which the member becomes legally obligated to pay as damages because of injury to any person arising out of the rendering or failure to render, during the period of this Agreement, professional services by one of the designated member's Medical Attendants and Medical Director designated pursuant to Section 401.265, Florida Statutes. The Trust shall hav~ the right and duty to defend any suit against the member seeking such damages, even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and such settlement of any claim or suit as it deems expedient, but the Trust shall not be obligated to pay any claim or any judgment or to defend any suit after the applicable limit of the Trust's liability has been exhausted by payment of judgments or settlements. II. EXCLUSIONS (- This coverage does not apply to: A. Any dishonest, fraudulent, criminal or malicious act or omissions of the member, any partner or employee, any intentional misconduct or intentional act; B. Liability of the designated member as an employer of others or as the proprietor, superintendent or executive officer of any hospital, sanitarium, clinic with bed and board facilities, or other business enterprise; C. To professional services rendered by physicians and/or nurses; however, this exclusion does not apply to a Medical Director designated pursuant to Section 401.265, Florida Statutes, when said Director is acting within the scope and in furtherance of the duties of the Medical Director as outlined in Section 401.265, Florida Statutes. D. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond by: (1) Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Microprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or (2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in paragraph a. above. ( " FMIT MA 1002 Page 1 of 1 ERRORS AND OMISSIONS LIABILITY ENDORSEMENT This endorsement issued by the Trust extends and modifies the provisions of the Agreement relating to liability for Public Officials Errors and Omissions as set forth below: It is agreed that as of the effective date hereof, the Agreement is amended in the following particulars: I. The Coverage Section is amended to include the following additional coverage: COVERAGE D - ERRORS AND OMISSIONS LIABILITY II. The Trust will pay all sums a member becomes legally obligated to pay to any person other than the member by reason of "Errors and Omissions" as defined in the agreement committed by a member acting in his official capacity which takes place during the period of this Agreement, subject to all terms, conditions, exclusions and limits of liability of the Agreement and this endorsement. III. The Definition Section is amended to include the following additional definitions which shall apply exclusively to this endorsement. A. Member for purposes of coverage under this endorsement shall not include any of the following individuals, boards, commissions, authorities, units or administrative departments or agencies of: ( 1. Schools 2. Airports 3. Hospitals B. Official Capacity means the capacity of a member while lawfully acting for or on behalf of the designated member, or while lawfully acting in aid of the duties or functions which come within the scope of the member's employment by the designated member. IV. The Exclusion Section of the Agreement is amended as follows for this endorsement: A. Exclusion J of the Agreement is amended to read: J. to bodily injury to any employee of the designated member arising out of and in the course of employment by the designated member or to any obligation of a member to indemnify another because of damages arising out of such injury; but this exclusion does not apply to liability assumed by the designated member under an incidental contract. B. Exclusion Z of the Agreement is deleted. C. The following additional exclusions are included for purposes of this endorsement only; and this endorsement does not apply to claims for liability as to any member arising out of the following: 1. based upon or attributable to any member gaining in fact any profit or advantage to which such member was not legally entitled, including remuneration paid in violation of law as determined by the courts; ( FMIT EO 1002 Page 1 of 5 ( (~ j 2. brought about or contributed to by fraud, dishonesty, or bad faith of a member; however, notwithstanding the foregoing, the member shall be protected under the terms of this Agreement as to any claims upon which suit may be brought against them by reason or any alleged fraud or dishonesty on the part of any member, unless a judgment or other final adjudication thereof adverse to such member shall establish that acts of active or deliberate dishonesty or fraud committed by such member was material to the cause of action so adjudicated; to any (a) liability arising out of estimates of probable costs or cost estimates being exceeded or faulty preparation of bid specifications, or plans, or (b) injury to, destruction or disappearance of any tangible property (including money) or the loss of use thereof; any claim demand or action seeking relief, or redress, in any form other than money damages, and any costs, fees, expenses or attorneys' fees relating to such claims; to any obligation for which a member becomes obligated to pay future wages as a result of any alleged wrongful employment practice. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond by: (1) Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Microprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or (2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual_problems described in paragraph a. above. 3. 4. 5. 6. D. Any violation of Constitutional Rights of any person which creates a cause of action for damages by or on behalf of any such person under anyone or more of the following Civil Rights Statutes: ( FMIT EO 1002 United States Code, Title 42, Section 1982 United States Code, Title 42, Section 1983 United States Code, Title 42, Section 1985 United States Code, Title 42, Section 1986 United States Code, Title 42, Section 12101 (ADA) United States Code, Title 29, Section 2601, et. seq. (FMLA) Civil Rights Act of 1991 Page 2 of 5 SUPPLEMENTAL EMPLOYMENT PRACTICES LIABILITY \ In consideration of the additional premium charged, it is hereby noted and agreed that coverage afforded by this agreement is extended to include Supplemental Employment Practices claims filed against a Designated Member or Member subject to the terms, conditions and exclusions of this endorsement and the terms, conditions and exclusions of the agreement. It is further noted and agreed that for the purposes of this endorsement only, the following definition shall apply: "Employment Practice Claims" shall mean a claim relating to a past, present or prospective employee of the Designated member arising out of an actual or alleged wrongful dismissal, discharge or termination, either actual or constructive, or employment, employment-related misrepresentation, wrongful failure to employ or promote, wrongful deprivation of career opportunity, wrongful discipline; failure to grant tenure or negligent employee evaluation; or sexual, gender, or workplace harassment (including the alleged creation of a hostile workplace environment); or unlawful discrimination, whether direct, indirect, intentional or unintentional; or failure to provide adequate employee policies and procedures. Exclusion CC4 is amended to read: employment related claim includes but is not limited to claims, accusations or charges of negligent hiring, placement, training or supervision arising from or related to actual or alleged sexual action, or any other type of actual or alleged abuse, or a communicable disease. Exclusion CC5 is amended to read: ( However, this exclusion does not apply and coverage is afforded under this Agreement to bodily injury or personal injury liability which may accrue against the "Designated Member" or "Member" as defined within the "Definition" section; ( FMIT EO 1002 Page 3 of 5 . EMPLOYEE BENEFITS PROGRAM ADMINISTRATION LIABILITY I ( The endorsement issued by the Trust extends and modifies the provision of the Agreement relating to liability for the administration of employee benefits programs as set forth below: I. The Coverage Section is amended to include the following additional coverage: The Trust will pay all sums a member becomes legally obligated to pay by reason of "Errors and Omissions" as defined in the Agreement, or other negligent act, committed in the administration of the designated members' employee benefits for present or former employees, which take place during the period of this Agreement, subject to the terms, conditions, exclusions and limits of liability of the Agreement and this endorsement. II. The Definition Section is amended to include the following additional definitions which shall apply exclusively to this endorsement: A. "Member" in this endorsement means only the designated member and individuals serving on boards or commissions for the purpose of administering employee benefits programs, acting within the scope of their authority by or on behalf of the designated member except as excluded herein. III. The Exclusions Section of the Agreement is amended as follows for this endorsement: A. Exclusion EE is deleted. B. The following additional exclusions are included for purposes of this endorsement only; and this endorsement does not apply to claims for liability as to any member arising out of the following: ( 1. As a result of dishonest, intentionally fraudulent, criminal or malicious acts or omissions of any member, however, this exclusion shall not apply to any member who did not: a) Personally participate in committing any such act or omission; or b) Remain passive after having personal knowledge of any such act or omission. 2. As a result of an intentional violation of any Workers' Compensation, Unemployment Insurance, Social Security or Disability Benefits law or administrative interpretation of such laws. 3. As a result of the failure to provide benefits because said benefits are not properly funded or an insurers failure to comply with the terms of its contract. 4. As a result of advice given to any employee to participate or not to participate in any Stock Subscription, Individual Retirement Account, or Salary Reduction Plan. 5. As a result of the investment or non-investment of employee benefit funds. 6. As a result of the failure of any investment to perform as predicted or expected by a member. 7. As a result of the termination or failure of any employee benefit plan. 8. As a result of fines, taxes or penalties imposed by law or other matters for which coverage may not be available under law. ( / FMIT EO 1002 Page 4 of 5 ( (~/ ( FMIT EO 1002 9. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directlyor indirectly out of a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond by: (1) Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Microprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or (2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in paragraph a. above. Page 5 of 5 ( (~} c LAW ENFORCEMENT LIABILITY ENDORSEMENT This endorsement issued by the Trust extends and modifies the provisions of the Agreement relating to Law Enforcement Liability as set forth below: It is agreed that as of the effective date hereof the Agreement is amended in the following particulars: This Agreement will provide coverage for losses, including personal injury, arising out of the course and scope of law enforcement and includes, but is not limited to, false arrest, detention, malicious prosecution, excessive force and assault and battery. FMIT LE 1002 Page 1 of 1 FLORIDA MUNICIPAL INSURANCE TRUST AUTOMOBILE LIABILITY AND PHY$tCAtDAMAGE DECLARATIONS Agreement No.: FMIT #0648 I. DESIGNATED MEMBER: City of Winter Springs II. Government Description Municipality III. COVERAGE PERIOD From October 1, 2002 to October 1, 2003 12:01 A.M. Standard Time at the address of the Designated Member. Premium IV. Automobile 1. Automobile Liability Number of Vehicles: ( 2. Uninsured Motorists Protection 3. Personal Injury Protection 4. Automobile Medical Payments 5. Automobile Physical Damage Basis e uctl e vpe Iml e remlum Per Schedule $25,000 DSL $2,000,000 $50,619 153 N/A N/A $10,000 Included $1,000 Included Per Schedule Per Schedule N/A $13,770 D d 'bl IT L' 't N t P V. This Agreement includes these endorsements and schedules: See Schedule B VI. ESTIMATED ANNUAL PREMIUM Florida Municipal Insurance Trust (FMIT) Normal Premium $70,571 Incentive Credit $6,182 Net Premium $64,389 Florida League of Cities Sponsored Insurance Programs Since 1977 ( THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT. FMIT AUTO DEC 1002 Page 1 of 2 12/13/02 Form # FMIT IND FMIT GC FMIT DSL FMIT AL FMIT PIP FMIT AM FMIT APD FMIT ARR FMIT SE AL ( ( FMIT AUTOMOBILE LIABILITY A'NO PHYSICAL DAMAGE COVERAGES October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List City of Winter springs, FMIT #0648 Schedule B Description Indemnity Agreement Coverage Agreement Deductible Stoploss Endorsement provisions Automobile Liability Personal Injury Protection Benefits Automobile Medical Payments Automobile Physical Damage Coverage Form Automobile Reimbursement Coverage Specific Excess Endorsement - Automobile Liabilty FMIT AUTO DEe 1002 Page 2 of 2 FLORIDA MUNICIPAL INSURANCE TRUST INDEMNITY AGREEMENT THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own selection. These members of the Florida Municipal Insurance Trust, all local government entities, have organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained, which are given to and accepted by each member hereof to the other, the parties to this instrument covenant, stipulate and agree as follows: RESPONSIBILITIES OF MEMBER Each member of the Trust agrees to abide by the following rules and regulations: I. GENERAL CONDITIONS A. The member agrees the Board of Trustees, the governing body of the Trust, comprised entirely of local elected officials, will set up, operate and enforce its own administrative rules, regulations and by-laws as between the individual members of the Trust and shall otherwise direct the affairs of the Trust; ( B. The member and the Trust agree all members of the Trust hereby agree that the Board may admit as members of this Trust only acceptable employers in the state of Florida who have common governmental interest. The Board or its designee shall be sole judge of whether or not an applicant shall be admitted to membership; c. The member agrees to maintain a reasonable loss prevention program in order to provide the maximum in safety and lawful practices as such may relate to the potential liability assumed by the Trust under this Agreement or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement; O. The member agrees to provide immediate notification of such occurrence to the Trust in the event of an occurrence likely to give rise to a claim within the scope of this Agreement, or any other agreement, certificate, document or other instrument executed by the Trust and.. the member pursuant to this Agreement; E. The member agrees to promptly make all contributions for coverages arising under this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement at the time and. in the manner directed by the Board of Trustees. Said contributions may be reduced by any discount, participation credit, or other contribution reduction program established by the Board of Trustees; F. The member agrees in the event of payment of any loss by the Trust on behalf of the member, the Trust shall be subrogated to the extent of such payment to all the rights of the member against any party or other entity legally responsible for damages resulting from said loss, and in such event, the member hereby agrees, on behalf of itself, its officers, employees, and agents to execute and deliver such instruments and papers as is required, and do whatever else is reasonably necessary, to secure such right to the Trust, and to cooperate with and otherwise assist the Trust as may be necessary to effect any recovery sought by the Trust pursuant to such subrogated rights; ( FMIT INO 1002 Page 1 of 4 G. The member agrees the Board of Trustees, its Administrator, and any of their other agents, servants, employees or attorneys, shall be permitted at all reasonable times and upon reasonable notice to inspect the property, work places, plants, works, machinery and appliances covered pursuant to this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and shall be permitted at all reasonable times while the member participates in the Trust, and up to and including two (2) years following the termination of its membership in the Trust, to examine the members' books, vouchers, contracts, documents and records of any and every kind which show or tend to show or verify any loss that may be paid or may have been paid by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, or which show or verify the accuracy of any contribution which is paid or payable by the member pursuant to the terms of this Agreement, or any other agreement, certification, document or any other instrument executed by the Trust and the member pursuant to this Agreement; H. The members hereby delegate to the Board of Trustees the responsibility to contract for handling the administrative and servicing functions of the Trust. The Board may pay a reasonable fee for such, which shall be negotiated from time to time by the Board of Trustees. These fees shall be in consideration of all services and expenses contracted for with the Trust, which services or expenses may include the collecting, disbursing, and accounting for monies collected, counseling with members as to the safety hazards, claims handling and investigations, and legal services, actuarial services and accounting services and for the purpose of providing for excess insurance coverage. Books and records of all contractors employed by the Trust are to be open to inspection by the Board of Trustees or their agents at all reasonable times and as otherwise required by law; ( I. The member and the Trust agree the administrator, to be appointed by the Board, shall deposit to the account of the Trust, at any bank or banks designated by the Board, all contributions or other monies, as and when collected and said monies shall be disbursed only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules, regulations and by-laws of the Board, and (2) the Agreement between the Board and the administrator; J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of the member any claims, suits or other legal proceedings which may at any time be instituted against the member on account of bodily injury liability, property damage liability, errors and omissions liability, civil rights liability, personal injury liability or any other such liability, monetary or otherwise, to the extent such defense and liability has been assumed by the Trust pursuant to this Agreement or any other agreement, certificate, documents, or other instrument executed by the Trust and the member pursuant to this Agreement, subject to any and all of the definitions, terms, conditions and exclusions contained in said agreements, certificates, documents or other instruments, although such claims, suits, allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed against the member in any such legal proceedings defended by the Trust or the members, all interest accruing after entry of judgement in such proceedings, and all expenses incurred in the investigation, negotiation or defense of such claims, suits, allegations or demands. Such defense shall be subject to the control of the Trust and its Administrator, which may make such investigation and settlement of any such claim, suit, or other legal proceeding, monetary or otherwise, as they deem expedient; K. The member agrees the liability of the Trust is specifically limited to the discharge of the liability of its members assumed pursuant to this Agreement or any other agreement, certificate, document, or any other instrument executed by the member and the Trust pursuant to this Agreement; FMIT IND 1002 Page 2 of 4 L. The member agrees the coverage of the Trust does not apply to punitive or exemplary damages; M. The Trust shall operate on a fiscal year from 12:01 a.m. October 1st to 12:01 October 1st of the succeeding year. Application for continuing membership, when approved in writing by the Board or their designee, shall constitute a continuing contract for each succeeding fiscal period unless cancelled by the Board or unless the member shall have resigned or withdrawn from said Trust by written notice; N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees coverage by the Trust for a member under the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of September of each calendar year; O. Except as otherwise provided herein, the member and the Trust agree such member's coverage may be canceled by the Trust or the member at any time upon no less than forty- five (45) days prior written notice by the Board of Trustees or the Administrator to the member and to the Division of Workers' Compensation, if applicable, or by the member to the Trust, stating the date such cancellation shall be effective; however, cancellation by the member after the initial effective date of coverage (October 1), shall be conditioned upon Member's payment of an amount equal to ten (10) percent of the premium that is unearned by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice of cancellation to the member 10 days before the effective date of cancellation; P. The member agrees excess monies remaining after the payment of claims and claim expenses, and after provision has been made for the payment of open claims and outstanding reserves, may be distributed by the Board of Trustees to the members participating in the Trust in such manner as the Trustees shall deem to be equitable; ( a. The member agrees there will be no disbursements out of the reserve fund established by the Trust by way of dividends or distributions of accumulated reserves to members until provision has been made for all obligations against the Trust and except at the discretion of the Board of Trustees; R. The member agrees to permit qualified service providers, including attorneys selected by the Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits, allegations or demands that may result in liability assumed by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust or the member pursuant to this Agreement; S. The member shall make prompt payment of all contributions as required by the Board of Trustees, said contributions to be determined by said Board. The member shall fully cooperate with auditors of the Trust to promptly determine final audited contributions. Any disputes concerning contributions shall be resolved after payment. Any objections concerning the final audited contribution shall be filed within 60 days of billing of the final audited contributions. After that time, the audit shall be considered to be final; T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for late payment of contributions required under this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement; ( U. The member, through the Board of Trustees, does hereby appoint the Administrator of the Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and other documents reasonably necessary to accomplish the purposes and to fulfill the FMIT IND 1002 Page 3 of 4 responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses, medical expenses, and all other matters required or necessary insofar as they affect the member's liability under federal or Florida law and insofar as such matters are covered pursuant to the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and by the rules and regulations now or hereafter promulgated by the Board of Trustees; V. The Trust shall determine all questions of the scope of liability coverage, eligibility methods of providing or arranging for benefits, and all other related matters. It shall have full power to construe the provisions of this agreement and the other program documents in the terms used here and therein. Any such determination and any such construction adopted by the Trust in good faith shall be Qinding upon all parties hereto and the members, provided such determination or such construction is consistent with the laws of the State. The member agrees to abide by all the terms and conditions of this Agreement, the Participation Agreement, the Trust's By-laws, the rules and regulations, and any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to the Agreement; W. The member and the Trust agree the Trust will maintain an excess coverage program and reserve evaluation to protect the financial stability of the Trust in an amount and manner determined by a qualified and independent actuary; X. The member and the Trust agree the Trust will submit to the appropriate governmental agency annually an audited fiscal year-end financial statement prepared by an independent certified public accountant; Y. ( The member and the Trust agree that any member who formally applies for membership in this Trust and is accepted by the Board of Trustees shall thereupon become a party to the Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions contained therein, and said application shall constitute a counterpart of said Agreement and Declaration of Trust; and Z. Members duties after loss: FMIT IND 1002 1. give the Trust prompt written notice of any accident, occurrence or potential claim along with all relevant information concerning the claim. The member shall have a continuing duty to provide to the Trust all relevant information promptly as the member becomes aware of such information; and cooperate fully with the Trust in defense or settlement of claims or opposition to claims bills, and in the enforcement of any right of contribution or indemnity; and forward to the Trust every notice, demand, summons or other process served upon the member relating to any occurrence, and take no further action concerning the occurrence without the approval of the Trust or the servicing agent; and take reasonable steps to prevent additional or cumulative bodily injury, personal injury or property damage from or arising out of the same or similar conditions or circumstances; and not engage in settlement negotiations as to any claim or suit, and the Trust shall have no obligation to pay the amount of any settlement negotiated or agreed upon by a member without prior written approval by the Trust or the servicing agent; and agree to take all reasonable actions, where appropriate, which shall facilitate settlement of claims; and agree to responsible counsel selected by the Trust to defend the claim and agree not to use the designated member's counsel in defense of said action. 2. 3. 4. 5. 6. 7. Page 4 of 4 FLORIDA MUNICIPAL INSURANCE TRUST COVERAGE AGREEMENT In consideration of the payment of the contributions and the covenants and agreements set forth in the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the statements of the APPLICATION, the DECLARATIONS, and all terms, conditions, limits and other provisions of the COVERAGE AGREEMENT, the Trust agrees with the member as to the following: LIMITS OF LIABILITY Regardless of the number of (1) members under this Agreement, (2) persons or organizations who sustain injury or damage, or (3) claims made or suits brought on account of bodily injury, property damage or personal injury, the liability of the Trust is limited as follows: The total liability of the Trust applicable to "each person" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by one person or organization as the result of any one occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. The total liability of the Trust applicable to "each occurrence" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than one person or organization as the result of anyone occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. ( For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence. DEFENSE AND SETTLEMENT In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers appropriate, any claim or suit demanding money damages covered by this Agreement. The Trust will defend any suit against a member which alleges a claim for money damages covered by this Agreement even if such suit is groundless, false or fraudulent. However, the Trust has no duty to defend a member in any action which on its face alleges facts excluded or not covered by this Agreement. In the event a suit or other action contains allegations which allege damages which the Trust has a duty to defend and other allegations which allege damages or other relief that the Trust does not have a duty to defend, the Trust will defend all allegations subject to the terms, conditions, limits of liability and exclusions of the Agreement; however, undertaking such defense shall not obligate the Trust to ,pay any judgments, settlements or awards which a member becomes legally obligated to pay for allegations to which coverage does not apply. The Trust's duty to defend ends when applicable Limits of Insurance have been exhausted. FMIT GC 1002 Page 1 of 10 DEFINITIONS The following definitions apply throughout this Agreement unless modified or excluded: A. Advertising Injury, means injury arising out of an offense committed during the Agreement period occurring in the course of the designated member's advertising activities; if such injury arises out of libel, slander, defa'mation, violation or right of privacy, piracy, unfair competition, or infringement of copyright, title, or slogan. B. Agreement Territory, means anywhere in the world. C. Automobile, means a land motor vehicle, trailer or semi-trailer designed for travel on public roads (including any machinery or apparatus attached thereto), but does not include mobile equipment. D. Bodily Injury, means bodily injury, disability, disfigurement, sickness or disease or death resulting from an occurrence and sustained by any person, and any loss, injury or damages sustained by any person because of bodily injury, which occurs during the period of this Agreement. E. Completed Operations Hazard, includes bodily injury and property damage arising out of operations or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs after such operations have been completed or abandoned and occurs away from the premises owned by or rented to the designated member. "Operations" includes materials, parts or equipment furnished in connection therewith. Operations shall be deemed completed at the earliest of the following items: 1. When all operations to be performed by or on behalf of the designated member under the contract have been completed, ( 2. When all operations to be performed by or on behalf of the designated member at the site of the operations have been completed, or 3. When the portion of the work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing an operation for a principal as a part of the same project. Operations which may require further service or maintenance work, or correction, repair or replacement because of any defect or deficiency, but which are otherwise complete shall be deemed complete. The completed operations hazard does not include bodily injury or property damage arising out of operations in connection with the transportation of property, unless the bodily injury or property damage arises out of a condition in or on a vehicle created by the loading or unloading thereof. F. Contractual Liability, means liability expressly assumed under a written contract or agreement; provided, however, that contractual liability shall not be construed as including liability under a warranty of the fitness or quality of the designated member's products or a warranty that work performed by or on behalf of the designated member will be done in a workmanlike manner; and provided, however, that contractual liability shall not be construed as including liability under any hold harmless agreement or agreement to indemnify any non-public or private person, corporation, or entity under any contract or agreement. FMIT GC 1002 Page 2 of 10 G. Designated Member, means the entity, organization or constitutional officer named in Item I. or V. of the Declarations of this Agreement; designated member does not include employees or agents of that entity or organization. H. Designated Member's Products, means goods or products manufactured, sold, handled, or distributed by the designated member or by others trading under his name, including any container thereof (other than a vehicle), but "designated member's products" shall not include a vending machine or any other property, rented to or located for use of others but not sold. I. Elevator, means any hoisting or lowering device to connect floors or landings, whether or not in service, and all appliances thereof; but does not include an automobile servicing hoist, a material hoist used in alteration, construction or demolition operations, or an inclined conveyor used exclusively for carrying property or a dumbwaiter. J. Employee Benefits Program, means any pension and profit sharing plan; individual retirement account (IRA) plan; salary reduction plan under Internal Revenue Code 401 (k) or Amendments; employee stock subscription plan, savings plan; group plan for life, health, dental, disability, automobile, home owners, or legal services insurance; social security system benefits; workers' compensation and unemployment insurance; travel and vacation plans; or educational tuition reimbursement plans created, administered or endorsed by a member. K. Errors and Omissions, means an actual or alleged error or misstatement or act of omission or neglect or breach of duty including misconduct or official misconduct by the members in their official capacity, individually or collectively, or any matter of claims against them solely by reason of their having served or acted in an official capacity. L. Incidental Contract, means a written (a) lease of premises, (b) easement agreement, except in connection with construction or demolition operations on or adjacent to a railroad, (c) undertaking to indemnify a municipality required by municipal ordinance, except in connection with work for the municipality, (d) sidetrack agreement, or (e) elevator maintenance agreement; but does not include any hold harmless agreement or agreement to indemnify any non-public or private person, corporation, or entity under any contract or agreement. ( M. Incidental Medical Malpractice Injury, means bodily injury arising out of the rendering of or failure to render medical services or treatment by a non-professional during the period of this Agreement, including the following services: 1. medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or 2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. N. Inverse Condemnation, means a cause of action by a property owner to recover the monetary value of property that has been taken by the designated member having the power of eminent domain where no formal exercise of that power has been undertaken and includes any claim alleging lost profits both future and past. O. Member, as used herein means: a. the designated member; b. while acting within the scope of his employment, any officer (except constitutional officers), volunteer, servant, or employee of the designated member, including elected and appointed officials, and members of Boards or Commissions. However, the coverage so provided any officer, servant, or employee does not apply to bodily injury to another officer, servant or employee of the designated member injured in the course of and arising out of his employment. FMIT GC 1002 Page 3 of 10 The coverage afforded applies separately to each member against whom claim is made or suit is brought, except with respect to the limits of liability of the Trust; and does not apply to bodily injury or property damage or personal injury liability arising out of the conduct of any partnership or joint venture of which a member is a partner or participant and which is not specified in this Agreement as a designated member. P. Mobile Equipment, means a land vehicle (including any machinery or apparatus attached thereto), whether or not self propelled, (a) not subject to motor vehicle registration, or (b) maintained for use exclusively on premises owned by or rented to the designated member, including the ways immediately adjoining, or (c) designed for use principally off public roads, or (d) designed or maintained for the sole purpose of affording mobility to equipment of the following types forming an integral part of or permanently attached to such vehicle: power cranes, shovels, loaders, diggers and drills; concrete mixers, graders, scrapers, rollers and other road construction or repair equipment; air compressors, pumps and generators, including spreading, welding and building cleaning equipment; and geophysical exploration and well servicing equipment. Q. Occurrence, means an event or accident, including continuous or repeated exposure to conditions which result in bodily injury, property damage or personal injury and not arising from any form of intentional misconduct. R. Personal Injury, means injury sustained by any person or organization arising out of one or more of the following offenses committed during the term of this Agreement. However, this coverage does not apply to law enforcement operations. 1. False arrest, detention, imprisonment; 2. Wrongful entry or eviction, or other invasion of the right of private occupancy; ( 3. Publication or utterance: a) of a libel or slander or other defamatory or disparaging material; b) in violation of an individual's right or privacy; or except that publications or utterances in the course of or related to broadcasting, publishing, or telecasting activities conducted by or on behalf of the designated member shall not be deemed personal injury; 4. Assault and battery, not committed by or at the direction of the designated member unless committed for the purpose of protection of persons or property. S. Products Hazard, includes bodily injury and property damage arising out of a designated member's products or reliance upon a presentation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs away from premises owned by or rented to the designated member and after physical possession of such products has been relinquished to others. T. Property Damage, means (a) physical injury to or destruction of tangible property which occurs during the policy period, including the loss of use thereof at any time resulting there from, or (b) loss of use of tangible property which has not been physically injured or destroyed provided such loss of use is caused by an occurrence during the period of this Agreement. FMIT GC 1002 Page 4 of 10 EXCLUSIONS This Coverage Agreement does not apply: A. to liability assumed by a designated member under an expressed or implied contract or agreement except an incidental contract or inter-local agreements with other governmental entities; but this exclusion does not apply to an implied warranty of fitness or quality of the designated member's products or an implied warranty that work performed by or on behalf of the designated member will be done in a workmanlike manner; ( ( B. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any automobile operated by or rented or loaned to any member; 2. any other automobile operated by any person in the course of his employment by any member; but this exclusion does not apply to the parking of an automobile on premises owned by, rented to or controlled by the designated member or the ways immediately adjoining, if such automobile is not owned by or rented or loaned to any member; 3. any vehicle while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any contest or activity; C. to bodily injury or property damage arising out of: 1. the ownership, maintenance, operation, use, loading or unloading of any mobile equipment while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any such contest or activity; 2. the operation or use of any trailer designed for use therewith; or 3. the ownership, maintenance, operation, or use of a skateboard/skate park facility, in-line skating facility or water theme park; D. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any watercraft over twenty six (26) feet in length; 2. any passenger being carried for a consideration while in or upon, entering or alighting from any watercraft; or 3. barge or lighter rented by the designated member to others with respect to which the designated member does not furnish employees to operate and does not have any operating control; 4. any watercraft while being used in any pre-arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any contest or activity; 5. any watercraft or structure being used as an artificial reef or similar purpose; E. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of: 1. any aircraft owned or operated by or rented or loaned to any member; 2. any other aircraft operated by any person in the course of his employment by any member; but this exclusion does not apply to aircraft while parked on premises owned by, rented to or controlled by the designated member; F. to any liability arising out of or caused or contributed to by any maintenance, operation, use or control of or responsibility for any airfield, airport, runway, hangar, building or other property or facility designed for, used, connected, associated or affiliated with or in any way related to aviation or aviation activities or operations; provided that liability for services performed or premises located at or on any airfield, airport or aviation facility not directly related to aviation activities or operations, and not covered by any other liability insurance, shall not be excluded from coverage by this exclusion; FMIT GC 1002 Page 5 of 10 G. any claim for bodily injury, property damage (including the loss of use thereof), personal injury or advertising injury caused by, contributed to or arising out of the actual or threatened discharge, dispersal, release, or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, electromagnetic radiation, liquids or gases, waste materials or other irritants, pollutants or contaminants into or upon the land, the atmosphere or any course or body of water, whether above or below ground and includes all claims involving mold, spores and/or fungus. Also, excluded from coverage under this agreement is the process of continued surface and/or subsurface degradation and deterioration of lead based paint that has been applied to any surface of any building whether considered commercial or residential. It is understood and agreed that the intent and effect of this exclusion is to delete from all coverages afforded by this policy any claim, suit, action, judgment, liability, settlement, defense or expenses (including any loss, cost, or expense arising out of any governmental direction, order or request that the member test for, monitor, clean up, remove, contain, treat, detoxify or neutralize pollutants) in any way arising out of such actual or threatened discharge, dispersal, release or escape, whether such results from the member's activities or the activities of others, whether or not such a sudden or gradual, and whether or not such is accidental, intended, foreseeable, fortuitous or inevitable and wherever such happens; H. to bodily injury or property damage due to war, whether or not declared, civil war, insurrection, rebellion and revolution, or to any act or condition incident to any of the foregoing; I. to any obligation for which any member or any carrier as his insurer may be held liable under any workers compensation, employers liability, unemployment compensation or disability benefits law, or under any similar law and including any claims under the Americans with Disabilities Act; ( J. to bodily injury to any employee of the designated member arising out of and in the course of this employment by the designated member or to any obligation of a member to indemnify another because of damages arising out of such injury; but this exclusion does not apply to liability assumed by the designated member under an incidental contract. This exclusion shall include any liability incurred by a designated member as a result of an alleged wrongful discharge; failure to promote; demotion or transfer of any employee of the designated member; K. to property damage to property owned or occupied by, leased, or rented to a designated member; L. to property damage to premises alienated by the designated member arising out of such premises or any part thereof; M. to loss of use of tangible property which has not been physically injured or destroyed resulting from a delay in lack of performance by or on behalf of the designated member of any contract or agreement; N. to property damage to the designated member's products arising out of such products or any part of such products; to property damage to work performed by or on behalf of the designated member arising out of the work or any portion thereof, or out of materials, parts or equipment furnished in connection therewith; and to damages claimed for the withdrawal, inspection, repair, replacement, or loss of use of the designated member's products or work completed by or for the designated member or of any property of which such products or work form a part, if such products, work or property are withdrawn from the market or from use because of any known or suspected defect or deficiency therein; FMIT GC 1002 Page 6 of 10 ( O. to any liability from the designated member's completed operations arising out of: 1. loss of sales, customers or profits suffered by a person or entity affected by the actions of the designated member or its agents including any damages sustained by such person or entities by virtue of a business interruption; or 2. loss resulting from theft of any property which at the time of loss is not an integral part of a building or structure including direct loss by pillage and looting occurring during and at the immediate place of a riot or civil commotion; P. to any liability arising in whole, or in part out of 1. any act or omission of a member committed while acting outside the course and scope of his employment, or committed in bad faith with malicious purpose, or in a manner exhibiting wanton and willful disregard of human rights, safety or property; 2. any member obtaining remuneration or financial gain to which the member was not legally entitled; 3. the willful violation of any federal, state or local law, ordinance or regulation committed by or with the knowledge or consent of any member; or 4. official misconduct by any member; Q. to any liability arising out of or in any way connected with the operation of the principals of eminent domain, condemnation proceedings, inverse condemnation or takings law, by whatever name called, whether permanent or temporary, including but not limited to, claims arising out of federal, state or local land use, environmental, air, ground or water pollution, or health, safety and welfare laws, ordinances or regulations, claims arising from Ch. 95-181, Laws of Florida, as may be amended from time to time, or claims arising from activities by or on behalf of a member which result in permanent or temporary loss of use or value of property, whether such liability accrues directly against the member, or by virtue of any agreement entered into by or on behalf of the member; however, this exclusion does not apply to bodily injury, property damage or personal injury resulting from a claim against the designated member for inverse condemnation; the limit of inverse condemnatiOn claims is the amount of liability described in the General/Professional Liability section of the Declarations Page or $1,000,000 aggregate per fund year, whichever is the lesser amount, subject to a deductible of $5,000.00 per occurrence. R. to any liability for injury, sickness, disease, death or destruction due to the rendering of or failure to render any professional service by any doctor, surgeon, dentist, nurse, physician's assistant, paramedic, emergency medical technician or other medical professional of a designated member; S. to any liability arising out of or in connection with or caused or contributed to by any failure or inability to supply, in whole or in part, any adequate quantity or quality of power, steam, pressure or fuel; T. to any liability arising out of or caused or contributed to by or connected with any actual or alleged violation of the Employee Retirement Income Security Act of 1974 (Public Law 93-406) or any amendment thereto or any similar provision of any local, state or federal law, statutory or common; U. to any liability arising out of or caused or contributed to by any breakage and/or water overflow of any dam or reservoir; V. to any liability for fines, punitive or exemplary damages; or any non compensatory damages or penalties imposed pursuant to any federal or state anti-trust, civil rights, anti-discrimination, or racketeer influence and corrupt organization (RICO) laws; W. to any damages imposed by special act of the Legislature; FMIT GC 1002 Page 7 of 10 X. to loss caused directly or indirectly by nuclear hazard. Nuclear hazard means any nuclear reaction, radiation, a radioactive contamination, all whether controlled or uncontrolled or however caused, or any consequence of any of these; Y. to personal injury arising out of any publication or utterance described in sub-paragraph Q 3 of the definition of Personal Injury contained in the Definition section of this Agreement (a) if the first injurious publication or utterance of the same or similar material by or on behalf of the designated member was made prior to the effective date of this coverage; (b) concerning any organization or business enterprise, or its products or services, made by or at the direction of any member with knowledge of the falsity thereof; Z. to any liability arising out of errors and omissions as defined herein; AA. to bodily injury or property damage for which the designated member or his indemnitee may be held liable; 1. as an entity or organization engaged in manufacturing, distributing, selling or serving alcoholic beverages; or 2. if not so engaged, as an owner or lessor of premises used for such purposes, if such liability is imposed a) by, or because of the violation of, any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any alcoholic beverages; or b) by reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol or which causes or contributes to the intoxication of any person. This exclusion does not apply and coverage is afforded under the Agreement for bodily injury or property damage claims or liability resulting from the providing or serving of alcoholic beverages without charge to the public at functions incidental to a designated member's business or activity otherwise covered under the Agreement or any endorsement to the Agreement; ( to any claim, demand or action seeking injunctive, declaratory, writ of mandamus, or any other non-monetary relief against a designated member or any of its agents; CC. to any liability arising out of any actual or alleged sexual action, abuse, communicable disease or employment related claim, defined for purposes of this exclusion as: 1. sexual action includes, but is not limited to, any verbal or non-verbal communication, behavior or conduct with sexual connotations or purposes, whether for sexual gratification, intimidation, coercion or other purpose, and regardless of whether such action is alleged to be intentional or negligent. 2. abuse shall include, but is not limited to, the negligent or intentional infliction of physical, emotional or psychological injury or harm on any person or persons in the care, custody or control of any member. 3. communicable disease includes but is not limited to Acquired Immune Deficiency Syndrome (AIDS), and any venereal disease. 4. employment related claim includes but is not limited to claims, accusations or charges of negligent or intentional hiring, placement, training or supervision arising from or related to actual or alleged sexual action, or any other type of actual or alleged abuse, or a communicable disease. 5. However, this exclusion does not apply and coverage is afforded under this Agreement to bodily injury or personal injury liability which may accrue against the "Designated Member" as defined within the "Definition" section; SS. DD. to any liability for injury, loss or damage sustained by any person or entities arising from or in anyway involving asbestos or other products containing asbestos or to asbestosis or any other disease including mesothelioma and cancer related to asbestos exposure nor any liability for costs or expenses incurred in removing, cleaning up or nullifying such asbestos product; ( FMIT GC 1002 Page 8 of 10 EE. to any liability arising out of errors and omissions as defined herein or other negligent or wrongful act committed in the administration of any employee benefits program as defined herein, for present or former employees of the designated member; FF. to any liability arising out of or caused by or contributed to or connected with alleged violation of the following: 1. Florida Whistle Blowers Act, Sec. 112.3187, Florida Statutes. 2. Federal "Fair Labor Standards Act". 3. Chapter 447, Florida Statutes; GG. any claim requesting return or reimbursement of a special assessment, tax, service charge or fee or any other overpayment to the designated member or member; HH. to any claim for attorneys' fees or costs for any action not covered by this Agreement; II. to any damages which accrued or occurred prior to the effective date of this Agreement notwithstanding the date of the occurrence; JJ. advertising injury arising out of: 1. Failure of performance of contract, but this exclusion does not apply to the unauthorized appropriation of ideas upon alleged breach of implied contract, or 2. Infringement of trademark, service mark, or trade name, other than titles or slogans, by use thereof or in connection with goods, products or services sold, offered for sale, or advertised, or 3. Incorrect description or mistake in advertising price of goods, products or services sold, offered for sale or advertised. Also, with respect to advertising injury: 1. To any member in the business of advertising, broadcasting, or telecasting, or ( 2. To any injury arising out of any act committed by the member with actual malice. KK. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond by: (1) Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Microprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or (2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in paragraph a. above. ( FMIT GC 1002 Page 9 of 10 OTHER INSURANCE The coverage afforded by this Agreement is primary, except when stated to apply in excess of or contingent upon the absence of other insurance. When this coverage is primary and the member has other insurance which is stated to be applicable to the loss on an excess or contingent basis, the amount of the Trust's liability under this Agreement shall not be reduced by the existence of such other insurance. If all other valid and collectible insurance provides for contribution by equal shares, the Trust shall not be liable for a greater proportion of such loss than would be payable if each party contributes an equal share until the share of each party equals the lowest applicable limit of liability under anyone policy or coverage agreement or the full amount of the loss is paid, and with respect to any amount of loss not so paid the remaining parties then continue to contribute equal shares of the remaining amount of the loss until each such party has paid its limit in full or the full amount of the loss is paid. If any such other insurance does not provide for contribution by equal shares, the Trust shall not be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss bears to the total applicable limit of all valid and collectible insurance against such loss. ( ) ( FMIT GC 1002 Page 10 of 10 DEDUCTIBLE STOP LOSS ENDORSEMENT PROVISIONS I. Member City of Winter Springs II. Stop loss Coverage Applies 0 A. Workers Compensation & Employers Liability gg B. General Liability gg C. Auto Liability 0 D. Property 0 E. Automobile Physical Damage III. Applicable Stoploss Deductible A. Workers Compensation & Employers Liability $ B. General Liability $ 25,000 C. Auto Liability $ 25,000 D. Property $ E. Automobile Physical Damage $ IV. Applicable Deductible Stoploss Amount A. $ 188,303 FMIT DSL 1002 Page 1 of 2 The endorsement provides for a limitation on the number of deductibles or amount of loss incurred by a member under a deductible program as offered by the Florida Municipal Insurance Trust. I. IT IS AGREED THAT: A. The Trust's liability to pay claims on behalf of the member under this endorsement applies only to the members deductible amounts as stated in the Declarations and only after satisfaction of the Deductible Stoploss amount as stated in this endorsement. B. The Trust agrees with the member that the member's obligations under applicable deductible endorsements cease when the member had paid losses within the deductible that exceed: {1} Three {3} times the largest deductible as stated in the Provisions or {2} the Deductible Stop loss Amount, whichever is greater. C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full force and effect, including those with respect to: {1} the Trust's rights and duties in the defense of claims and {2} the member's duties in the event of an accident or occurrence, irrespective of the application of deductible amount or deductible stoploss. D. The member will immediately report in writing: {1} all accidents or incidents which may give rise to liability. {2} all Notice of Claims. {3} all lawsuits involving a claim for damages. ( E. The Trust shall select and retain all defense attorneys and other service providers as necessary and shall directly control and supervise their activities. All such costs incurred in these services shall be paid by the Trust. F. The deductible amount shall include the amount of any payment resulting from a covered claim in the aggregate up to the deductible amount stated in the declarations. The member's responsibility under the deductible shall continue even though the contract may have been cancelled or expired. G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust and not included in the deductible amount. H. The Trust may settle or defend any claim as it considers appropriate without the member's consent regardless of any deductible amount. I. The Trust is authorized to make reasonable additions, changes, or deletions to these reporting requirements. J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount due within 45 days of the invoice date. Failure to pay this sum will result in the revocation of the member's deductible plan privileges. K. Recoveries shall be applied to the member's deductible until satisfied. L. The Definitions Section of the Trust is amended per this additional definition: {1} Deductible stoploss is coverage which limits a members deductible payment obligations to a certain fixed amount. ( FMIT DSL 1002 Page 2 of 2 /- ,~, '",-, / Automobile~ Schedule City of Winter Springs, FMIT#0648 10/01/2002 - 10/01/2003 Veh # Eft Date Total Prem Exp Date City # Model Year Make Description 10 # Class Cost Code New Liab PIP Med Pay UM Comp Oed SP Oed Coli Oed Physical Damage 10/0112002 10/01/2002 10/01/2002 2 10/01/2002 3 10/01/2002 4 10/01/2002 5 10/01/2002 6 10/01/2002 7 10/01/2002 8 10/01/2002 9 10/01/2002 10 10/01/2002 11 10/01/2002 12 10/0112002 13 10/01/2002 14 10/01/2002 15 10/01/2002 16 10/0112002 17 10/0112002 18 10/0112002 19 10/01/2002 20 10/0112002 21 10/01/2002 12/13/02 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 1999 FORD 1994 FORD 2002 FORD 1998 FORD 1996 FORD 1991 FORD 1995 FORD 2002 FORD 1994 FORD 1992 FORD 1992 E-ONE 1992 E-ONE 1994 FORD 1994 FORD 1982 GRUMMAN 1994 FORD 1996 CHEVROLET 1999 MEDIC MAST 2001 FORD 2001 MEDIC MAST 1988 FORD NON OWNED AUTOS HIRED AUTOS 6601 6619 01499 01499 01499 01499 7398 7398 01499 01499 7398 01499 7909 7909 7398 7398 7909 7398 01499 7919 01499 7919 7398 $10,000 $10,000 $22,000 $10,000 $10,000 $10,000 $10,000 $22,000 $10,000 $12,572 $179,000 $179,000 $12,198 $12,198 $132,545 $14,000 $28,515 $134,568 $17,440 $135.468 $11,486 $39 $39 $434 $434 $434 $434 $246 $246 $434 $434 $246 $434 $341 $341 $246 $246 $341 $246 $434 $661 $434 $661 $246 City of Winter Springs, FMIT #0648 $0 $0 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $10 $5 $10 $5 $0 $0 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $0 n/a $0 n/a $0 n/a $0 n/a $0 $1,000 $0 n/a $0 nla $0 nla $0 n/a $0 $1,000 $0 n/a $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 Normal Premium n/a n/a n/a n/a n/a $1,000 nla nla nla n/a nla nla $1,000 n/a $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 nla n/a nla nla n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Page $0 $0 $0 $0 $312 $0 $0 $0 $0 $312 $0 $159 $184 $184 $83 $83 $184 $83 $250 $326 $284 $421 $83 $39 $39 $440 $440 $752 $440 $252 $252 $440 $752 $252 $599 $531 $531 $335 $335 $531 $335 $690 $998 $724 $1,093 $335 $70,571 of 7 -~ AutomobifitSchedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/0112003 Veh # Eft Date Total Prem 6:fe City # Model Year Make Description 10 # Class Cost Code New Llab PIP Med Pay UM C8~ SP Oed Coli Oed Physical Damage 22 10/0112002 23 10/01/2002 24 10/0112002 25 10/01/2002 26 10/0112002 27 10/0112002 28 10/01/2002 29 10/01/2002 30 10/01/2002 31 10/01/2002 32 10/01/2002 33 10/01/2002 34 10/01/2002 35 10/01/2002 36 10/0112002 37 10/01/2002 38 10/01/2002 39 10/01/2002 40 10/01/2002 41 10/01/2002 42 10/01/2002 43 10/01/2002 44 10/01/2002 12/13/02 10/0112003 10/0112003 10/0112003 10/01/2003 10/0112003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/0112003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 10/01/2003 1989 FORD 1986 CHEVROLET 1994 FORD 1991 FORD 1998 FORD 1999 FORD 2001 FORD 1996 FORD 2002 FORD 1992 FORD 1996 FORD 1997 FORD 1991 FORD 1992 FORD 2000 FORD 1988 FORD 1994 FORD 1988 FORD 2000 VW 1993 MAZDA 2001 VW 1997 FORD 1997 FORD 7919 01499 01499 7398 01499 01499 01499 01499 01499 01499 7398 01499 01499 01499 01499 01499 01499 01499 7398 01499 7398 7398 7398 $49,528 $13,763 $10,000 $10,000 $10,000 $10,000 $21,000 $10,000 $22,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $10,000 $23,000 $19,000 $23,000 $17,000 $17,000 $661 $434 $434 $246 $434 $434 $434 $434 $434 $434 $246 $434 $434 $434 $434 $434 $434 $434 $246 $434 $246 $246 $246 City of Winter Springs. FMIT #0648 $10 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $0 $1,000 $0 $1,000 $0 n/a $0 n/a - $0 nla $0 n/a $0 $1,000 $0 n/a $0 $1,000 $0 n/a $0 n/a $0 n/a $0 n/a $0 nla $0 $1,000 $0 n/a $0 nla $0 nla $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 $0 $1,000 Normal Premium nla nla $1,000 $1,000 n/a nla n/a n/a nla $1,000 n/a n/a n/a n/a n/a n/a $1,000 nla n/a n/a $1,000 nla nla nla nla $1,000 $1,000 $1,000 $1,000 $1,000 n/a n/a n/a n/a nla nla $187 $159 $0 $0 $0 $0 $312 $0 $312 $0 $0 $0 $0 $0 $166 $0 $0 $0 $171 $190 $206 $98 $98 n/a n/a n/a n/a nla n/a n/a n/a n/a nla Page 2 of 7 $859 $599 $440 $252 $440 $440 $752 $440 $752 $440 $252 $440 $440 $440 $606 $440 $440 $440 $423 $630 $458 $350 $350 $70,571 ~" , ,.-/ Automobile Schedule City of Winter Springs, FMIT #0648 1 0/01/2002 - 1 0/01/2003 Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Med UM C8::1 SP Coli Physical Total Date Dae Year Code New Pay Oed Oed Damage Prem 45 10/01/2002 10/0112003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 46 10/0112002 10/0112003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350 47 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350 48 10/01/2002 10/0112003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 49 10/01/2002 10/0112003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350 50 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 51 10/0112002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 52 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 53 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 54 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 55 10/01/2002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 '$1,000 n/a $1,000 $98 $350 56 10/01/2002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 57 10/01/2002 10/01/2003 1992 FORD 7398 $16,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 58 10/01/2002 10/01/2003 1996 MERCURY 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 59 10/01/2002 10/01/2003 1994 PONTIAC 7398 $24,000 $246 $5 $1 $0 $1,000 n/a $1,000 $126 $378 60 10/01/2002 10/0112003 2001 CHEVROLET 01499 $24,500 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752 61 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 62 10/01/2002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 63 10/01/2002 10/0112003 1993 FORD 7398 $16,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350 64 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $132 $384 65 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 66 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 67 10/01/2002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 Normal Premium $70,571 12/13/02 City of Winter Springs, FMIT #0648 Page 3 of 7 - ~ Automobi'reSchedule City of Winter Springs, FMIT #0648 1 % 112002 - 1 % 112003 Veh# Eft EX~ City # Model Make Description 10# Class Cost Liab PIP Med UM co~ SP Coli Physical Total Date Dae Year Code New Pay De Oed Oed Damage Prem 68 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 69 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 70 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 71 1010112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n1a $1,000 $132 $384 72 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n1a $1,000 $132 $384 73 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 74 10/01/2002 10/01/2003 1997 MERC 7398 $24,000 $246 $5 $1 $0 $1,000 n/a $1,000 $126 $378 75 10/0112002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 76 10/0112002 10/0112003 1996 FORD 7398 $17,250 $246 $5 $1 $0 $1,000 n1a $1,000 $98 $350 77 10/0112002 10/0112003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 78 10/0112002 10/01/2003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 79 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 80 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 81 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nfa $1,000 $132 $384 82 10/01/2002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 nfa $1,000 $98 $350 83 10/0112002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 84 10/01/2002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 85 10/0112002 10/0112003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 nfa $1,000 $98 $350 86 10/0112002 1 % 1/2003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 87 1 % 112002 1 % 1/2003 1999 MERCURY 7398 $25,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 88 10/0112002 10/0112003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 89 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 90 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n1a $1,000 $171 $423 Normal Premium $70,571 12/13/02 City of Winter Springs, FMIT #0648 Page 4 of 7 --- AutomobilifSchedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/01/2003 Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Mad UM CO":? SP Coli Physical Total Date Da e Year Code New Pay De Oed Oed Damage Prem 91 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 92 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 93 10/0112002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 94 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423 95 10/0112002 10/01/2003 2001 CHEVROLET 7398 $24,500 $246 $5 $1 $0 $1,000 n/a $1,000 $206 $458 96 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384 97 10/01/2002 10/01/2003 1995 TOYOTA 7398 $19,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 98 1 % 112002 10/01/2003 1996 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 99 10/0112002 10/0112003 1986 FORD 7398 $46,000 $246 $5 $1 $0 $1,000 n/a $1,000 $210 $462 100 10/01/2002 10/0112003 1994 FORD 7398 $16,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350 101 10/01/2002 10/01/2003 1992 FORD 01499 $10,000 $434 $5 $1 $0 n/a nla nla $0 $440 102 10/01/2002 10/01/2003 2001 FORD 01499 $21,000 $434 $5 $1 $0 $1,000 nla $1,000 $312 $752 103 10/0112002 10/01/2003 1994 FORD 21499 $18,000 $434 $5 $1 $0 nla n/a n/a $0 $440 104 10/01/2002 10/01/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 nla $1,000 $247 $687 105 10/01/2002 10/01/2003 1993 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 106 10/0112002 10/0112003 1991 FORD 01499 $10,000 $434 $5 $1 $0 nla n/a nla $0 $440 107 10/01/2002 10/01/2003 1993 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 108 10/01/2002 10/01/2003 1988 FORD 01499 $10,000 $434 $5 $1 $0 nla n/a n/a $0 $440 109 10/0112002 10/01/2003 1996 FORD 01499 $10,000 $434 $5 $1 $0 n/a nla n/a $0 $440 110 10/01/2002 10/01/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 111 10/01/2002 10/01/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 n/a $1,000 $247 $687 112 10/01/2002 10/01/2003 1999 FORD 21499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 113 10/0112002 10/0112003 1995 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 Normal Premium $70,571 12/13/02 City of Winter Springs, FMIT #0648 Page 5 of 7 ,-' AutomobileSchedule City of Winter Springs, FMIT #0648 10101/2002 - 10101/2003 Veh # Eff Date Total Prem 6:fe City # Model Year Make Description 10 # Class Cost Code New Liab PIP Med Pay UM C8:! SP Oed Coli Oed Physical Damage 114 10101/2002 115 10101/2002 116 10101/2002 117 10101/2002 118 10101/2002 119 10101/2002 120 10101/2002 121 10101/2002 122 10101/2002 123 10101/2002 124 10101/2002 125 10101/2002 126 10101/2002 127 10101/2002 128 10101/2002 129 10/0112002 130 10/0112002 131 10101/2002 132 10/0112002 133 10101/2002 134 10101/2002 135 10101/2002 10101/2003 10101/2003 10101/2003 10101/2003 10101/2003 1 0101/2003 10101/2003 10101/2003 1010112003 10101/2003 10101/2003 10101/2003 1010112003 10101/2003 10101/2003 1010112003 10101/2003 10101/2003 1010112003 1010112003 10101/2003 10101/2003 1987 FORD 1985 FORD 1989 DIESEL 1999 FORD 2001 FORD 1998 FORD 2002 STERLING 1999 FORD 1992 FORD 1995 FORD 1992 FORD 1999 FORD 1995 FORD 1993 FORD 1990 FORD 1999 FORD 1993 FORD 2000 FORD 1997 FORD 1986 FORD 1994 FORD 1994 FORD 31499 $19,000 31499 $17,500 21499 $28,000 01499 $19,000 01499 $21,000 01499 $18,000 31499 $180,000 01499 $19,000 01499 $12,000 o $30,000 21459 $12,000 01499 $19,000 01499 $15,000 01499 $13,000 01499 $10,000 01499 $19,000 01499 $13,000 01499 $20,000 01499 $17,000 01499 $40,000 7909 $14,000 01499 $14,000 01499 $530 $530 $434 $434 $434 $434 $530 $434 $434 $564 $434 $434 $434 $434 $434 $434 $434 $434 $434 $341 $434 $434 $6 $6 $5 $5 $5 $5 $6 $5 $5 $7 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $1 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 nla nla nla nla nla nla nla $1,000 nla nla $0 $0 $0 $0 $312 $0 $551 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $247 $0 $0 $0 $0 $537 $537 $440 $440 $752 $440 $1,088 $440 $440 $572 $440 $440 $440 $440 $440 $440 $440 $687 $440 $347 $440 $440 12/13/02 City of Winter Springs, FMIT #0648 nla nla nla $1,000 nla $1,000 nla nla nla nla nla nla nla nla nla nla $1,000 nla nla nla nla Normal Premium nla $1,000 nla nla nla nla nla nla nla nla nla nla nla nla $1,000 nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla nla Page 6 of 7 $70,571 -, .- , , Automobire"Schedule City of Winter Springs, FMIT #0648 10101/2002 - 10101/2003 Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Med UM co":? SP Coli Physical Total Date Dae Year Code New Pay De Oed Oed Damage Prem 136 10101/2002 10101/2003 1996 FORD 01499 $16,000 $434 $5 $1 $0 n/a n/a nla $0 $440 137 10101/2002 10101/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a nla n/a $0 $440 138 10101/2002 10101/2003 2002 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752 139 10101/2002 1010112003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 n/a $1,000 $247 $687 140 10101/2002 10101/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 nla $1,000 $247 $687 141 10101/2002 10101/2003 2002 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752 142 1010112002 10101/2003 1990 JEEP 01499 $10,000 $434 $5 $1 $0 n/a n/a nla $0 $440 143 10101/2002 1010112003 1997 FORD 01499 $17,000 $434 $5 $1 $0 n/a n/a nla $0 $440 144 1010112002 10101/2003 1997 FORD 01499 $17,000 $434 $5 $1 $0 nla n/a nla $0 $440 145 10101/2002 10101/2003 1991 FORD 21499 $18,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 146 10101/2002 10101/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 147 1010112002 1010112003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a nla $0 $440 148 1010112002 10101/2003 1997 FORD 01499 $17,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 149 10101/2002 10101/2003 1994 FORD 01499 $14,000 $434 $5 $1 $0 n/a n/a n/a $0 $440 150 10101/2002 10101/2003 1988 FORD 01499 $8,000 $434 $5 $1 $0 nla n/a n/a $0 $440 151 10101/2002 10101/2003 1994 FORD 01499 $14,000 $434 $5 $1 $0 n/a n/a nla $0 $440 152 1010112002 10101/2003 1987 FORD 21479 $7,000 $346 $4 $1 $0 nla nla n/a $0 $351 153 1010112002 10101/2003 2001 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 nla $1,000 $312 $752 Total Normal Premiums $54,335 $784 $153 $0 $15,299 $70,571 Incentive Credit $70,571 -$6,182 $64,389 Normal Premium Net Premium 12/13/02 City of Winter Springs, FMIT #0648 Page 7 of 7 AUTOMOBILE LIABILITY This endorsement issued by the Trust extends and modifies the provision of the Agreement relating to Automobile Liability as set forth below: It is agreed that as of the effective date hereof the Agreement is amended in the following particulars: I. The Coverage section is amended to include the following additional coverage: The Trust will also pay all sums which the designated member becomes legally obligated to pay as damages because of: A. Bodily Injury, or B. Property Damage to which this coverage applies, caused by an occurrence and arising out of the ownership, maintenance or use, including loading and unloading, of a scheduled automobile, including newly acquired automobiles, which takes place during the period of this Agreement. II. The Members section VII is amended to include the following additional persons for purposes of the coverage provided by this endorsement only: A. Any other person while using an owned automobile or a hired automobile with the permission of the designated member, provided his actual operation or (if he is not operating) his other actual use thereof is within the scope of such permission, but with respect to bodily injury or property damage arising out of the loading or unloading thereof, such other person shall be a member only if he is: ( 1. a lessee or borrower of the automobile, or 2. an employee of the designated member or of such lessee or borrower: B. Any other person or organization but only with respect to his or its liability because of acts or omissions of a member under the above. C. None of the following is a member: 1. the owner or lessee (of whom the designated member is a sub-lessee) of a hired automobile or the owner of a non-owned automobile or any agent or employee of any such owner or lessee; 2. any person or organization, other than the designated member, with respect to: a) a motor vehicle while used with any trailer owned or hired by such person or organization, or b) a trailer while used with any motor vehicle owned or hired by such person or organization; 3. any person while employed in or otherwise engaged in duties in connection with an automobile business, other than an automobile business operated by the designated member. { '. FMIT AL 1002 Page 1 of 2 III. The Definitions section is amended to include the following additional definitions: A. Automobile Business, means the business or occupation of selling, repairing, servicing, storing, or parking automobiles; B. Hired Automobile, means an automobile not owned by the designated member which is used under contract on behalf of, or loaned to, the designated member, provided such automobile is not owned by or registered in the name of an employee or agent of the designated member who is granted an operating allowance of any sort for the use of such automobile; C. Non-owned Automobile, means an automobile which is neither an owned automobile nor a hired automobile; D. Occurrence, means an event or accident, including continuous or repeated exposure to conditions which result in bodily injury, property damage or personal injury and not arising from any form of intentional misconduct. E. Owned Automobile, means an automobile owned by the designated member; F. Private Passenger Automobile, means a four wheel private passenger or station wagon type automobile; G. Trailer, includes a semi-trailer but does not include mobile equipment. IV. The Conditions section is amended to include the following additional condition: A. Excess Coverage - Hired and Non-Owned Automobiles. With respect to a hired automobile, or a non-owned automobile, this coverage shall be excess over any other valid and collectible insurance available to the designated member. ( V. The Limits of Liability section is amended to include the following: The above provisions regarding the limits of the Trust's liability apply regardless of the number of: A. Owned automobiles; B. Automobiles involved in the occurrence, or, C. Automobiles to which this Agreement and all endorsements thereto apply. The limits of liability for Bodily Injury or Property Damage caused by an occurrence arising out of the maintenance or use, including loading and unloading of any automobile leased by the designated member for a period of one (1) year or longer which takes place during the period of this Agreement, shall be not less than $100,000/$300,000 bodily injury liability and $50,000 property damage liability. The Trust's limits of liability shall not be added or stacked by virtue of there being more than one automobile or member to which this Agreement and all endorsements thereto might apply. VI. The Exclusions section is amended as follows: ( VII. Exclusion B, items 1. and 2., are deleted. Schedule of Covered Automobiles attached. FMIT AL 1002 Page 2 of 2 PERSONAL INJURY PROTECTION BENEFITS This endorsement issued by the Trust extends and modifies the provIsions of the Agreement relating to Automobile Liability Personal Injury Protection Benefits as set forth below: It is agreed that as of the effective date hereof the Agreement is amended in the following particulars: I. The Trust will pay, in accordance with the Florida Motor Vehicle No-Fault Law, as amended, to or for the benefit of the injured person: A. 80% of medical expenses, and B. 60% of work loss, and C. replacement services expenses, and D. funeral, burial or cremation expenses, incurred as a result of bodily injury, caused by an accident arising out of the ownership, maintenance or use of a motor vehicle and sustained by: 1. a member while occupying a motor vehicle or, while a pedestrian through being struck by a motor vehicle; or 2. any other person while occupying the covered motor vehicle or, while a pedestrian, through being struck by the covered motor vehicle. II. EXCLUSIONS ( III. ( FMIT PIP 1002 This endorsement does not apply: A. to a member while occupying a motor vehicle of which the member is the owner and which is not a covered motor vehicle under this coverage; to any person while operating the covered motor vehicle without the express or implied consent of the member; to any person, if such person's conduct contributed to his bodily injury under any of the following circumstances: 1. causing bodily injury to himself intentionally; 2. while committing a felony; to the member for work loss if an entry in the schedule or declarations indicates such coverage does not apply; to any pedestrian, other than the member who is not a legal resident of the State of Florida; to any person, other than the member, if such person is the owner of a motor vehicle with respect to which security is required under the Florida Motor Vehicle No-Fault Law, as amended; to any person, other than the member who is entitled to personal injury protection benefits from the owner or owners of a motor vehicle which is not a covered motor vehicle under this endorsement or from the owner's insurer; to any person who sustains bodily injury while occupying a motor vehicle located for use as a residence or premises. B. C. D. E. F. G. H. LIMIT OF LIABILITY; APPLICATION OF DEDUCTIBLE; OTHER INSURANCE Regardless of the number of persons covered, policies or bonds applicable, vehicles involved or claims made, the total aggregate limit of personal injury protection benefits available under the Florida Motor Vehicle No-Fault Law, as amended, from all sources combined including this Agreement, for all loss and expense incurred by or on behalf of anyone person who sustains bodily injury as the result of anyone accident shall be $10,000.00; provided that payment for funeral, cremation or burial expenses included in the foregoing shall in no event exceed $5,000. Page 1 of 4 j'N";'~'.\"~""'.--'--'-- '1~""~,~---o;-.",!..-,n:'" ".~. Any amount payable under this endorsementshall be reduced by the amount of benefits an injured person has recovered or is entitled to recover for the same elements of loss under the workers' compensation laws of any state or the Federal Government or the Medicaid program. If benefits have been received under the Florida Motor Vehicle No-Fault Law, as amended, from any insurer for the same items of loss and expenses for which benefits are available under this agreement, the Trust shall not be liable to make duplicate payments to or for the benefit of the injured person, but the insurer paying such benefits shall be entitled to recover from the Trust its equitable pro rata share of the benefits paid and expenses incurred in processing the claim. The amount of any deductible stated in the schedule of this amendment shall be deducted from the total amount of all sums otherwise payable by the Trust with respect to all loss and expenses incurred by or on behalf of each person to whom the deductible applies and who sustains bodily injury as the result of anyone accident, and if the total amount of such loss and expense exceeds such deductible, the total limit of benefits the Trust is obligated to pay shall then be the difference between such deductible amount and the applicable limit of the Trust's liability. Such deductible amount shall not be applied to funeral, cremation or burial expenses. If an entry in the schedule or declaration so indicates any amount payable under this Trust to the member shall be reduced by any benefits payable by the Federal Government to active or retired military personnel and their dependent relatives. IV. DEFINITIONS When used in reference to this Section: "bodily injury" means bodily injury, sickness, or disease, including death at any time resulting there from; ( "medical expense" means reasonable expenses for necessary medical, surgical, x-ray, dental, ambulance, hospital, professional nursing and rehabilitative services for prosthetic devices and for necessary remedial treatment and services recognized and permitted under the laws of the state for an injured person who relies upon spiritual means through prayer alone for healing in accordance with his religious beliefs; "motor vehicle" means any self-propelled vehicle with four or more wheels which is a type both designed and required to be licensed for use on the highways of Florida and any trailer or semi-trailer designed for use with such vehicle. A motor vehicle does not include: A. a mobile home; or B. any motor vehicle which is used in mass transit or public school transportation and designed to transport more than five passengers exclusive of the operator of the motor vehicle and which is owned by a municipality, a transit or public school transportation authority, or a political subdivision of the state; C. except for the purposes of FS 627.7372, any motor vehicle of any type used as a taxi cab or limousine. ( "occupying" means in or upon or entering into or alighting from; "covered motor vehicle" means a motor vehicle: A. of which the member is the owner, and B. with respect to which security is required to be maintained under the Florida Motor Vehicle No-Fault Law, and C. for which a premium is charged, or which is a trailer, other than a mobile home, designed for use with a motor vehicle. FMIT PIP 1002 Page 2 of 4 '.' "pedestrian" means a person while not an occupant of any self-propelled vehicle; "owner" means a person or organization who holds the legal title to a motor vehicle, and also includes: A. a debtor having the right to possession, in the event a motor vehicle is the subject of a security agreement, and, B. a lessee having the right to possession, in the event a motor vehicle is the subject of a lease with option to purchase and such lease agreement is for a period of six months or more, and, C. a lessee having the right to possession, in the event a motor vehicle is the subject of a lease without option to purchase, and such lease agreement is for a period of six months or more, and the lease agreement provides that the lessee shall be responsible for securing insurance; "work loss" means with respect to the period of disability of the injured person, any loss of income and earning capacity from inability to work proximately caused by the injury sustained by the injured person; "replacement services expenses" means with respect to the period of disability of the injured person all expenses reasonably incurred in obtaining from others ordinary and necessary services in lieu of those that, but for such injury, the injured person would have performed without income for the benefit of his household. V. COVERAGE PERIOD; TERRITORY ( This coverage under this Section applies only to accidents which occur during the period of this Agreement. A. in the State of Florida; B. as respects the member, while occupying the covered motor vehicle outside the State of Florida but within the United States of America, its territories or possessions or Canada; VI. CONDITIONS A. Notice. In the event of an accident, written notice of the loss must be given to the Trust or any of its authorized agents as soon as practicable. If any injured person or his legal representatives shall institute legal action to recover damages for bodily injury against a third party, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as practicable to the Trust by such injured person or his legal representa- tive. B. Action Against the Trust. No action shall lie against the Trust unless, as a condition precedent thereto, there shall have been full compliance with all terms of this endorsement, not until 30 days after the required notice of accident and reasonable proof of claim has been filed with the Trust. C. Proof of Claim; Medical Reports and Examinations; Payments of Claim Withheld. As soon as practicable the person making the claim shall give to the Trust written proof of claim, under oath if required, which may include full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other information as may assist the Trust in determining the amount due and payable. Such person shall submit to mental or physical examinations at the Trust's expense when and as often as the Trust may reasonably require. A copy of the medical report shall be forwarded to such person if requested. If the person unreasonably refuses to submit to an FMIT PIP 1002 Page 3 of 4 examination, the Trust will not be liable for subsequent personal injury protection benefits. Whenever a person making a claim is charged with committing a felony the Trust shall withhold benefits until at the trial level the prosecution makes a formal entry on the record that it will not prosecute the case against the person, the charge is dismissed or the person is acquitted. D. Reimbursement and Subrogation, unless prohibited by the Florida Motor Vehicle No-Fault Law, as amended, and in the event of payment to or for the benefits of any injured person under this endorsement; 1. the Trust shall be reimbursed to the extent of such payment, exclusive of reasonable attorney's fees and other reasonable expenses, out of the proceeds of any settlement OF judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made and the Trust shall have a lien on such proceeds to such extent; 2. the Trust is subrogated to the rights of the person to whom or for whose benefit such payments were made to the extent of such payments. Such person shall execute and deliver the instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing after loss to prejudice such rights. 3. the Trust providing personal injury protection benefits on a private passenger motor vehicle, as defined in the Florida Motor Vehicle No-Fault Law, shall be entitled to reimbursement to the extent of the payment of personal injury protection benefits from the owner or insurer of the owner of a commercial motor vehicle, as defined in the Florida Motor Vehicle No- Fault Law, if such injured person sustained the injury while occupying, or while a pedestrian through being struck by, such commercial motor vehicle. Special Provision for Rented or Leased Vehicles. Notwithstanding any provision of this coverage to the contrary, if a person is injured while occupying, or through being struck by, a motor vehicle rented or leased under a rental or lease agreement which does not specify otherwise in bold type on the face of such agreement, the personal injury protection coverage afforded under the lessor's policy shall be primary. ( ( FMIT PIP 1002 E. Page 4 of 4 AUTOMOBILE MEDICAL PAYMENTS This endorsement issued by the Trust extends and modifies the provisions of the Agreement relating to Automobile Medical Payments as set forth below: It is agreed that as of the effective date hereof the Agreement is amended in the following particulars: I. The Trust will pay reasonable expenses incurred for necessary medical and funeral expenses to or for a member who sustains bodily injury caused by an accident. II. Limits of Liability. Regardless of the number of covered automobiles, members, claims made or vehicles involved in the accident, the most the Trust will pay for bodily injury for each member injured in anyone accident is the limit of Automobile Medical Payments shown in the Declarations. III. Additional Definition. "Occupying" means in, upon, getting in, on, out, or off. IV. Additional Exclusions. This coverage does not apply to: E. bodily injury sustained by a member while occupying a vehicle for primary use other than as a means of transportation; bodily injury sustained while occupying or struck by any vehicle owned by, furnished or available for regular use by the member; bodily injury to an employee arising out of and in the course of employment; bodily injury to a member while working in a business of selling, servicing, repairing or parking autos; bodily injury caused by declared or undeclared war or insurrection or any of their consequences; bodily injury to anyone using a vehicle without a reasonable belief that the person is entitled to do so. A. B. ( C. D. F. ( , FMIT AM 1002 Page 1 of 1 :-~ AUTOMOBILE PHYSICAL DAMAGE COVERAGE FORM Various provisions in this Agreement restrict coverage. Read the entire Agreement carefully to determine rights, duties and what is and is not covered. Throughout the Agreement the words "you" and "your" refer to the member shown in the Declarations. The words "we," "us" and "our" refer to the Trust providing this insurance. A. COVERAGE The Trust will pay for direct physical loss or damage to a covered automobile as described in the Declarations caused by or resulting from any covered cause of loss. 1. Covered Property Covered property, as used in this coverage part, means any "auto" described in the schedule which you own, hire, borrow, or lease, including newly acquired autos (refer to schedule). 2. Covered Causes of Loss a. Comprehensive Coverage From any cause except the covered automobile's collision with another object or its overturn. ( b. Collision Coverage Caused by the covered automobile's collision with another object or its overturn. c. Specified Causes of Loss Coverage. Caused by: 1. Fire, lightning or explosion; 2. Theft; 3. The sinking, burning, collision, or derailment of any conveyance transporting the covered "auto"; or 4. Mischief or vandalism. B. EXCLUSIONS 1. The Trust will not pay for loss or damage caused directly or indirectly by any of the following: Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Wear and tear, freezing, mechanical or electrical breakdown unless caused by other loss covered by this endorsement. b. Blowouts, punctures or other road damage to tires unless caused by other loss covered by this endorsement. c. Loss to tape decks or other sound reproducing equipment not permanently installed in a covered auto. ( d. Loss to tapes, records or other sound reproducing devices designed for use with sound reproducing equipment. FMIT APD 1002 Page 1 of 4 C. DEDUCTIBLE The Trust will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds the deductible shown in the schedule or in the Declarations. We will then pay the amount of loss or damage in excess of the deductible, up to the applicable Limit of Insurance. D. LOSS CONDITIONS The following conditions apply in addition to the common Agreement conditions. 1. Duties in the event of loss or damage a. Promptly notify the Trust or the Service Agent of any accident or loss and report how, when and where the accident or loss happened. b. Do what is reasonably necessary after a loss to protect the covered automobile from further loss. c. Submit a proof of loss when required by the Trust. 2. Inspection and Appraisal ( Permit the Trust to inspect and appraise the damaged property BEFORE its repair or disposition. If there is a failure to agree as to the amount of loss, either party may further demand an appraisal of the loss. In such event, both parties may agree on one competent appraiser to make the final decision or each party may select his own appraiser and bear his own cost of appraisal, and a competent and disinterested umpire will be selected to make the final decision. 3. Loss Payment a. a. At the Trust's option, it may: 1. Pay for, repair, or replace damaged or stolen property; or 2. For theft, return the stolen property, at its expense. The Trust will pay for any damage that results to the automobile from the theft. b. The Trust will pay the lesser of the following amounts: 1. The actual cash value of the damaged or stolen property at the time of loss. 2. The cost of repairing or replacing the damaged or stolen property with other of like kind or quality. c. For each covered automobile, the Trust's obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the auto schedule. d. Loss to any sound receiving or transmitting equipment designed for use as a two- way mobile radio or telephone or scanning monitor or radar transmitting or receiving device, including its antennas and other accessories, unless permanently installed in the automobile or scheduled elsewhere. ( FMIT APD 1002 Page 2 of 4 4. Other Insurance a. For any covered automobile owned or leased, this Agreement is primary. b. When this Agreement and other policies covered on the same basis, either excess or primary, the Trust will pay only its share. Its share is the proportion that the limit of this Agreement bears to the total of the limits of this Agreement and all the policies covering on the same basis. 5. Right to Recover a. If the Trust makes any payment, it shall be subrogated and have the right to enforce its subrogation rights against any other party who caused the loss or damage. The member, its agents and employees are required to cooperate with the Trust in the enforcement of its rights of collection against the party or parties causing the loss and shall do nothing to jeopardize the rights of the Trust without the Trust's prior consent and authorization. E. COVERAGE EXTENSIONS 1. Limited Replacement Cost: We will reimburse the Designed Member for an owned and scheduled private passenger vehicle that is involved in a covered total loss if the vehicle has less than 15,000 miles and is within the first 12 months of being scheduled. 2. Member's Personal Effects: In the event of a covered loss, we will pay a maximum of $500.00 for member's personal effects while in a scheduled private passenger vehicle owned by the Designated Member. The covered vehicle must show evidence of forced entry. ( 3. Auto Lease Coverage: In the event of a covered total loss to a covered auto shown in the schedule, we will pay any unpaid amount on the lease of your covered auto less: 1) the amount paid under Part D of the agreement; and 2) any: a. overdue lease payments at the time of the loss: b. financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. security deposits not refunded by a lessor; d. costs for extended warranties, Credit Life insurance, Health, Accident or Disability insurance purchased with the lease; and e. carry-over balances from previous leases. The most we will pay for anyone occurrence is up to $5,000.00. The most we will pay in any Trust year is up to $10,000.00. F. DEFINITIONS Automobile business, means the business or occupation of selling, repairing, servicing, storing, or parking automobiles. FMIT APD 1002 Page 3 of 4 Hired Automobile, means an automobile not owned by the designated member which is used under contract on behalf of, or loaned to, the designated member, provided such automobile is not owned by or registered in the name of an employee or agent of the designated member who is granted an operating allowance of any sort for the use of any such automobile. Owned Automobile, means an automobile owned by the designated member. Private Passenger Automobile, means a four-wheel private passenger or station wagon type automobile. Trailer, includes a semi-trailer but does not include mobile equipment, unless scheduled. Loss, means direct and accidental damage or loss. ( ( FMIT APD 1002 Page 4 of 4 RENTAL REIMBURSEMENT COVERAGE This endorsement issued by the Trust extends and modifies the provisions of the Agreement relating to Automobile Physical Damage as set forth below. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. This endorsement provides only those coverages where a premium is shown in the Automobile Physical Damage portion of the Schedule. It applies only to a covered "auto" described or designated in the Schedule. B. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. C. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of day: 1. Fourteen (14) days. or 2. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. ( ; i D. Our payment is limited to the lesser of the following amounts: 1. Necessary and actual expenses incurred. 2. The maximum payment stated applicable to "anyone day" or "anyone period". E. This coverage does not apply while there are spare or reserve "autos" available to you for use in your operations. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage as follows: Maximum Amount Payable: $25.00 per scheduled automobile per occurrence, or thirty five hundred dollars ($3,500.00) in the aggregate for the Trust year provided. ( FMIT ARR 1002 Page 1 of 1 ,,,,~,- t;~"-~;;t~i-, ;::'h-~'-:t'-~'H~ -:~ SPECIFIC EXCESS ENDORSEMENT - AUTOMOBILE LIABILITY This endorsement, when issued by the Florida Municipal Insurance Trust, does not in any way modify the provisions of the Coverage Agreement. It does extend the monetary limits of liability, as stated in the Limits of Liability in the Declarations, as set forth below: It is agreed that the specific limits of liability are $2.000.000 (combined single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section 768.28(5) Florida Statutes or liability imposed pursuant to Federal Law, or to any liability resulting from actions taken outside of the State of Florida where it is determined by a court of competent jurisdiction that the liability limitations contained in Section 768.28(5), Florida Statutes, are inapplicable, if such liability is covered by the Agreement. The limits provided herein are inclusive of the $100,000 each person and $200,000 each occurrence as set forth in the Declarations of the Agreement and within the Coverage Agreement itself,but in no way exceed $2.000.000 (combined single limit) per occurrence. Exclusion W is amended as follows: To any damages imposed by an act of the legislature, except for claims bills passed by the legislature pursuant to Section 768.28(5), Florida Statutes, against a member, for damages covered under the terms of this Agreement. ( FMIT SE AL 1002 Page 1 of 1 DEDUCTIBLE STOPLOSS ENDORSEMENT PROVISIONS I. Member City of Winter Springs II. Stoploss Coverage Applies 0 A. Workers Compensation & Employers Liability ~ B. General Liability ~ C. Auto Liability 0 D. Property 0 E. Automobile Physical Damage III. Applicable Stoploss Deductible A. Workers Compensation & Employers Liability $ ( ) B. General Liability $ 25,000 } C. Auto Liability $ 25,000 D. Property $ E. Automobile Physical Damage $ IV. Applicable Deductible Stoploss Amount A. $ 188,303 ( FMIT DSL 1002 Page 1 of 2 The endorsement provides for a limitation on the number of deductibles or amount of loss incurred by a member under a deductible program as offered by the Florida Municipal Insurance Trust. I. IT IS AGREED THAT: A. The Trust's liability to pay claims -on behalf of the member under this endorsement applies only to the members deductible amounts as stated in the Declarations and only after satisfaction of the Deductible Stop loss amount as stated in this endorsement. B. The Trust agrees with the member that the member's obligations under applicable deductible endorsements cease when the member had paid losses within the deductible that exceed: (1) Three (3) times the largest deductible as stated in the Provisions or (2) the Deductible Stoploss Amount, whichever is greater. C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full force and effect, including those with respect to: (1) the Trust's rights and duties in the defense of claims and (2) the member's duties in the event of an accident or occurrence, irrespective of the application of deductible amount or deductible stoploss. D. The member will immediately report in writing: (1) all accidents or incidents which may give rise to liability. (2) all Notice of Claims. (3) all lawsuits involving a claim for damages. ( E. The Trust shall select and retain all defense attorneys and other service providers as necessary and shall directly control and supervise their activities. All such costs incurred in these services shall be paid by the Trust. F. The deductible amount shall include the amount of any payment resulting from a covered claim in the aggregate up to the deductible amount stated in the declarations. The member's responsibility under the deductible shall continue even though the contract may have been cancelled or expired. G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust and not included in the deductible amount. H. The Trust may settle or defend any claim as it considers appropriate without the member's consent regardless of any deductible amount. I. The Trust is authorized to make reasonable additions, changes, or deletions to these reporting requirements. J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount due within 45 days of the invoice date. Failure to pay this sum will result in the revocation of the member's deductible plan privileges. K. Recoveries shall be applied to the member's deductible until satisfied. L. The Definitions Section of the Trust is amended per this additional definition: (1) Deductible stoploss is coverage which limits a members deductible payment obligations to a certain fixed amount. ( FMIT DSL 1002 Page 2 of 2 FLORIDA MUNICIPAL INSURANCE TRUST PROPERTY, ALLIED LINES AND CRIME DECLARATIONS I. DESIGNATED MEMBER: ( City of Winter Springs II. Government Description Municipality Agreement No.: FMIT #0648 III. COVERAGE PERIOD From October 1, 2002 the Designated Member. to October 1, 2003 12:01 A.M. Standard Time at the address of Premium Blanket: Basis De uctl e I VDe 1m e remlum $49,573 $1,000 $18,687,980 Included $1,000 $2,546,260 Included 100% Replacement Cost Yes No Per Extension Included 100% $250,000 Included Per Extension $0 Included Yes Included Per Extension $250 Included Per Extension $0 Included $0 Per Schedule Included $0 Per Schedule Included Per Schedule Included d 'bl fT L' it N tp IV. Property and Allied Coverages Real Property Personal Property Coinsurance: Valuation Basis: Blanket: Inflation Guard: Time Element Business Income Coinsurance: Extra Expense Inland Marine ( valuable Papers , Accounts Receivable Crime Money & Securities - Loss Inside - Loss Outside Bond Honesty Blanket Bond V. This Agreement includes these endorsements and schedules: See Schedule C VI. ESTIMATED ANNUAL PREMIUM Normal Premium Incentive Credit Net Premium Florida Municipal Insurance Trust (FMIT) $55,081 $5,508 $49,573 ( '. Florida League of Cities Sponsored Insurance Programs Since 1977 THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT, FMIT PROP DEC 1002 Original Page 1 of 2 09/25/2002 Form # FMIT IND (10-02) FMIT GC (10-02) FMIT DSL (10-02) FMIT MPC (10-02) IL 00 17 (11-98) IL 02 55 (07-02) PR-SCHED (01-02) CP 14 50 (10-00) FMIT FCR (10-02) CP 00 90 (07-88) CP 00 10 (10-00) FMIT PROP 03 (10-02) CP 01 25 (06-95) CP 10 30 (10-00) FMIT PROP 12 (10-02) CP 00 50 (10-00) (~. . \00 32 (10-00) , IT EBC (10-02) FMIT IM SCH (10-02) FMIT PROP 02 (10-02) CM 00 01 (09-00) CM 00 66 (09-00) CM 00 67 (09-00) FMIT PROP 05 (10-02) ( FMIT PROP DEC 1002 FMIT PROPERTY AND ALLIED COVERAGES October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List FMIT #0648 Schedule C Description COMMON Indemnity Agreement Coverage Agreement Deductible Stoploss Endorsement Provisions Miscellaneous Property Coverages Common Policy Conditions Florida Changes - Cancellation And Nonrenewal PROPERTY Property Schedule Radio Or Television Antennas Fungus Remediation Commercial Property Conditions Building And Personal Property Coverage Form Coverage Extensions Florida Changes Causes of Loss - Special Form Ordinance Or Law Coverage Extra Expense Coverage Form Business Income Coverage (Without Extra Expense) Equipment Breakdown Coverage INLAND MARINE Miscellaneous Schedule Of Inland Marine Inland Marine Floater Commercial Inland Marine Conditions Accounts Receivable Coverage Form Valuable Papers And Records Coverage Form CRIME Public Employees Blanket Bond Page 2 of 2 Miscellaneous Property Coverages , FMIT #0648 October 1, 2002 - October 1, 2003 Business Income Loc # Bldg # 001 001 Limit $250,000 Extra Expense Loc # Bldg # 001 001 All locations are covered under Coverage Extension 5g. Valuable Papers Loc # Bldg # 001 001 All locations are covered under Coverage Extension 5c. Accounts Receivable ( Loc # Bldg # 001 001 All locations are covered under Coverage Extension 5f. Bond Type Honesty Blanket Bond Crime/Bond Bond Limit $50,000 Coinsurance 100% Limit $250,000 Limit $100,000 Limit $100,000 Deductible Amount $0 Money & Securities (Theft, Disappearance & Destruction) Inside: OUtside: Limit $10,000 $10,000 c FMIT MPC 1002 Deductible Amount None None Page 1 of 1 09/25/2002 ~, ,-~_...., i Member's Property Schedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/01/2003 Location# Address Occuoanev Construction Cause of ~ld9 Cause of Pers Loss 2!!!L LOSS rroK Lac Bid 2!!!L 001 001 1126 E. State Rd 434, WS Winter City Hall Complex- City Hall Fire Resistive Special Form $2,662,717 Special Form $1,105,907 Springs,FL 001 002 1126 E. State Rd 434, WS Winter Gas Tank & Pump Non-Combustible Special Form $16,306 $0 Springs,FL 001 003 1126 E. State Rd 434, WS Winter Appex Utility Building Joisted Masonry Special Form $53,550 Special Form $52,500 Springs,FL 002 001 102 Moss Road, WS Winter Springs,FL Fire Station #24 - Fire House Fire Resistive Special Form $540,855 Special Form $138,100 002 002 102 Moss Road, WS Winter Springs,FL Antenna & Radio Tower Non-Combustible Special Form $2,285 $0 003 001 850 Northem Way, WS Winter Springs,FL Fire Station #26 - Fire House Joisted Masonry Special Form $400,336 Special Form $36,800 004 001 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - ConcessionslP&R Joisted Masonry Special Form $309,472 Special Form $12,900 Office 004 002 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Maintenance Garage Non-Combustible Special Form $139,901 Special Form $84,000 004 003 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 22 Concrete Light Non-Combustible Special Form $64,738 $0 Poles 004 004 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 152 Ballfield Non-Combustible Special Form $103,542 $0 Lights 004 005 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 38 Single Fixt, Non-Combustible Special Form $47,242 $0 Site Lighting 004 006 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 11 Double Fixt, Non-Combustible Special Form $14,998 $0 Site Lighting 004 007 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Irrigation Sys & Non-Combustible Special Form $119,023 $0 Pumps 004 008 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - New Soccer Conc Joisted Masonry Special Form $220,000 $0 StlRestrm 005 001 Torcaso Winter Springs,FL Torcaso Park - New Restrooms Joisted Masonry Special Form $127,000 $0 006 001 Moss Winter Springs,FL Moss Park - New Restrooms Joisted Masonry Special Form $120,000 $0 007 001 Trotwood Winter Springs,FL Trotwood Park - existing restrooms Joisted Masonry . Special Form $84,000 $0 008 001 400 N. Edgemon Ave., WS Winter Senior Center Joisted Masonry Special Form $265,173 Special Form $59,000 Springs, Fe 008 002 400 N. Edgemon Ave., WS Winter Civic Center Joisted Masonry Special Form $192,441 Special Form $42,000 Springs,Fe 009 001 300 Moss Road, WS Winter Springs,FL Police Complex - Police Station Fire Resistive Special Form $1,186,069 Special Form $493,000 Page 1 of 4 09/25/2002 "'----. ,~ Member's''f'foperty Schedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/01/2003 Location# Address Occuoancv Construction Cause of ~ldK Cause of Pars Loss -!!!!L Loss rro~ Loc Bid -!!!!L 010 001 110 N. Flamingo Ave. Winter Springs,FL Public Works - Garage Joisted Masonry Special Form $154,530 Special Form $38,053 010 002 100 N. Flamingo Ave. Winter Springs,FL Public Works - Utility Office Joisted Masonry Special Form $71,556 Special Form $80,000 011 001 N. 1st Street Winter Springs,FL Public Works - Storage Joisted Masonry Special Form $16,438 $0 012 001 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Digesters Fire Resistive Special Form $2,480,844 $0 Springs,FL 012 002 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Chlroine Fire Resistive Special Form $219,300 Special Form $94,700 Springs,FL Contact 012 003 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Filters Fire Resistive Special Form $37,026 Special Form $9,300 Springs,FL 012 005 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Aerator Fire Resistive Special Form $128,214 Special Form $25,000 Springs,FL 012 006 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Plant Ops Fire Resistive Special Form $61,812 Special Form $200,000 Springs,FL 012 007 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Lift Station Non-Combustible Special Form $112,455 $0 Springs,FL 012 008 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Reclaim Fire Resistive Special Form $481,134 $0 Springs,FL Water Tank 013 001 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Pump House Non-Combustible Special Form $138,433 $0 013 002 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - LP Gas Tank Non-Combustible Special Form $914 $0 013 003 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Ground Level Tank Non-Combustible Special Form $238,663 $0 013 004 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Hydropneumatic Tank Non-Combustible Special Form $46,868 $0 013 005 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Water Well Non-Combustible Special Form $20,397 $0 013 006 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Well #6 Water Plant 2 Non-Combustible Special Form $174,962 $0 013 007 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $129,753 $0 013 008 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $97,654 $0 014 001 1000 W SR 434, WS Winter Springs,FL West Wastewater Plant #2 - Water Plant Fire Resistive Special Form $1,985,480 $0 015 001 Bahama Rd, WS Winter Springs,FL Water Plant #3 - LP Gas Tank Non-Combustible Special Form $914 $0 015 002 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Ground Level Tank Non-Combustible Special Form $238,663 $0 015 003 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Well Non-Combustible Special Form $19,789 $0 Page 2 of 4 09/25/2002 ~ , ,~ Member'sPfoperty Schedule City of Winter Springs, FMIT #0648 10/01/2002 -10/01/2003 Locatlon# Address Occupancy Construction Cause of ~Idi Cause of Pers Loss -!!!!!.. Loss rrog Lac Bid -!!!!!.. 015 004 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Plant Fire Resistive Special Form $336,362 $0 015 005 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Chlorinator Building Fire Resistive Special Form $66,309 $0 016 001 851 Northern Way Winter Springs,FL Water Plant #1 - E. Water Plant Op. Bldg Fire Resistive Special Form $128,775 Special Form $75,000 016 002 851 Northern Way Winter Springs,FL Water Plant #1 - Chlorine Handling Fire Resistive Special Form $63,257 $0 Facility 016 003 851 Northern Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0 016 004 851 Northern Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0 017 001 Indian Ridge Seminole Winter Springs,FL Lift Station Non-Combustible Special Form $85,898 $0 018 001 David Street Winter Springs,FL Lift Station Non-Combustible Special Form $76,104 $0 019 001 Hacienda Village Winter Springs,FL Lift Station Non-Combustible Special Form $58,473 $0 020 001 Tanglewood Drive Winter Springs,FL Lift Station Non-Combustible Special Form $91,777 $0 021 001 S. Edgemon Ave Winter Springs,FL Lift Station & Fence Non-Combustible Special Form $343,598 $0 022 001 Panama Circle Winter Springs,FL Lift Station Non-Combustible Special Form $63,446 $0 023 001 Alton & Mockingbird Winter Springs,FL Lift Station Non-Combustible Special Form $89,667 $0 024 001 E. of Wetland 1000's Winter Springs,FL Lift Station Non-Combustible Special Form $53,045 $0 025 001 Club Drive Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0 026 001 Dolphin Road Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0 027 001 Papaya Lane Winter Springs,FL Lift Station Non-Combustible Special Form $33,462 $0 028 001 Sybilwood Circle Winter Springs,FL Lift Station Non-Combustible Special Form $26,989 $0 029 001 Tuscany Place Winter Springs,FL Lift Station Non-Combustible Special Form $34,095 $0 030 001 Winter Springs Blvd. Winter Springs,FL Lift Station Non-Combustible Special Form $50,605 $0 031 001 Northern Way Winter Springs,FL Lift Station Non-Combustible Special Form $28,500 $0 032 001 Wood Duck Drive Winter Springs,FL Lift Station Non-Combustible Special Form $41,046 $0 033 001 Seneca Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $65,224 $0 034 001 Seneca Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $46,107 $0 035 001 Trotwood Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $44,982 $0 Page 3 of 4 09/25/2002 r--. ~. Member's Ffoperty Schedule City of Winter Springs, FMIT #0648 10/01/2002 - 10/01/2003 Locatlon# Lac Bid Address Cause of LosS Pers rro~ ...!!!!L Occuoancy Construction Cause of Loss ~ldH ...!!!!L 036 037 038 039 040 041 042 001 Seneca Blvd & Chelse Winter Springs,FL 001 Shepard Rd. Winter Springs,FL 001 Cherry Creek Circle Winter Springs,FL 001 Vistawilla Drive Winter Springs,FL 001 Nandina Terrace Winter Springs,FL 001 Winter Springs Blvd Winter Springs,FL 001 Various Winter Springs,FL Lift Station Lift Station Lift Station Lift Station Lift Station Oak Forest Wall Tuscawilla Lighting and Beautification Improvements Non-Combustible Non-Combustible Non-Combustible Non-Combustible Non-Combustible Joisted Masonry Non-Combustible Special Form Special Form Special Form Special Form Special Form Special Form Special Form $45,955 $46,589 $57,674 $45,010 $49,802 $500,000 $2,000,000 $18,687,980 $0 $0 $0 $0 $0 $0 $0 $2,546,260 Total: Page 4 of 4 09/2512002 ( \ POLICY NUMBER: 0648-P COMMERCIAL PROPERTY CP 14501000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RADIO OR TELEVISION ANTENNAS This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM BUILDERS' RISK COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM STANDARD PROPERTY POLICY SCHEDULE* Premo Bldg. No. No. 002 002 Limit Of Insurance $2,285 Causes Of Loss Form Applicable Special Form Including Theft Coinsurance Percentage 100% Additional Premium Included *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara- tions. A. The following is added to Covered Property: Radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers, as described in the Schedule. B. The following is deleted from Property Not Cov- ered: "Radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers". C. Property covered under this endorsement is sub- ject to all applicable provisions of the Causes of Loss form indicated in the Schedule, as well as to the following exclusions: We will not pay for loss or damage caused by or resulting from any of the following: 1. Dampness or dryness of atmosphere; 2. Changes in or extremes of temperature; or 3. Rain, snow, ice or sleet. CP 14501000 Copyright, Insurance Services Office, Inc., 1999 Original Page 1 of 1 o Miscellaneous Schedule of Inland Marine All Miscellaneous mobile equipment items $15,000 or less are covered on a blanket basis. Watercraft & Scheduled items over $15,000: Item # Limit Description Blanket Inland Marine Deductible 1 $500 ( Note: Items valued greater than $50,000: Deductible is either the listed amount or 2% of the limit. (Whichever is greater) ( FMIT 1M SCH 1002 Page 1 of 1 THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY. ( FUNGUS CLEAN UP AND REMOVAL LIMITATION ENDORSEMENT THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL PROPERTY COVERAGE PART SCHEDULE FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT: $15,000.00 I. The following definitions are added to the policy: a. The term fungus(i), as used in this endorsement and throughout the entire policy, includes, but is not limited to, any form or type of mildew, mold, mushroom, rust, smuts, or yeast, including any allergens, irritants, mycotoxins, or scents, byproducts, microbial volatile organic compounds produced by or associated therewith. b. The term spore(s), as used in this endorsement and throughout the entire policy, means any reproductive body produced by or arising out of any fungus(i). II. a. We will pay your expenses for testing for, monitoring, abatement, mitigation, removal, remediation or disposal of: ( (1) Any fungus(i) or spore(s); or (2) Any substance, vapor, gas or byproducts produced by or arising out of any fungus(i) or spore( s ) provided: (3) Such expense is caused by or results from a Covered Cause of Loss that occurs during the policy period; (4) Subject to all other policy conditions, the necessity of such expense is reported to us in writing within 60 days of the date on which the Covered Cause of Loss occurs; and (5) We authorize you to incur such expense. b. (1 ) Regardless of the number of claims, insured locations or occurrences, the most we will pay under this policy, in excess of any applicable deductible, for the sum of all covered expenses described in 1. above, is the FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT shown in the SCHEDULE of this endorsement. (2) Subject to b.(1) above, the FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT applies to and includes the costs associated with the replacement of Covered Property discarded or destroyed as part of the removal or remediation of fungus or spores. ( (3) The FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT is part of, and not in addition to, the Limit of Insurance applicable to the Covered Property. FMIT FCR 1002 Page 1 of 1 IL 00 1711 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. ( A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; ( b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 1711 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 o IL 02 55 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: BOilER AND MACHINERY COVERAGE PART CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART FARM COVERAGE PART ( A. Paragraph 2. of the Cancellation Common Policy Condition is replaced by the following: 2. Cancellation For Policies In Effect 90 Days Or Less a. If this policy has been in effect for 90 days or less, we may cancel this policy by mailing or delivering to the first Named Insured writ- ten notice of cancellation, accompanied by the specific reasons for cancellation, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 20 days before the effective date of cancellation if we cancel for any other reason, except we may cancel immedi- ately if there has been: (a) A material misstatement or misrepre- sentation; or (b) A failure to comply with underwriting requirements established by the in- surer. b. We may not cancel: (1) On the basis of property insurance claims that are the result of an act of God, unless we can demonstrate, by claims frequency or otherwise, that you have failed to take action reasonably necessary as requested by us to prevent recurrence of damage to the insured property; or ( (2) On the basis of filing of claims for partial loss caused by sinkhole damage, re- gardless of whether this policy has been the subject of a sinkhole claim, or on the basis of the risk associated with the oc- currence of such a claim. However, we may cancel this policy if: (a) The total of such property insurance claim payments for this policy ex- ceeds the current policy limits of coverage for property damage; or (b) You have failed to repair the struc- ture in accordance with the engineer- ing recommendations upon which any loss payment or policy proceeds were based. B. The following is added to the Cancellation Com- mon Policy Condition: 7. Cancellation For Policies In Effect For More Than 90 Days a. If this policy has been in effect for more than 90 days, we may cancel this policy only for one or more of the following rea- sons: (1) Nonpayment of premium; (2) The policy was obtained by a material misstatement; (3) There has been a failure to comply with underwriting requirements established by the insurer within 90 days of the ef- fective date of coverage; IL 02 55 07 02 @ ISO Properties, Inc., 2001 Page 1 of 2 o ( (4) There has been a substantial change in the risk covered by the policy; (5) The cancellation is for all insureds under such policies for a given class of insur- eds; (6) On the basis of property insurance claims that are the result of an act of God, if we can demonstrate, by claims frequency or otherwise, that you have failed to take action reasonably neces- sary as requested by us to prevent re- currence of damage to the insured prop- erty;or (7) On the basis of filing of claims for partial loss caused by sinkhole damage, or on the basis of the risk associated with the occurrence of such a claim, if: (a) The total of such property insurance claim payments for this policy ex- ceeds the current policy limits of coverage for property damage; or (b ) You have failed to repair the struc- ture in accordance with the engineer- ing recommendations upon which any loss payment or policy proceeds were based. b. If we cancel this policy for any of these reasons, we will mail or deliver to the first Named Insured written notice of cancella- tion, accompanied by the specific reasons for cancellation, at least: (1) 10 days before the effective date of cancellation if cancellation is for non- payment of premium; or (2) 45 days before the effective date of cancellation if: (a) Cancellation is for one or more of the reasons stated in 7.a.(2) through 7.a.(7) above; and (b) This policy does not cover a residen- tial structure or its contents; or (3) 90 days before the effective date of cancellation if: (a) Cancellation is for one or more of the reasons stated in7.a.(2) through 7.a.(7) above; and (b) This policy covers a residential struc- ture or its contents. ( C. The following is added: NONRENEWAL 1. If we decide not to renew this policy we will mail or deliver to the first Named Insured written no- tice of nonrenewal, accompanied by the spe- cific reason for nonrenewal, at least: a. 90 days prior to the expiration of the policy if this policy covers a residential structure or its contents; or b. 45 days prior to the expiration of the policy for all other policies. 2. Any notice of nonrenewal will be mailed or delivered to the first Named Insured's last mail- ing address known to us. If notice is mailed, proof of mailing will be sufficient proof of notice. 3. We may not refuse to renew this policy: a. On the basis of property insurance claims that are the result of an act of God, unless we can demonstrate, by claims frequency or otherwise, that you have failed to take ac- tion reasonably necessary as requested by us to prevent recurrence of damage to the insured property; or b. On the basis of filing of claims for partial loss caused by sinkhole damage, regard- less of whether this policy has been the subject of a sinkhole claim, or on the basis of the risk associated with the occurrence of such a claim. However, we may refuse to renew this policy if: (1) The total of such property insurance claim payments for this policy exceeds the current policy limits of coverage for property damage; or (2) You have failed to repair the structure in accordance with the engineering rec- ommendations upon which any loss payment or policy proceeds were based. Page 2 of 2 @ ISO Properties, Inc., 2001 IL 02 55 07 02 o COMMERCIAL PROPERTY COMMERCIAL PROPERTY CONDITIONS This Coverage Part is subject to the following conditions, the Common Policy Conditions and applicable Loss Conditions and Additional Conditions in Commercial Property Coverage Forms. ( A. CONCEALMENT, MISREPRESENTATION OR FRAUD This Coverage Part is void in any case of fraud by you as it relates to this Coverage Part at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a mate- rial fact concerning: 1. This Coverage Part; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this Coverage Part. B. CONTROL OF PROPERTY Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at anyone or more locations will not affect cover- age at any location where, at the time of loss or damage, the breach of condition does not exist. C. INSURANCE UNDER TWO OR MORE COVERAGES If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. D. LEGAL ACTION AGAINST US No one may bring a legal action against us under this Coverage Part unless: 1. There has been full compliance with all of the terms of this Coverage Part; and 2. The action is brought within 2 years after the date on which the direct physical loss or dam- age occurred. E. LIBERALIZATION If we adopt any revision that would broaden the coverage under this Coverage Part without addi- tional premium within 45 days prior to or during the policy period, the broadened coverage will imme- diately apply to this Coverage Part. ( CP 00 90 07 88 F. NO BENEFIT TO BAILEE No person or organization, other than you, having custody of Covered Property will benefit from this insurance. G.OTHERINSURANCE 1. You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Cover- age Part bears to the Limits of Insurance of all insurance covering on the same basis. 2. If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of cov- ered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. H. POLICY PERIOD, COVERAGE TERRITORY Under this Coverage Part: 1. We cover loss or damage commencing: a. During the policy period shown in the Decla- rations; and b. Within the coverage territory. 2. The coverage territory is: a. The United States of America (including its territories and possessions); b. Puerto Rico; and c. Canada. Copyright, ISO Commercial Risk Services, Inc., 1983, 1987 o Page 1 of 2 I. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything neces- sary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: ( ( 1. Prior to a loss to your Covered Property or Covered Income. 2. After a loss to your Covered Property or Cov- ered Income only if, at time of loss, that party is one of the following: a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or c. Your tenant. This will not restrict your insurance. Page 2 of 2 Copyright, ISO Commercial Risk Services, Inc., 1983, 1987 CP 00 90 07 88 o COMMERCIAL PROPERTY CP 00 10 10 00 BUILDING AND PERSONAL PROPERTY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section H. - Definitions. ( A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Cov- ered Cause of Loss. 1. Covered Property Covered Property, as used in this Coverage Part, means the type of property described in this Section, A.1., and limited in A.2., Property Not Covered, if a Limit of Insurance is shown in the Declarations for that type of property. a. Building, meaning the building or structure described in the Declarations, including: (1) Completed additions; (2) Fixtures, including outdoor fixtures; (3) Permanently installed: (a) Machinery and (b) Equipment; (4) Personal property owned by you that is used to maintain or service the building or structure or its premises, including: (a) Fire extinguishing equipment; (b) Outdoor furniture; (c) Floor coverings; and (d) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering; (5) If not covered by other insurance: (a) Additions under construction, altera- tions and repairs to the building or structure; (b) Materials, equipment, supplies and temporary structures, on or within 100 feet of the described premises, used for making additions, altera- tions or repairs to the building or structure. b. Your Business Personal Property located in or on the building described in the Decla- rations or in the open (or in a vehicle) within 100 feet of the described premises, consist- ing of the following unless otherwise speci- fied in the Declarations or on the Your Busi- ness Personal Property - Separation of Coverage form: (1) Furniture and fixtures; (2) Machinery and equipment; (3) "Stock"; (4) All other personal property owned by you and used in your business; (5) Labor, materials or services furnished or arranged by you on personal property of others; (6) Your use interest as tenant in improve- ments and betterments. Improvements and betterments are fixtures, alterations, installations or additions: (a) Made a part of the building or struc- ture you occupy but do not own; and (b) You acquired or made at your ex- pense but cannot legally remove; (7) Leased personal property for which you have a contractual responsibility to in- sure, unless otherwise provided for un- der Personal Property of Others. ( CP 00 10 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 1 of 13 o ( c. Personal Property Of Others that is: (1) In your care, custody or control; and (2) Located in or on the building described in the Declarations or in the open (or in a vehicle) within 100 feet of the described premises. However, our payment for loss of or dam- age to personal property of others will only be for the account of the owner of the prop- erty. 2. Property Not Covered Covered Property does not include: a. Accounts, bills, currency, deeds, food stamps or other evidences of debt, money, notes or securities. Lottery tickets held for sale are not securities; b. Animals, unless owned by others and boarded by you, or if owned by you, only as "stock" while inside of buildings; c. Automobiles held for sale; d. Bridges, roadways, walks, patios or other paved surfaces; e. Contraband, or property in the course of illegal transportation or trade; f. The cost of excavations, grading, backfilling or filling; g. Foundations of buildings, structures, ma- chinery or boilers if their foundations are be- low: (1) The lowest basement floor; or (2) The surface of the ground, if there is no basement; h. Land (including land on which the property is located), water, growing crops or lawns; i. Personal property while airborne or water- borne; j. Bulkheads, pilings, piers, wharves or docks; k. Property that is covered under another coverage form of this or any other policy in which it is more specifically described, ex- cept for the excess of the amount due (whether you can collect on it or not) from that other insurance; I. Retaining walls that are not part of a build- ing; m. Underground pipes, flues or drains; ( n. The cost to research, replace or restore the information on valuable papers and records, including those which exist on electronic or magnetic media, except as provided in the Coverage Extensions; o. Vehicles or self-propelled machines (includ- ing aircraft or watercraft) that: (1) Are licensed for use on public roads; or (2) Are operated principally away from the described premises. This paragraph does not apply to: (a) Vehicles or self-propelled machines or autos you manufacture, process or warehouse; (b) Vehicles or self-propelled machines, other than autos, you hold for sale; (c) Rowboats or canoes out of water at the described premises; or (d) Trailers, but only to the extent provided for in the Coverage Extension for Non- Owned Detached Trailers. p. The following property while outside of buildings: (1) Grain, hay, straw or other crops; (2) Fences, radio or television antennas (including satellite dishes) and their lead- in wiring, masts or towers, signs (other than signs attached to buildings), trees, shrubs or plants (other than "stock" of trees, shrubs or plants), all except as provided in the Coverage Extensions. 3. Covered Causes Of Loss See applicable Causes of Loss Form as shown in the Declarations. 4. Additional Coverages a. Debris Removal (1) Subject to Paragraphs (3) and (4), we will pay your expense to remove debris of Covered Property caused by or result- ing from a Covered Cause of Loss that occurs during the policy period. The ex- penses will be paid only if they are re- ported to us in writing within 180 days of the date of direct physical loss or dam- age. Page 2 of 13 Copyright, Insurance Services Office, Inc., 1999 CP 00 10 10 00 o ( (2) Debris Removal does not apply to costs to: (a) Extract "pollutants" from land or water; or (b) Remove, restore or replace polluted land or water. (3) Subject to the exceptions in Paragraph (4), the following provisions apply: (a) The most we will pay for the total of direct physical loss or damage plus debris removal expense is the Limit of Insurance applicable to the Cov- ered Property that has sustained loss or damage. (b) Subject to (a) above, the amount we will pay for debris removal expense is limited to 25% of the sum of the deductible plus the amount that we pay for direct physical loss or dam- age to the Covered Property that has sustained loss or damage. (4) We will pay up to an additional $10,000 for debris removal expense, for each lo- cation, in anyone occurrence of physical loss or damage to Covered Property, if one or both of the following circum- stances apply: (a) The total of the actual debris removal expense plus the amount we pay for direct physical loss or damage ex- ceeds the Limit of Insurance on the Covered Property that has sustained loss or damage. (b) The actual debris removal expense exceeds 25% of the sum of the de- ductible plus the amount that we pay for direct physical loss or damage to the Covered Property that has sus- tained loss or damage. Therefore, if (4)(a) and/or (4)(b) apply, our total payment for direct physical loss or damage and debris removal expense may reach but will never exceed the Limit of Insurance on the Covered Prop- erty that has sustained loss or damage, plus $10,000. ( (5) Examples The following examples assume that there is no coinsurance penalty. Example #1 Limit of Insurance Amount of Deductible Amount of Loss Amount of Loss Payable $ 90,000 $ 500 $ 50,000 $ 49,500 ($50,000 - $500) $ 10,000 Debris Removal Expense Debris Removal Expense Payable ($10,000 is 20% of $50,000) $ 10,000 The debris removal expense is less than 25% of the sum of the loss payable plus the deductible. The sum of the loss pay- able and the debris removal expense ($49,500 + $10,000 = $59,500) is less than the Limit of Insurance. Therefore the full amount of debris removal ex- pense is payable in accordance with the terms of Paragraph (3). Example #2 Limit of Insurance Amount of Deductible Amount of Loss Amount of Loss Payable $ 90,000 $ 500 $ 80,000 $ 79,500 ($80,000 - $500) $ 30,000 Debris Removal Expense Debris Removal Expense Payable Basic Amount Additional Amount $ 10,500 $ 10,000 The basic amount payable for debris removal expense under the terms of Paragraph (3) is calculated as follows: $80,000 ($79,500 + $500) x .25 = $20,000; capped at $10,500. The cap applies because the sum of the loss payable ($79,500) and the basic amount payable for debris removal expense ($10,500) cannot exceed the Limit of In- surance ($90,000). CP 00 10 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 3 of 13 o ( The additional amount payable for debris removal expense is provided in accor- dance with the terms of Paragraph (4), because the debris removal expense ($30,000) exceeds 25% of the loss pay- able plus the deductible ($30,000 is 37.5% of $80,000), and because the sum of the loss payable and debris re- moval expense ($79,500 + $30,000 = $109,500) would exceed the Limit of In- surance ($90,000). The additional amount of covered debris removal ex- pense is $10,000, the maximum payable under Paragraph (4). Thus the total pay- able for debris removal expense in this example is $20,500; $9,500 of the debris removal expense is not covered. b. Preservation Of Property If it is necessary to move Covered Property from the described premises to preserve it from loss or damage by a Covered Cause of Loss, we will pay for any direct physical loss or damage to that property: (1) While it is being moved or while tempo- rarily stored at another location; and (2) Only if the loss or damage occurs within 30 days after the property is first moved. c. Fire Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss, we will pay up to $1,000 for your liability for fire department service charges: (1) Assumed by contract or agreement prior to loss; or (2) Required by local ordinance. No Deductible applies to this Additional Coverage. d. Pollutant Clean Up And Removal We will pay your expense to extract "pollut- ants" from land or water at the described premises if the discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. - This Additional Coverage does not apply to costs to test for, monitor or assess the exis- tence, concentration or effects of "pollut- ants". But we will pay for testing which is performed in the course of extracting the "pollutants" from the land or water. The most we will pay under this Additional Coverage for each described premises is $10,000 for the sum of all covered ex- penses arising out of Covered Causes of Loss occurring during each separate 12 month period of this policy. e. Increased Cost Of Construction (1) This Additional Coverage applies only to buildings to which the Replacement Cost Optional Coverage applies. (2) In the event of damage by a Covered Cause of Loss to a building that is Cov- ered Property, we will pay the increased costs incurred to comply with enforce- ment of an ordinance or law in the course of repair, rebuilding or replace- ment of damaged parts of that property, subject to the limitations stated in e.(3} through e.(9} of this Additional Cover- age. (3) The ordinance or law referred to in e.(2} of this Additional Coverage is an ordi- nance or law that regulates the construc- tion or repair of buildings or establishes zoning or land use requirements at the described premises, and is in force at the time of loss. (4) Under this Additional Coverage, we will not pay any costs due to an ordinance or law that: (a) You were required to comply with before the loss, even when the build- ing was undamaged; and (b) You failed to comply with. (5) Under this Additional Coverage, we will not pay any costs associated with the enforcement of an ordinance or law which requires any insured or others to test for, monitor, clean up, remove, con- tain, treat, detoxify or neutralize, or in any way respond to, or assess the ef- fects of "pollutants". ( Page 4 of 13 Copyright, Insurance Services Office, Inc., 1999 CP 00101000 o ( (6) The most we will pay under this Addi- tional Coverage, for each described building insured under this Coverage Form, is $10,000 or 5% of the Limit of Insurance applicable to that building, whichever is less. If a damaged building is covered under a blanket Limit of In- surance which applies to more than one building or item of property, then the most we will pay under this Additional Coverage, for that damaged building, is the lesser of: $10,000 or 5% times the value of the damaged building as of the time of loss times the applicable coin- surance percentage. The amount payable under this Addi- tional Coverage is additional insurance. (7) With respect to this Additional Coverage: (a) We will not pay for the Increased Cost of Construction: (i) Until the property is actually re- paired or replaced, at the same or another premises; and (ii) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage, not to exceed two years. We may extend this period in writing dur- ing the two years. (b) If the building is repaired or replaced at the same premises, or if you elect to rebuild at another premises, the most we will pay for the Increased Cost of Construction, subject to the provisions of e.(6) of this Additional Coverage, is the increased cost of construction at the same premises. (c) If the ordinance or law requires relo- cation to another premises, the most we will pay for the Increased Cost of Construction, subject to the provi- sions of e.(6) of this Additional Cov- erage, is the increased cost of con- struction at the new premises. (8) This Additional Coverage is not subject to the terms of the Ordinance or Law Exclusion, to the extent that such Exclu- sion would conflict with the provisions of this Additional Coverage. ( CP 00101000 ------:"'7 ~..- (9) The costs addressed in the Loss Pay- ment and Valuation Conditions, and the Replacement Cost Optional Coverage, in this Coverage Form, do not include the increased cost attributable to en- forcement of an ordinance or law. The amount payable under this Additional Coverage, as stated in e.(6) of this Addi- tional Coverage, is not subject to such limitation. 5. Coverage Extensions Except as otherwise provided, the following Ex- tensions apply to property located in or on the building described in the Declarations or in the open (or in a vehicle) within 100 feet of the de- scribed premises. If a Coinsurance percentage of 80% or more or, a Value Reporting period symbol, is shown in the Declarations, you may extend the insur- ance provided by this Coverage Part as follows: a. Newly Acquired Or Constructed Property (1) Buildings If this policy covers Building, you may extend that insurance to apply to: (a) Your new buildings while being built on the described premises; and (b) Buildings you acquire at locations, other than the described premises, intended for: (i) Similar use as the building de- scribed in the Declarations; or (ii) Use as a warehouse. The most we will pay for loss or damage under this Extension is $250,000 at each building. (2) Your Business Personal Property (a) If this policy covers Your Business Personal Property, you may extend that insurance to apply to: (i) Business personal property, in- cluding such property that you newly acquire, at any location you acquire other than at fairs, trade shows or exhibitions; Copyright, Insurance Services Office, Inc., 1999 o Page 5 of 13 ~ ( } ( (ii) Business personal property, in- cluding such property that you newly acquire, located at your newly constructed or acquired buildings at the location described in the Declarations; or (Hi) Business personal property that you newly acquire, located at the described premises. The most we will pay for loss or damage under this Extension is $100,000 at each building. (b) This Extension does not apply to: (i) Personal property of others that is temporarily in your possession in the course of installing or per- forming work on such property; or (ii) Personal property of others that is temporarily in your possession in the course of your manufacturing or wholesaling activities. (3) Period Of Coverage With respect to insurance on or at each newly acquired or constructed property, coverage will end when any of the following first occurs: (a) This policy expires; (b) 30 days expire after you acquire the property or begin construction of that part of the building that would qualify as covered property; or (c) You report values to us. We will charge you additional premium for values reported from the date you acquire the property or begin construc- tion of that part of the building that would qualify as covered property. b. Personal Effects And Property Of Others You may extend the insurance that applies to Your Business Personal Property to apply to: (1) Personal effects owned by you, your officers, your partners or members, your managers or your employees. This ex- tension does not apply to loss or dam- age by theft. (2) Personal property of others in your care, custody or control. The most we will pay for loss or damage under this Extension is $2,500 at each de- scribed premises. Our payment for loss of or damage to personal property of others will only be for the account of the owner of the property. c. Valuable Papers And Records - Cost Of Research You may extend the insurance that applies to Your Business Personal Property to apply to your costs to research, replace or restore the lost information on lost or damaged valuable papers and records, including those which exist on electronic or magnetic media, for which duplicates do not exist. The most we will pay under this Extension is $2,500 at each described premises, unless a higher limit is shown in the Decla- rations. d. Property Off-Premises (1) You may extend the insurance provided by this Coverage Form to apply to your Covered Property while it is away from the described premises, if it is: (a) Temporarily at a location you do not own, lease or operate; (b) In storage at a location you lease, provided the lease was executed af- ter the beginning of the current policy term; or (c) At any fair, trade show or exhibition. (2) This Extension does not apply to prop- erty: (a) In or on a vehicle; or (b) In the care, custody or control of your salespersons, unless the property is in such care, custody or control at a fair, trade show or exhibition. (3) The most we will pay for loss or damage under this Extension is $10,000. e. Outdoor Property You may extend the insurance provided by this Coverage Form to apply to your outdoor fences, radio and television antennas (in- cluding satellite dishes), signs (other than signs attached to buildings), trees, shrubs and plants (other than "stock" of trees, shrubs or plants), including debris removal expense, caused by or resulting from any of the following causes of loss if they are Cov- ered Causes of Loss: (1) Fire; (2) Lightning; (3) Explosion; (4) Riot or Civil Commotion; or (5) Aircraft. Page 6 of 13 Copyright, Insurance Services Office. Inc., 1999 CP 00 10 1000 o ( The most we will pay for loss or damage under this Extension is $1,000, but not more than $250 for anyone tree, shrub or plant. These limits apply to anyone occur- rence, regardless of the types or number of items lost or damaged in that occurrence. f. Non-Owned Detached Trailers (1) You may extend the insurance that applies to Your Business Personal Property to apply to loss or damage to trailers that you do not own, provided that: (a) The trailer is used in your business; (b) The trailer is in your care, custody or control at the premises described in the Declarations; and (c) You have a contractual responsibility to pay for loss or damage to the trailer. (2) We will not pay for any loss or damage that occurs: (a) While the trailer is attached to any motor vehicle or motorized convey- ance, whether or not the motor vehi- cle or motorized conveyance is in motion; (b) During hitching or unhitching opera- tions, or when a trailer becomes ac- cidentally unhitched from a motor vehicle or motorized conveyance. (3) The most we will pay for loss or damage under this Extension is $5,000, unless a higher limit is shown in the Declarations. (4) This insurance is excess over the amount due (whether you can collect on it or not) from any other insurance cover- . ing such property. Each of these Extensions is additional insurance. The Additional Condition, Coinsurance, does not apply to these Extensions. B. Exclusions And Limitations See applicable Causes of Loss Form as shown in the Declarations. C. Limits Of Insurance The most we will pay for loss or damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations. The most we will pay for loss or damage to out- door signs attached to buildings is $1,000 per sign in anyone occurrence. ( The limits applicable to the Coverage Extensions and the Fire Department Service Charge and Pol- lutant Clean Up and Removal Additional Cover- ages are in addition to the Limits of Insurance. Payments under the Preservation of Property Addi- tional Coverage will not increase the applicable Limit of Insurance. D. Deductible In anyone occurrence of loss or damage (herein- after referred to as loss), we will first reduce the amount of loss if required by the Coinsurance Condition or the Agreed Value Optional Coverage. If the adjusted amount of loss is less than or equal to the Deductible, we will not pay for that loss. If the adjusted amount of loss exceeds the Deducti- ble, we will then subtract the Deductible from the adjusted amount of loss, and will pay the resulting amount or the Limit of Insurance, whichever is less. When the occurrence involves loss to more than one item of Covered Property and separate Limits of Insurance apply, the losses will not be combined in determining application of the Deductible. But the Deductible will be applied only once per occur- rence. Example No.1: (This example assumes there is no coinsurance pen- alty.) Deductible: Limit of Insurance - Bldg. 1: Limit of Insurance - Bldg. 2: Loss to Bldg. 1: Loss to Bldg. 2: $ 250 $ 60,000 $ 80,000 $ 60,100 $ 90,000 The amount of loss to Bldg. 1 ($60,100) is less than the sum ($60,250) of the Limit of Insurance applicable to Bldg. 1 plus the Deductible. The Deductible will be subtracted from the amount of loss in calculating the loss payable for Bldg. 1: - $ 60,100 250 $ 59,850 Loss Payable - Bldg. 1 The Deductible applies once per occurrence and therefore is not subtracted in determining the amount of loss payable for Bldg. 2. Loss payable for Bldg. 2 is the Limit of Insurance of $80,000. Total amount of loss payable: $59,850 + 80,000 = $139,850 CP 00101000 Copyright, Insurance Services Office, Inc., 1999 Page 7 of 13 o Example No.2: (This example, too, assumes there is no coinsurance penalty. ) The Deductible and Limits of Insurance are the same as those in Example NO.1. Loss to Bldg. 1: $ 70,000 (exceeds Limit of Insurance plus Deductible) Loss to Bldg. 2: $ 90,000 (exceeds Limit of Insurance plus Deductible) Loss Payable - Bldg. 1: $60,000 (Limit of Insurance) Loss Payable - Bldg. 2: $80,000 (Limit of Insurance) Total amount of loss payable: $140,000 ( E. Loss Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions. 1. Abandonment There can be no abandonment of any property to us. 2. Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a com- petent and impartial appraiser. The two ap- praisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3. Duties In The Event Of Loss Or Damage a. You must see that the following are done in the event of loss or damage to Covered Property: (1) Notify the police if a law may have been broken. (2) Give us prompt notice of the loss or damage. Include a description of the property involved. (3) As soon as possible, give us a descrip- tion of how, when and where the loss or damage occurred. ( (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Prop- erty, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasi- ble, set the damaged property aside and in the best possible order for examina- tion. (5) At our request, give us complete inven- tories of the damaged and undamaged property. Include quantities, costs, val- ues and amount of loss claimed. (6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of dam- aged and undamaged property for in- spection, testing and analysis, and per- mit us to make copies from your books and records. (7) Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. (8) Cooperate with us in the investigation or settlement of the claim. b. We may examine any insured under oath, while not in the presence of any other in- sured and at such times as may be rea- sonably required, about any matter relating to this insurance or the claim, including an insured's books and records. In the event of an examination, an insured's answers must be signed. 4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged prop- erty; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and qual- ity, subject to b. below. Page 8 of 13 Copyright, Insurance Services Office, Inc., 1999 CP 00 10 10 00 o i \ We will determine the value of lost or dam- aged property, or the cost of its repair or re- placement, in accordance with the applica- ble terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition. b. The cost to repair, rebuild or replace does not include the increased cost attributable to enforcement of any ordinance or law regu- lating the construction, use or repair of any property. c. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. d. We will not pay you more than your financial interest in the Covered Property. e. We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claims against us for the own- ers' property. We will not pay the owners more than their financial interest in the Cov- ered Property. f. We may elect to defend you against suits arising from claims of owners of property. We will do this at our expense. g. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part and: (1) We have reached agreement with you on the amount of loss; or (2) An appraisal award has been made. 5. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, the property will be returned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the recovered property, subject to the Limit of Insurance. c- } ( 6. Vacancy a. Description Of Terms (1) As used in this Vacancy Condition, the term building and the term vacant have the meanings set forth in (1)(a) and (1)(b) below: (a) When this policy is issued to a ten- ant, and with respect to that tenant's interest in Covered Property, building means the unit or suite rented or leased to the tenant. Such building is vacant when it does not contain enough business personal property to conduct customary operations. (b) When this policy is issued to the owner or general lessee of a build- ing, building means the entire build- ing. Such building is vacant unless at least 31 % of its total square footage is: (i) Rented to a lessee or sub-lessee and used by the lessee or sub- lessee to conduct its customary operations; and/or (ii) Used by the building owner to conduct customary operations. (2) Buildings under construction or renova- tion are not considered vacant. b. Vacancy Provisions If the building where loss or damage occurs has been vacant for more than 60 consecu- tive days before that loss or damage oc- curs: (1) We will not pay for any loss or damage caused by any of the following even if they are Covered Causes of Loss: (a) Vandalism; (b) Sprinkler leakage, unless you have protected the system against freez- ing; (c) Building glass breakage; (d) Water damage; (e) Theft; or (f) Attempted theft. (2) With respect to Covered Causes of Loss other than those listed in b.(1){a) through b.(1){f) above, we will reduce the amount we would otherwise pay for the loss or damage by 15%. CP 00 10 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 90f 13 o ( 7. Valuation We will determine the value of Covered Prop- erty in the event of loss or damage as follows: a. At actual cash value as of the time of loss or damage, except as provided in b., c., d., e. and f. below. b. If the Limit of Insurance for Building satis- fies the Additional Condition, Coinsurance, and the cost to repair or replace the dam- aged building property is $2,500 or less, we will pay the cost of building repairs or re- placement. The cost of building repairs or replacement does not include the increased cost attribut- able to enforcement of any ordinance or law regulating the construction, use or repair of any property. However, the following prop- erty will be valued at the actual cash value even when attached to the building: (1) Awnings or floor coverings; (2) Appliances for refrigerating, ventilating, cooking, dishwashing or laundering; or (3) Outdoor equipment or furniture. c. "Stock" you have sold but not delivered at the selling price less discounts and ex- penses you otherwise would have had. d. Glass at the cost of replacement with safety glazing material if required by law. e. Tenant's Improvements and Betterments at: (1) Actual cash value of the lost or damaged property if you make repairs promptly. (2) A proportion of your original cost if you do not make repairs promptly. We will determine the proportionate value as fol- lows: (a) Multiply the original cost by the num- ber of days from the loss or damage to the expiration of the lease; and (b) Divide the amount determined in (a) above by the number of days from the installation of improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option pe- riod will replace the expiration of the lease in this procedure. (3) Nothing if others pay for repairs or re- placement. f. Valuable Papers and Records, including those which exist on electronic or magnetic media (other than prepackaged software programs), at the cost of: (1) Blank materials for reproducing the records; and ( (2) labor to transcribe or copy the records when there is a duplicate. F. Additional Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions. 1. Coinsurance If a Coinsurance percentage is shown in the Declarations, the following condition applies. a. We will not pay the full amount of any loss if the value of Covered Property at the time of loss times the Coinsurance percentage shown for it in the Declarations is greater than the Limit of Insurance for the property. Instead, we will determine the most we will pay using the following steps: (1) Multiply the value of Covered Property at the time of loss by the Coinsurance per- centage; (2) Divide the Limit of Insurance of the property by the figure determined in Step (1); (3) Multiply the total amount of loss, before the application of any deductible, by the figure determined in Step (2); and (4) Subtract the deductible from the figure determined in Step (3). We will pay the amount determined in Step (4) or the limit of insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. Example No.1 (Underinsurance): When: The value of the prop- erty is The Coinsurance per- centage for it is The Limit of Insurance for it is $ The Deductible is $ The amount of loss is $ Step (1): $250,000 x 80% = $200,000 (the minimum amount of insurance to meet your Coinsurance requirements) Step (2): $100,000 + $200,000 = .50 Step (3): $40,000 x .50 = $20,000 Step (4): $20,000 - $250 = $19,750 We will pay no more than $19,750. The remaining $20,250 is not covered. $ 250,000 80% 100,000 250 40,000 Page 10 of 13 Copyright, Insurance Services Office, Inc., 1999 CP 00101000 o Example No.2 (Adequate Insurance): c. The mortgageholder has the right to receive ( When: The value of the prop- loss payment even if the mortgageholder erty is $ 250,000 has started foreclosure or similar action on The Coinsurance per- the building or structure. centage for it is 80% d. If we deny your claim because of your acts The Limit of Insurance or because you have failed to comply with for it is $ 200,000 the terms of this Coverage Part, the mort- The Deductible is $ 250 gageholder will still have the right to receive The amount of loss is $ 40,000 loss payment if the mortgageholder: (1) Pays any premium due under this Cov- The minimum amount of insurance to meet erage Part at our request if you have your Coinsurance requirement is $200,000 failed to do so; ($250,000 x 80%). Therefore, the Limit of (2) Submits a signed, sworn proof of loss Insurance in this Example is adequate and within 60 days after receiving notice no penalty applies. We will pay no more from us of your failure to do so; and than $39,750 ($40,000 amount of loss mi- (3) Has notified us of any change in owner- nus the deductible of $250). ship, occupancy or substantial change in b. If one Limit of Insurance applies to two or risk known to the mortgageholder. more separate items, this condition will ap- All of the terms of this Coverage Part will ply to the total of all property to which the then apply directly to the mortgageholder. limit applies. e. If we pay the mortgageholder for any loss or Example No.3: damage and deny payment to you because of your acts or because you have failed to When: The value of property is: comply with the terms of this Coverage Bldg. at Location No.1 $ 75,000 Part: Bldg. at Location No.2 $ 100,000 (1) The mortgageholder's rights under the ( Personal Property at mortgage will be transferred to us to the Location No.2 $ 75,000 extent of the amount we pay; and $ 250,000 (2) The mortgageholder's right to recover The Coinsurance per- the full amount of the mortgageholder's centage for it is 90% claim will not be impaired. The Limit of Insurance for Buildings and Per- At our option, we may pay to the mortgage- sonal Property at Loca- holder the whole principal on the mortgage tion Nos. 1 and 2 is $ 180,000 plus any accrued interest. In this event, your The Deductible is $ 1,000 mortgage and note will be transferred to us The amount of loss is: and you will pay your remaining mortgage Bldg. at Location No.2 $ 30,000 debt to us. Personal Property at f. If we cancel this policy, we will give written Location No.2. $ 20,000 notice to the mortgageholder at least: $ 50,000 (1) 10 days before the effective date of Step (1): $250,000 x 90% = $225,000 cancellation if we cancel for your non- (the minimum amount of insurance to payment of premium; or meet your Coinsurance requirements (2) 30 days before the effective date of and to avoid the penalty shown below) cancellation if we cancel for any other Step (2): $180,000 + $225,000 = .80 reason. Step (3): $50,000 x .80 = $40,000 g. If we elect not to renew this policy, we will Step (4): $40,000 - $1,000 = $39,000 give written notice to the mortgageholder at We will pay no more than $39,000. The remaining least 10 days before the expiration date of $11,000 is not covered. this policy. 2. Mortgageholders a. The term mortgageholder includes trustee. ( b. We will pay for covered loss of or damage to buildings or structures to each mortgage- holder shown in the Declarations in their or- der of precedence, as interests may appear. CP 00 10 1000 Copyright, Insurance Services Office, Inc., 1999 Page 11 of 13 o ,. ( G. Optional Coverages If shown as applicable in the Declarations, the fol- lowing Optional Coverages apply separately to each item. 1. Agreed Value a. The Additional Condition, Coinsurance, does not apply to Covered Property to which this Optional Coverage applies. We will pay no more for loss of or damage to that prop- erty than the proportion that the Limit of In- surance under this Coverage Part for the property bears to the Agreed Value shown for it in the Declarations. b. If the expiration date for this Optional Cov- erage shown in the Declarations is not ex- tended, the Additional Condition, Coinsur- ance, is reinstated and this Optional Cover- age expires. c. The terms of this Optional Coverage apply only to loss or damage that occurs: (1) On or after the effective date of this Optional Coverage; and (2) Before the Agreed Value expiration date shown in the Declarations or the policy expiration date, whichever occurs first. 2. Inflation Guard a. The Limit of Insurance for property to which this Optional Coverage applied will auto- matically increase by the annual percentage shown in the Declarations. b. The amount of increase will be: (1) The Limit of Insurance that applied on the most recent of the policy inception date, the policy anniversary date, or any other policy change amending the Limit of Insurance, times (2) The percentage of annual increase shown in the Declarations, expressed as a decimal (example: 8% is .08), times (3) The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance, divided by 365. ( ( Example: If: The applicable Limit of Insurance is $ 100,000 The annual percentage increase is 8% The number of days since the beginning of the policy year (or last policy change) is 146 The amount of increase is $100,000 x .08 x 146 + 365 = $ 3,200 3. Replacement Cost a. Replacement Cost (without deduction for depreciation) replaces Actual Cash Value in the Loss Condition, Valuation, of this Cov- erage Form. b. This Optional Coverage does not apply to: (1) Personal property of others; (2) Contents of a residence; (3) Manuscripts; (4) Works of art, antiques or rare articles, including etchings, pictures, statuary, marbles, bronzes, porcelains and bric-a- brac; or (5) "Stock", unless the Including "Stock" option is shown in the Declarations. Under the terms of this Replacement Cost Optional Coverage, tenants' improvements and betterments are not considered to be the personal property of others. c. You may make a claim for loss or damage covered by this insurance on an actual cash value basis instead of on a replacement cost basis. In the event you elect to have loss or damage settled on an actual cash value basis, you may still make a claim for the additional coverage this Optional Cov- erage provides if you notify us of your intent to do so within 180 days after the loss or damage. d. We will not pay on a replacement cost basis for any loss or damage: (1) Until the lost or damaged property is actually repaired or replaced; and Page 12 of 13 Copyright, Insurance Services Office, Inc., 1999 CP 00 10 10 00 o ~. (2) Unless the repairs or replacement are made as soon as reasonably possible after the 1055 or damage. With respect to tenants' improvements and betterments, the following also apply: (3) If the conditions in d.(1) and d.(2) above are not met, the value of tenants' im- provements and betterments will be de- termined as a proportion of your original cost, as set forth in the Valuation Condi- tion of this Coverage Form; and (4) We will not pay for 1055 or damage to tenants' improvements and betterments if others pay for repairs or replacement. e. We will not pay more for 1055 or damage on a replacement cost basis than the least of (1), (2) or (3), subject to f. below: (1) The Limit of Insurance applicable to the lost or damaged property; (2) The cost to replace the lost or damaged property with other property: (a) Of comparable material and quality; and (b) Used for the same purpose; or (3) The amount actually spent that is nec- essary to repair or replace the lost or damaged property. If a building is rebuilt at a new premises, the cost described in e.(2) above is limited to the cost which would have been incurred if the building had been rebuilt at the original premises. f. The cost of repair or replacement does not include the increased cost attributable to enforcement of any ordinance or law regu- lating the construction, use or repair of any property. c~ ( 4. Extension Of Replacement Cost To Personal Property Of Others a. If the Replacement Cost Optional Coverage is shown as applicable in the Declarations, then this Extension may also be shown as applicable. If the Declarations show this Ex- tension as applicable, then Paragraph 3.b.(1) of the Replacement Cost Optional Coverage is deleted and all other provisions of the Replacement Cost Optional Cover- age apply to replacement cost on personal property of others. b. With respect to replacement cost on the personal property of others, the following limitation applies: If an item(s) of personal property of others is subject to a written contract which gov- erns your liability for 1055 or damage to that item(s), then valuation of that item(s} will be based on the amount for which you are li- able under such contract, but not to exceed the lesser of the replacement cost of the property or the applicable Limit of Insur- ance. H. Definitions 1. "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 2. "Stock" means merchandise held in storage or for sale, raw materials and in-process or fin- ished goods, including supplies used in their packing or shipping. Page 13 of 13 o CP 00 10 1000 Copyright, Insurance Services Office, Inc., 1999 THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY. COVERAGE EXTENSIONS Unless otherwise specified, your coverage extensions under the Building and Personal Property Coverage Form CP 00 10 10 00 have been amended as follows: 5. COVERAGE EXTENSIONS a. Newly ACQuired or Constructed Property - The most we will pay for loss or damage under this Extension is 50% of the Limit of Insurance for Building and Business Personal Property shown in the Declarations, but not more than $1,000,000 per location. 1. Insurance under this Extension for each newly acquired or constructed property will end when any of the following first occurs: a) This agreement expires. b) 60 days expire after you acquire or begin to construct the property if in excess of $1,000,000 (Building and Business Personal Property); or c) You report values to us. ( b. Valuable Papers and Records - Cost of Research - The most we will pay under this Extension is $10,000 per location, to a maximum of $100,000 per member per occurrence. c. Outdoor Property/Signs - (other than signs attached to buildings). The most we will pay for loss or damage to signs under this Extension is $10,000. d. Ac-r.ounts Receivable - You may extend the insurance that applies to your Business Personal Property to apply to your records of accounts receivable while they are at a "covered location." Accounts Receivable are amounts owed to you by those with whom you deal in operating your business. The most we will pay for loss under this Extension is $10,000 per location to a maximum of $100,000 per member per occurrence. e. Extra Expense - You may extend the insurance that applies to your Business Personal Property to apply to expenses over and above your ordinary business expenses, which are necessary to avoid or minimize the suspension of business and return to normal operations after a covered loss to "buildings" or "business personal property" at a "covered location." The most we will pay for loss under this Extension is $50,000 per location to a maximum of $500,000 per member per occurrence. f. Flood Coverage - Excess of Loss - The most we will pay for loss or damage under this extension is $500,000 per occurrence excess of the maximum amount of coverage available from the National Flood Insurance Program per location or $250,000 per location, whichever is greater. However, in no event shall the liability of the Trust for all losses falling within the scope of this extension due to anyone flood loss exceed $500,000 in anyone loss occurrence nor shall the aggregate liability of the Trust for all such losses exceed $500,000 in any Trust year commencing with the effective date of this coverage. ( FMIT PROP 03 1002 Page 1 of 2 ( ( f ( For the purpose of this coverage the term flood shall mean surface water, waves, tide or tidal water and the rising (including the overflow or breaking of boundaries) of lakes, ponds, reservoirs, harbors, streams and similar bodies of water, spray from any of the foregoing, and water which backs up through sewers or drains. If this policy covers a building, or part thereof, it shall cover direct loss by flood to foundations, excavations, and all other portions of said building, or part thereof, even though this Trust by this policy may have excluded foundations, excavations and such portions of said building, or part thereof, from coverage. The Trust shall not be liable hereunder for loss by flood to glass, or lettering or ornamentation thereon, which at the time of such loss may be separately covered as such against loss by flood under any other policy of insurance. g. Piers, wharfs and docks - Coverage is extended to include the Causes of Loss - Basic Form for scheduled piers, wharfs, and docks. However, we will not pay for loss or damage caused by the peril of windstorm/hail. h. Underground pipes flues, and drains - Coverage is extended to include the Causes of Loss - Basic Form for scheduled underground pipes, flues, and drains. i. Business Interruption - You may extend the insurance that applies to Designated Member owned and scheduled water treatment and wastewater treatment facilities to apply to business interruption to a covered cause of loss. The most we will pay in any Trust year is $50,000. j. Police Dogs - We will pay for the in line of duty death of a certified police canine owned by the Designated Member. The most we will pay under this Extension is $5,000 per canine. The most we will pay in any Trust year is $5,000. k. Terrorism - The most we will pay for loss or damage under this extension is $5,000,000.00 per occurrence. This extension is limited to scheduled locations to which coverage applies to real property, personal property, business income and extra expense. I. -Electronic Data Processing EQuipment (Software) - We will pay for mechanical breakdown for software at scheduled locations of the Designated Member. Software means all forms of converted data and/or instruction vehicles employed in your data processing operation. Also included is the medium on which data is recorded such as magnetic tapes, hard disk or floppy disks. Software that is the property of others is covered as long as you are responsible for it. The most we will pay for a loss under this extension is $10,000.00 per occurrence. FMIT PROP 03 1002 Page 2 of 2 POLICY NUMBER: COMMERCIAL PROPERTY CP 01 25 06 95 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART ( A. When this endorsement is attached to the Stan- dard Property Policy CP 00 99 the term Coverage Part in this endorsement is replaced by the term Policy. B. The following provision applies when a Coinsur- ance percentage is shown in the Declarations: Florida law states as follows: Coinsurance contract: The rate charged in this pol- icy is based upon the use of the coinsurance clause attached to this policy, with the consent of the Insured. C. The following is added: If loss or damage to Covered Property is caused by or results from Windstorm, the following exclu- sion applies in: 1. Broward County; 2. Dade County; 3. Martin County; 4. Monroe County; 5. Palm Beach County; and 6. All the areas east of the west bank of the Intra- Coastal Waterway in the Counties of: a. Indian River; and b. St. Lucie. Windstorm Exterior Paint and Waterproofing Exclusion We will not pay for loss or damage to: 1. Paint; or 2. Waterproofing material; applied to the exterior of Buildings. We will not include the value of paint or waterproofing material to determine: a. The amount of the Windstorm or Hail De- ductible; or b. The value of Covered Property when apply- ing the Coinsurance Condition. ( CP 01 25 06 95 D. The LOSS PAYMENT Condition dealing with the number of days within which we must pay for cov- ered loss or damage is replaced by the following: Provided you have complied with all the terms of this Coverage Part, we will pay for covered loss or damage: (1) Within 20 days after we receive the sworn proof of loss and reach written agreement with you; or (2) Within 30 days after we receive the swom proof of loss and: (a) There is an entry of a final judgment; or (b) There is a filing of an appraisal award with us. E. Sinkhole Collapse 1. Paragraph A.10., SINKHOLE COLLAPSE, of the Causes of Loss - Basic Form and the Causes of Loss - Broad Form; 2. Paragraph A.2.c.(8) of COVERED CAUSES OF LOSS of the Mortgageholders Errors and Omissions Coverage Form; and 3. Paragraph A.3.h., SINKHOLE COLLAPSE, of the Standard Property Policy are replaced by the following: Sinkhole Collapse, meaning loss or damage cause,d by the sudden sinking or collapse of land into underground empty spaces created by the action of water on limestone or similar rock formations. This cause of loss does not in- clude: a. The cost of filling sinkholes; or b. Sinking or collapse of land into man-made underground cavities. Copyright, ISO Commercial Risk Services, Inc., 1994 o Page 1 of 2 ( I ( " 't.j}','f~}tY'H1 F. Paragraph F.1. of DEFINITIONS of the Causes of Loss - Special Form is replaced by the following: 1. Sinkhole collapse means the sudden sinking or collapse of land into underground empty spaces created by the action of water on lime- stone or similar rock formations. This cause of loss does not include: a. The cost of filling sinkholes; or b. Sinking or collapse of land into man-made underground cavities. Page 2 of 2 Copyright, ISO Commercial Risk Services, Inc., 1994 o CP 01 25 06 95 COMMERCIAL PROPERTY CP 10 30 10 00 CAUSES OF LOSS - SPECIAL FORM Words and phrases that appear in quotation marks have special meaning. Refer to Section F. - Definitions. (H A. Covered Causes Of Loss When Special is shown in the Declarations, Cov- ered Causes of Loss means Risks Of Direct Physical Loss unless the loss is: 1. Excluded in Section B., Exclusions; or 2. Limited in Section C., Limitations; that follow. B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes con- currently or in any sequence to the loss. a. Ordinance Or Law The enforcement of any ordinance or law: (1) Regulating the construction, use or repair of any property; or (2) Requiring the tearing down of any prop- erty, including the cost of removing its debris. This exclusion, Ordinance Or Law, applies whether the loss results from: (1) An ordinance or law that is enforced even if the property has not been dam- aged; or (2) The increased costs incurred to comply with an ordinance or law in the course of construction, repair, renovation, remod- eling or demolition of property, or re- moval of its debris, following a physical loss to that property. b. Earth Movement (1) Earthquake, including any earth sinking, rising or shifting related to such event; (2) Landslide, including any earth sinking, rising or shifting related to such event; (3) Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; (4) Earth sinking (other than sinkhole col- lapse), rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. But if Earth Movement, as described in b.(1) through (4) above, results in fire or explosion, we will pay for the loss or dam- age caused by that fire or explosion. (5) Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or ef- fusion results in fire, building glass breakage or Volcanic Action, we will pay for the loss or damage caused by that fire, building glass breakage or Volcanic Action. Volcanic action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: (a) Airborne volcanic blast or airborne shock waves; (b) Ash, dust or particulate matter; or (c) Lava flow. All volcanic eruptions that occur within any 168 hour period will constitute a sin- gle occurrence. Volcanic action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss or damage to the described property. c. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction or- dered by governmental authority and taken at the time of a fire to prevent its spread, if the fire would be covered under this Cover- age Part. ( CP 10 30 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 1 of 7 o ( d. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radio- active contamination, results in fire, we will pay for the loss or damage caused by that fire. e. Utility Services The failure of power or other utility service supplied to the described premises, how- ever caused, if the failure occurs away from the described premises. But if the failure of power or other utility ser- vice results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. This exclusion does not apply to the Busi- ness Income coverage or to Extra Expense coverage. Instead, the Special Exclusion in Paragraph B.4.a.(1) applies to these cover- ages. f. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, includ- ing action in hindering or defending against an actual or expected attack, by any government, sovereign or other au- thority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by gov- ernmental authority in hindering or de- fending against any of these. g. Water (1) Flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; (2) Mudslide or mudflow; (3) Water that backs up or overflows from a sewer, drain or sump; or (4) Water under the ground surface press- ing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. ( ( Page 2 of 7 But if Water, as described in g.(1) through g.(4) above, results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage. Exclusions B.1.a. through B.1.g. apply whether or not the loss event results in widespread damage or affects a substantial area. 2. We will not pay for loss or damage caused by or resulting from any of the following: a. Artificially generated electrical current, in- cluding electric arcing, that disturbs electri- cal devices, appliances or wires. But if artificially generated electrical current results in fire, we will pay for the loss or damage caused by that fire. b. Delay, loss of use or loss of market. c. Smoke, vapor or gas from agricultural smudging or industrial operations. d. (1) Wear and tear; (2) Rust, corrosion, fungus, decay, deterio- ration, hidden or latent defect or any quality in property that causes it to dam- age or destroy itself; (3) Smog; (4) Settling, cracking, shrinking or expan- sion; (5) Nesting or infestation, or discharge or release of waste products or secretions, by insects, birds, rodents or other ani- mals. (6) Mechanical breakdown, including rup- ture or bursting caused by centrifugal force. But if mechanical breakdown re- sults in elevator collision, we will pay for the loss or damage caused by that ele- vator collision. (7) The following causes of loss to personal property: (a) Dampness or dryness of atmos- phere; (b) Changes in or extremes of tempera- ture; or (c) Marring or scratching. But if an excluded cause of loss that is listed in 2.d.(1) through (7) results in a "specified cause of loss" or building glass breakage, we will pay for the loss or dam- age caused by that "specified cause of loss" or building glass breakage. Copyright, Insurance Services Office, Inc., 1999 o CP 10 30 10 00 ~ :~.'.!] ( e. Explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your con- trol. But if explosion of steam boilers, steam pipes, steam engines or steam turbines re- sults in fire or combustion explosion, we will pay for the loss or damage caused by that fire or combustion explosion. We will also pay for loss or damage caused by or result- ing from the explosion of gases or fuel within the furnace of any fired vessel or within the flues or passages through which the gases of combustion pass. f. Continuous or repeated seepage or leakage of water that occurs over a period of 14 days or more. g. Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or resulting from freezing, unless: (1) You do your best to maintain heat in the building or structure; or (2) You drain the equipment and shut off the supply if the heat is not maintained. h. Dishonest or criminal act by you, any of your partners, members, officers, managers, employees (including leased employees), directors, trustees, authorized representa- tives or anyone to whom you entrust the property for any purpose: (1) Acting alone or in collusion with others; or (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of de- struction by your employees (including leased employees); but theft by employees (including leased employees) is not cov- ered. i. Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. j. Rain, snow, ice or sleet to personal property in the open. k. Collapse, except as provided below in the Additional Coverage for Collapse. But if col- lapse results in a Covered Cause of Loss at the described premises, we will pay for the loss or damage caused by that Covered Cause of Loss. ( , CP 10 30 10 00 t, I. Discharge, dispersal, seepage, migration, release or escape of "pollutants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the "specified causes of loss". But if the dis- charge, dispersal, seepage, migration, re- lease or escape of "pollutants" results in a "specified cause of loss", we will pay for the loss or damage caused by that "specified cause of loss". This Exclusion, I., does not apply to dam- age to glass caused by chemicals applied to the glass. m. Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. 3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. a. Weather conditions. But this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph 1. above to produce the loss or damage. b. Acts or decisions, including the failure to act or decide, of any person, group, organiza- tion or governmental body. c. Faulty, inadequate or defective: (1) Planning, zoning, development, survey- ing, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remod- eling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property on or off the described premises. 4. Special Exclusions The following provisions apply only to the speci- fied Coverage Forms. a. Business Income (And Extra Expense) Coverage Form, Business Income (Without Extra Expense) Coverage Form, or Extra Expense Coverage Form We will not pay for: (1) Any loss caused directly or indirectly by the failure of power or other utility ser- vice supplied to the described premises, however caused, if the failure occurs outside of a covered building. Copyright, Insurance Services Office, Inc., 1999 o Page 3 of7 ( But if the failure of power or other utility service results in a Covered Cause of Loss, we will pay for the loss resulting from that Covered Cause of Loss. (2) Any loss caused by or resulting from: (a) Damage or destruction of "finished stock"; or (b) The time required to reproduce "fin- ished stock". This exclusion does not apply to Extra Expense. (3) Any loss caused by or resulting from direct physical loss or damage to radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers. (4) Any increase of loss caused by or result- ing from: (a) Delay in rebuilding, repairing or re- placing the property or resuming "operations", due to interference at the location of the rebuilding, repair or replacement by strikers or other persons; or (b) Suspension, lapse or cancellation of any license, lease or contract. But if the suspension, lapse or cancellation is directly caused by the "suspen- sion" of "operations", we will cover such loss that affects your Business Income during the "period of restora- tion" and any extension of the "period of restoration" in accordance with the terms of the Extended Business In- come Additional Coverage and the Extended Period Of Indemnity Op- tional Coverage or any variation of these. (5) Any Extra Expense caused by or result- ing from suspension, lapse or cancella- tion of any license, lease or contract be- yond the "period of restoration". (6) Any other consequential loss. b. Leasehold Interest Coverage Form (1) Paragraph B.1.a. Ordinance Or Law, does not apply to insurance under this Coverage Form. (2) We will not pay for any loss caused by: (a) Your cancelling the lease; (b) The suspension, lapse or cancella- tion of any license; or (c) Any other consequential loss. ( c. Legal Liability Coverage Form (1) The following exclusions do not apply to insurance under this Coverage Form: (a) Paragraph B.1.a., Ordinance Or Law; (b) Paragraph B.1.c., Governmental Action; (c) Paragraph B.1.d., Nuclear Hazard; (d) Paragraph B.1.e., Utility Services; and (e) Paragraph B.1.f., War And Military Action. (2) The following additional exclusions apply to insurance under this Coverage Form: (a) Contractual Liability We will not defend any claim or "suit", or pay damages that you are legally liable to pay, solely by reason of your assumption of liability in a contract or agreement. But this ex- clusion does not apply to a written lease agreement in which you have assumed liability for building damage resulting from an actual or attempted burglary or robbery, provided that: (i) Your assumption of liability was executed prior to the accident; and (ii) The building is Covered Property under this Coverage Form. (b) Nuclear Hazard We will not defend any claim or "suit", or pay any damages, loss, expense or obligation, resulting from nuclear reaction or radiation, or radioactive contamination, however caused. C. Limitations The following limitations apply to all policy forms and endorsements, unless otherwise stated. 1. We will not pay for loss of or damage to prop- erty, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. a. Steam boilers, steam pipes, steam engines or steam turbines caused by or resulting from any condition or event inside such equipment. But we will pay for loss of or damage to such equipment caused by or resulting from an explosion of gases or fuel within the furnace of any fired vessel or within the flues or passages through which the gases of combustion pass. Page 4 of 7 Copyright, Insurance Services Office, Inc., 1999 CP 10 30 10 00 . 0 ~;;..':';~ (CC) b. Hot water boilers or other water heating equipment caused by or resulting from any condition or event inside such boilers or equipment, other than an explosion. c. The interior of any building or structure, or to personal property in the building or struc- ture, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (2) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. d. Building materials and supplies not attached as part of the building or structure, caused by or resulting from theft. However, this limitation does not apply to: (1) Building materials and supplies held for sale by you, unless they are insured un- der the Builders Risk Coverage Form; or (2) Business Income coverage or Extra Expense coverage. e. Property that is missing, where the only evidence of the loss or damage is a short- age disclosed on taking inventory, or other instances where there is no physical evi- dence to show what happened to the prop- erty. f. Property that has been transferred to a person or to a place outside the described premises on the basis of unauthorized in- structions. 2. We will not pay for loss of or damage to the following types of property unless caused by the "specified causes of loss" or building glass breakage: a. Valuable papers and records, such as books of account, manuscripts, abstracts, drawings and card index systems, including those which exist on film, tape, disc, drum, cell or other data processing, recording or storage media. Valuable papers and re- cords do not include prepackaged software programs. b. Animals, and then only if they are killed or their destruction is made necessary. c. Fragile articles such as statuary, marbles, chinaware and porcelains, if broken. This restriction does not apply to: (1) Glass; or ( , CP 10 30 1000 ~1" (2) Containers of property held for sale. d. Builders' machinery, tools and equipment owned by you or entrusted to you, provided such property is Covered Property. However, this limitation does not apply: (1) If the property is located on or within 100 feet of the described premises, unless the premises is insured under the Build- ers Risk Coverage Form; or (2) To Business Income coverage or to Extra Expense coverage. 3. The special limit shown for each category, a. through d., is the total limit for loss of or dam- age to all property in that category. The special limit applies to anyone occurrence of theft, re- gardless of the types or number of articles that are lost or damaged in that occurrence. The special limits are: a. $2,500 for furs, fur garments and garments trimmed with fur. b. $2,500 for jewelry, watches, watch move- ments, jewels, pearls, precious and semi- precious stones, bullion, gold, silver, plati- num and other precious alloys or metals. This limit does not apply to jewelry and watches worth $100 or less per item. c. $2,500 for patterns, dies, molds and forms. d. $250 for stamps, tickets, including lottery tickets held for sale, and letters of credit. These special limits are part of, not in addition to, the Limit of Insurance applicable to the Covered Property. This limitation, C.3., does not apply to Business Income coverage or to Extra Expense cover- age. 4. We will not pay the cost to repair any defect to a system or appliance from which water, other liquid, powder or molten material escapes. But we will pay the cost to repair or replace dam- aged parts of fire extinguishing equipment if the damage: a. Results in discharge of any substance from an automatic fire protection system; or b. Is directly caused by freezing. However, this limitation does not apply to Busi- ness Income coverage or to Extra Expense coverage. Copyright, Insurance Services Office, Inc., 1999 o Page 5 of 7 (~- O. Additional Coverage - Collapse The term Covered Cause of Loss includes the Ad- ditional Coverage - Collapse as described and lim- ited in 0.1. through 0.5. below. 1. With respect to buildings: a. Collapse means an abrupt falling down or caving in of a building or any part of a build- ing with the result that the building or part of the building cannot be occupied for its in- tended purpose; b. A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse; c. A part of a building that is standing is not considered to be in a state of collapse even if it has separated from another part of the building; d. A building that is standing or any part of a building that is standing is not considered to be in a state of collapse even if it shows evidence of cracking, bulging, sagging, bending, leaning, settling, shrinkage or ex- pansion. 2. We will pay for direct physical loss or damage to Covered Property, caused by collapse of a building or any part of a building that is insured under this Coverage Form or that contains Covered Property insured under this Coverage Form, if the collapse is caused by one or more of the following: a. The "specified causes of loss" or breakage of building glass, all only as insured against in this Coverage Part; b. Decay that is hidden from view, unless the presence of such decay is known to an in- sured prior to collapse; c. Insect or vermin damage that is hidden from view, unless the presence of such damage is known to an insured prior to collapse; d. Weight of people or personal property; e. Weight of rain that collects on a roof; f. Use of defective material or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation. However, if the collapse occurs after con- struction, remodeling or renovation is com- plete and is caused in part by a cause of loss listed in 2.a. through 2.e., we will pay for the loss or damage even if use of defec- tive material or methods, in construction, remodeling or renovation, contributes to the collapse. ( The criteria set forth in 1.a. through 1.d. do not limit the coverage otherwise provided under this Causes of Loss Form for the causes of loss listed in 2.a., 2.d. and 2.e. 3. With respect to the following property: a. Outdoor radio or television antennas (in- cluding satellite dishes) and their lead-in wiring, masts or towers; b. Awnings, gutters and downspouts; c. Yard fixtures; d. Outdoor swimming pools; e. Fences; f. Piers, wharves and docks; g. Beach or diving platforms or appurte- nances; h. Retaining walls; and i. Walks, roadways and other paved surfaces; if the collapse is caused by a cause of loss listed in 2.b. through 2.1., we will pay for loss or damage to that property only if: a. Such loss or damage is a direct result of the collapse of a building insured under this Coverage Form; and b. The property is Covered Property under this Coverage Form. 4. If personal property abruptly falls down or caves in and such collapse is not the result of collapse of a building, we will pay for loss or damage to Covered Property caused by such collapse of personal property only if: a. The collapse was caused by a Cause of Loss listed in 2.a. through 2.f. above; b. The personal property which collapses is inside a building; and c. The property which collapses is not of a kind listed in 3. above, regardless of whether that kind of property is considered to be personal property or real property. The coverage stated in this Paragraph 4. does not apply to personal property if marring and/or scratching is the only damage to that personal property caused by the collapse. Collapse of personal property does not mean cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion. 5. This Additional Coverage, Collapse, will not increase the Limits of Insurance provided in this Coverage Part. Page 6 of 7 Copyright, Insurance Services Office, Inc., 1999 CP 10 301000 o ( E. Additional Coverage Extensions 1. Property In Transit This Extension applies only to your personal property to which this form applies. a. You may extend the insurance provided by this Coverage Part to apply to your personal property (other than property in the care, custody or control of your salespersons) in transit more than 100 feet from the de- scribed premises. Property must be in or on a motor vehicle you own, lease or operate while between points in the coverage terri- tory. b. Loss or damage must be caused by or result from one of the following causes of loss: (1) Fire, lightning, explosion, windstorm or hail, riot or civil commotion, or vandal- ism. (2) Vehicle collision, upset or overturn. Collision means accidental contact of your vehicle with another vehicle or ob- ject. It does not mean your vehicle's con- tact with the road bed. (3) Theft of an entire bale, case or package by forced entry into a securely locked body or compartment of the vehicle. There must be visible marks of the forced entry. c. The most we will pay for loss or damage under this Extension is $5,000. This Coverage Extension is additional insur- ance. The Additional Condition, Coinsurance, does not apply to this Extension. 2. Water Damage, Other Liquids, Powder Or Molten Material Damage If loss or damage caused by or resulting from covered water or other liquid, powder or molten material damage loss occurs, we will also pay the cost to tear out and replace any part of the building or structure to repair damage to the system or appliance from which the water or other substance escapes. This Coverage Ex- tension does not increase the Limit of Insur- ance. ( CP 10 30 1000 3. Glass a. We will pay for expenses incurred to put up temporary plates or board up openings if repair or replacement of damaged glass is delayed. b. We will pay for expenses incurred to re- move or replace obstructions when repair- ing or replacing glass that is part of a build- ing. This does not include removing or re- placing window displays. This Coverage Extension, E.3., does not in- crease the Limit of Insurance. F. Definitions "Specified Causes of Loss" means the following: Fire; lightning; explosion; windstorm or hail; smoke; aircraft or vehicles; riot or civil commotion; vandalism; leakage from fire extinguishing equip- ment; sinkhole collapse; volcanic action; falling ob- jects; weight of snow, ice or sleet; water damage. 1. Sinkhole collapse means the sudden sinking or collapse of land into underground empty spaces created by the action of water on lime- stone or dolomite. This cause of loss does not include: a. The cost of filling sinkholes; or b. Sinking or collapse of land into man-made underground cavities. 2. Falling objects does not include loss or damage to: a. Personal property in the open; or b. The interior of a building or structure, or property inside a building or structure, unless the roof or an outside wall of the building or structure is first damaged by a falling object. 3. Water damage means accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of a plumbing, heating, air conditioning or other system or ap- pliance (other than a sump system including its related equipment and parts), that is located on the described premises and contains water or steam. Copyright, Insurance Services Office, Inc., 1999 o Page 7 of 7 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORDINANCE OR LAW COVERAGE This endorsement modifies insurance provided in the BUILDING AND PERSONAL PROPERTY COVERAGE FORM. A. If a Covered Cause of Loss occurs to covered Building property, we will pay: 1. For loss or damage caused by enforcement of any ordinance or law that: a. Requires the demolition of parts of the same property not damaged by a Covered Cause of Loss; b. Regulates the construction or repair of buildings, or establishes zoning or land use requirements at the described premises; and c. Is in force at the time of loss. ( 2. The increased cost to repair, rebuild or construct the property caused by enforcement of building, zoning or land use ordinance or law. If the property is repaired or rebuilt, it must be intended for similar occupancy as the current property, unless otherwise required by zoning or land use ordinance or law. 3. The cost to demolish and clear the site of undamaged parts of the property caused by enforcement of the building, zoning or land use ordinance or law. B. However, we will not pay under this endorsement for the costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify, or neutralize, or in any way respond to, or assess the effects of "pollutants." c. We will not pay for increased construction costs under this endorsement: ( 1. Until the property is actually repaired or replaced, at the same premises or elsewhere; and FMIT PROP 12 1002 2. Unless the repairs or replacement are made as soon as reasonably possible atter the loss or damage, not to exceed 2 years. We may extend this period in writing during the 2 years. D. We will not pay more: 1. If the property is repaired or replaced on the same premises, than the amount you actually spend to: a. Demolish and clear the site; and b. Repair, rebuild or construct the property but not for more than property of the same height, floor area and style on the same premises. 2. If the property is not repaired or replaced on the same premises, than: a. The amount you actually spend to demolish and clear the site of the described premises; and b. The cost to replace, on the same premises, the damaged or destroyed property with other property: (1) Of comparable material and quality; (2) Of the same height, floor area and style; and (3) Used for the same purpose. 3. For all loss or damage in any occurrence than the Limit of Insurance applicable to the covered Building property and no more than 25% over the actual loss to the property at any scheduled location. E. The terms of this endorsement apply separately to each building to which the endorsement applies. Page 1 of 1 ( ( FLORIDA MUNICIPAL INSURANCE TRUST MEMBER'S STATEMENT OF VALUES MUNICIPAL PROPERTY Member City of Winter Sprinqs FMIT # 0648 Headquarters Address 1126 East State Rd. 434 Winter Springs, FL 32708 Form of Coverage IXl o Replacement Cost applies to Items Agreed Amount applies to Items Coinsurance o 90% 1KI 100% Blanket Rate Effective Causes of loss for which rates are requested: o IXl o o Other (Specify) Other (Specify) Basic Special Basic Coverage may apply to specified locations. Refer to the Schedule of Property Locations. This statement of values form must be filed annually. MEMBER: All values submitted are accurate to the best of my knowledge and belief. Authorized Signature Date PROP-STMTVAL (1/93) 09/25/2002 COMMERCIAL PROPERTY CP 00 50 10 00 EXTRA EXPENSE COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section E. - Definitions. c- A. Coverage We will pay the actual and necessary Extra Ex- pense you sustain due to direct physical loss of or damage to property at premises which are de- scribed in the Declarations and for which an Extra Expense Limit of Insurance is shown in the Decla- rations. The loss or damage must be caused by or result from a Covered Cause of Loss. With respect to loss of or damage to personal property in the open or personal property in a vehicle, the de- scribed premises include the area within 100 feet of the site at which the described premises are lo- cated. With respect to the requirements set forth in the preceding paragraph, if you occupy only part of the site at which the described premises are located, your premises means: a. The portion of the building which you rent, lease or occupy; and b. Any area within the building or on the site at which the described premises are located, if that area services, or is used to gain access to, the described premises. 1. Extra Expense Extra Expense means necessary expenses you incur during the "period of restoration" that you would not have incurred if there had been no direct physical loss or damage to property: a. To avoid or minimize the "suspension" of business and to continue "operations": (1) At the described premises; or (2) At replacement premises or at tempo- rary locations, including: (a) Relocation expenses; and (b) Costs to equip and operate the re- placement or temporary locations; b. To minimize the "suspension" of business if you cannot continue "operations"; or c. (1) To repair or replace any property; or ( '\ (2) To research, replace or restore the lost information on damaged valuable pa- pers and records; to the extent it reduces the amount of loss that otherwise would have been payable under this Coverage Form. 2. Covered Causes Of Loss See applicable Causes of Loss Form as shown in the Declarations. 3. Additional Coverages a. Alterations And New Buildings We will pay for the actual and necessary Extra Expense you incur due to direct physical loss or damage at the described premises caused by or resulting from any Covered Cause of Loss to: (1) New buildings or structures, whether complete or under construction; (2) Alterations or additions to existing build- ings or structures; and (3) Machinery, equipment, supplies or build- ing materials located on or within 100 feet of the described premises and: (a) Used in the construction, alterations or additions; or (b) Incidental to the occupancy of new buildings. b. Civil Authority We will pay for the actual and necessary Extra Expense you incur caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property, other than at the described premises, caused by or re- sulting from any Covered Cause of Loss. This coverage will apply for a period of up to three consecutive weeks from the date of that action. CP 00 50 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 1 of 3 o c~ 4. Coverage Extension You may extend the insurance provided by this Coverage Part as follows: NEWLY ACQUIRED LOCATIONS a. You may extend your Extra Expense Cov- erage to apply to property at any location you acquire other than fairs or exhibitions. b. The most we will pay for loss under this Extension is $100,000 at each location. c. Insurance under this Extension for each newly acquired location will end when any of the following first occurs: (1) This policy expires; (2) 30 days expire after you acquire the property; or (3) You notify us of how you want this cov- erage to apply to that location. We will charge you additional premium from the date you acquire the property. This Extension is additional insurance. B. Exclusions And Limitations See applicable Causes of Loss Form as shown in the Declarations. C. Limits Of Insurance The most we will pay for loss in anyone occur- rence is the applicable Limit of Insurance shown in the Declarations. The limit applicable to the Coverage Extension is in addition to the Limits of Insurance. Payments under the following Additional Cover- ages will not increase the applicable Limit of Insur- ance: 1. Alterations and New Buildings; or 2. Civil Authority. D. Loss Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions. 1. Appraisal If we and you disagree on the amount of loss, either may make written demand for an ap- praisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdic- tion. The appraisers will state separately the amount of loss. If they fail to agree, they will submit their differences to the umpire. A deci- sion agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and ( Page 2 of 3 b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 2. Duties If You Incur Extra Expense a. You must see that the following are done if you incur Extra Expense: (1) Notify the police if a law may have been broken. (2) Give us prompt notice of the direct physical loss or damage. Include a de- scription of the property involved. (3) As soon as possible, give us a descrip- tion of how, when, and where the direct physical loss or damage occurred. , (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Prop- erty, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasi- ble, set the damaged property aside and in the best possible order for examina- tion. (5) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of dam- aged and undamaged property for in- spection, testing and analysis, and per- mit us to make copies from your books and records. (6) Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. (7) Cooperate with us in the investigation or settlement of the claim. (8) If you intend to continue your business, you must resume all or part of your "op- erations" as quickly as possible. b. We may examine any insured under oath, while not in the presence of any other in- sured and at such times as may be rea- sonably required, about any matter relating to this insurance or the claim, including an insured's books and records. In the event of an examination, an insured's answers must be signed. Copyright, Insurance Services Office, Inc., 1999 o CP 00 50 10 00 3. Limits On Loss Payment We will not pay more for Extra Expense than the percentages shown in the Declarations times the Limit of Insurance. When the "period of restoration" is: a. 30 days or less, the first percentage applies. b. 60 days or less, but more than 30 days, the second percentage applies. c. More than 60 days, the third percentage applies. Example: The Limit of Insurance is $ 100,000 The percentages shown in the Declara- tions are 40%-80%-100% The "period of restoration" ~ ~~ys The amount of Extra Expenses incurred is $ 90,000 ( We will not pay more than $100,000 times 80% (the percentage applicable for a "period of restoration" of 31-60 days), or $80,000. The remaining $10,000 is not covered. 4. Loss Determination a. The amount of Extra Expense will be de- termined based on: (1) All expenses that exceed the normal operating expenses that would have been incurred by "operations" during the "period of restoration" if no direct physi- cal loss or damage had occurred. We will deduct from the total of such ex- penses: (a) The salvage value that remains of any property bought for temporary use during the "period of restoration", once "operations" are resumed; and (b) Any Extra Expense that is paid for by other insurance, except for insurance that is written subject to the same plan, terms, conditions and provi- sions as this insurance; and (2) All necessary expenses that reduce the Extra Expense otherwise incurred. b. We will reduce the amount of your Extra Expense loss to the extent you can return "operations" to normal and discontinue such Extra Expense. ( c. If you do not resume "operations", or do not resume "operations" as quickly as possible, we will pay based on the length of time it would have taken to resume "operations" as quickly as possible. 5. Loss Payment We will pay for any loss within 30 days after we receive the proof of loss, if you have complied with all of the terms of this Coverage Part and: a. We reach agreement with you on the amount of loss; or b. An appraisal award has been made. E. Definitions 1. "Operations" means your business activities occurring at the described premises. 2. "Period of Restoration" means the period of time that: a. Begins with the date of direct physical loss or damage caused by or resulting from any Covered Cause of Loss at the described premises; and b. Ends on the earlier of: (1) The date when the property at the de- scribed premises should be repaired, rebuilt or replaced with reasonable speed and similar quality; or (2) The date when business is resumed at a new permanent location. "Period of restoration" does not include any in- creased period required due to the enforce- ment of any ordinance or law that: (1) Regulates the construction, use or re- pair, or requires the tearing down of any property; or (2) Requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants". The expiration date of this policy will not cut short the "period of restoration". 3. "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 4. "Suspension" means the slowdown or cessa- tion of your business activities. CP 00 50 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 3 of 3 o COMMERCIAL PROPERTY CP 00 32 10 00 BUSINESS INCOME (WITHOUT EXTRA EXPENSE) COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section G. - Definitions. (- A. Coverage Coverage is provided as described below for one or more of the following options for which a Limit of Insurance is shown in the Declarations: (i) Business Income including "Rental Value". (Ii) Business Income other than "Rental Value". (iii) "Rental Value". If option (i) above is selected, the term Business Income will include "Rental Value". If option (iii) above is selected, the term Business Income will mean "Rental Value" only. If Limits of Insurance are shown under more than one of the above options, the provisions of this Coverage Part apply separately to each. We will pay for the actual loss of Business Income you sustain due to the necessary "suspension" of your "operations" during the "period of restoration". The "suspension" must be caused by direct physi- cal loss of or damage to property at premises which are described in the Declarations and for which a Business Income Limit of Insurance is shown in the Declarations. The loss or damage must be caused by or result from a Covered Cause of Loss. With respect to loss of or damage to personal property in the open or personal prop- erty in a vehicle, the described premises include the area within 100 feet of the site at which the de- scribed premises are located. With respect to the requirements set forth in the preceding paragraph, if you occupy only part of the site at which the described premises are located, your premises means: (i) The portion of the_building which you rent, lease or occupy; and (Ii) Any area within the building or on the site at which the described premises are located, if that area services, or is used to gain ac- cess to, the described premises. ( CP 00 32 10 00 1. Business Income Business Income means the: a. Net Income (Net Profit or Loss before in- come taxes) that would have been earned or incurred; and b. Continuing normal operating expenses incurred, including payroll. For manufacturing risks, Net Income includes the net sales value of production. 2. Covered Causes Of Loss See applicable Causes of Loss Form as shown in the Declarations. 3. Additional Coverages a. Expenses To Reduce Loss In the event of a covered loss of Business Income, we will pay necessary expenses you incur, except the cost of extinguishing a fire, to avoid further loss of Business In- come. The total of our payment for Busi- ness Income loss and Expenses to Reduce Loss will not be more than the Business In- come loss that would have been payable under this Coverage Form (after application of any Coinsurance penalty) if the Expenses to Reduce Loss had not been incurred. This coverage does not increase the Limit of In- surance. The Coinsurance condition does not apply specifically to such Expenses to Reduce Loss, but it is used as described above to determine the total amount payable. b. Civil Authority We will pay for the actual loss of Business Income you sustain caused by action of civil authority that prohibits access to the de- scribed premises due to direct physical loss of or damage to property, other than at the described premises, caused by or resulting from any Covered Cause of Loss. This cov- erage begins 72 hours after the time of that action, and will apply for a period of up to three consecutive weeks from the date on which the coverage begins. Copyright, Insurance Services Office, Inc., 1999 o Page 1 of 7 (~- c. Alterations And New Buildings We will pay for the actual loss of Business Income you sustain due to direct physical loss or damage at the described premises caused by or resulting from any Covered Cause of Loss to: (1) New buildings or structures, whether complete or under construction; (2) Alterations or additions to existing build- ings or structures; and (3) Machinery, equipment, supplies or build- ing materials located on or within 100 feet of the described premises and: (a) Used in the construction, alterations or additions; or (b) Incidental to the occupancy of new buildings. If such direct physical loss or damage de- lays the start of "operations", the "period of restoration" will begin on the date "opera- tions" would have begun if the direct physi- cal loss or damage had not occurred. d. Extended Business Income (1) Business Income Other Than "Rental Value" If the necessary "suspension" of your "operations" produces a Business In- come loss payable under this policy, we will pay for the actual loss of Business Income you incur during the period that: (a) Begins on the date property (except "finished stock") is actually repaired, rebuilt or replaced and "operations" are resumed; and (b) Ends on the earlier of: (i) The date you could restore your "operations", with reasonable speed, to the level which would generate the business income amount that would have existed if no direct physical loss or damage had occurred; or (ii) 30 consecutive days after the date determined in (1)(a) above. However, Extended Business Income does not apply to loss of Business In- come incurred as a result of unfavorable business conditions caused by the im- pact of the Covered Cause of Loss in the area where the described premises are located. ( Loss of Business Income must be caused by direct physical loss or dam- age at the described premises caused by or resulting from any Covered Cause of Loss. (2) "Rental Value" If the necessary "suspension" of your "operations" produces a "Rental Value" loss payable under this policy, we will pay for the actual loss of "Rental Value" you incur during the period that: (a) Begins on the date property is actu- ally repaired, rebuilt or replaced and tenantability is restored; and (b) Ends on the earlier of: (i) The date you could restore tenant occupancy, with reasonable speed, to the level which would generate the "Rental Value" that would have existed if no direct physical loss or damage had oc- curred; or (ii) 30 consecutive days after the date determined in (2)(a) above. However, Extended Business Income does not apply to loss of "Rental Value" incurred as a result of unfavorable busi- ness conditions caused by the impact of the Covered Cause of Loss in the area where the described premises are lo- cated. Loss of "Rental Value" must be caused by direct physical loss or damage at the described premises caused by or result- ing from any Covered Cause of Loss. 4. Coverage Extension If a Coinsurance percentage of 50% or more is shown in the Declarations, you may extend the insurance provided by this Coverage Part as follows: NEWLY ACQUIRED LOCATIONS a. You may extend your Business Income Coverage to apply to property at any loca- tion you acquire other than fairs or exhibi- tions. b. The most we will pay for loss under this Extension is $100,000 at each location. c. Insurance under this Extension for each newly acquired location will end when any of the following first occurs: (1) This policy expires; (2) 30 days expire after you acquire or begin to construct the property; or (3) You report values to us. Page 2 of 7 Copyright, Insurance Services Office, Inc., 1999 CP 00 32 10 00 o ( We will charge you additional premium for values reported from the date you acquire the property. This Extension is additional insurance. The Additional Condition, Coinsurance, does not apply to this Extension. B. Exclusions And Limitations See applicable Causes of Loss Form as shown in the Declarations. C. Limits Of Insurance The most we will pay for loss in anyone occur- rence is the applicable Limit of Insurance shown in the Declarations. The limit applicable to the Coverage Extension is in addition to the Limit of Insurance. Payments under the following Additional Cover- ages will not increase the applicable Limit of Insur- ance: 1. Alterations and New Buildings; 2. Civil Authority; 3. Extended Business Income; 4. Expenses to Reduce Loss. D. Loss Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions. 1. Appraisal If we and you disagree on the amount of Net Income and operating expense or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdic- tion. The appraisers will state separately the amount of Net Income and operating expense or amount of loss. If they fail to agree, they will submit their differences to the umpire. A deci- sion agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 2. Duties In The Event Of Loss a. You must see that the following are done in the event of loss: (1) Notify the police if a law may have been broken. ( (2) Give us prompt notice of the direct physical loss or damage. Include a de- scription of the property involved. (3) As soon as possible, give us a descrip- tion of how, when, and where the direct physical loss or damage occurred. (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Prop- erty, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasi- ble, set the damaged property aside and in the best possible order for examina- tion. (5) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of dam- aged and undamaged property for in- spection, testing and analysis, and per- mit us to make copies from your books and records. (6) Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. (7) Cooperate with us in the investigation or settlement of the claim. (8) If you intend to continue your business, you must resume all or part of your "op- erations" as quickly as possible. b. We may examine any insured under oath, while not in the presence of any other in- sured and at such times as may be rea- sonably required, about any matter relating to this insurance or the claim, including an insured's books and records. In the event of an examination, an insured's answers must be signed. 3. Limitation - Electronic Media And Records We will not pay for any loss of Business In- come caused by direct physical loss of or dam- age to Electronic Media and Records after the longer of: a. 60 consecutive days from the date of direct physical loss or damage; or CP 00 3210 00 Copyright, Insurance Services Office, Inc., 1999 Page 3 of 7 o -~"'" r. .~~!,. , > ,,' ( b. The period, beginning with the date of direct physical loss or damage, necessary to re- pair, rebuild or replace, with reasonable speed and similar quality, other property at the described premises due to loss or dam- age caused by the same occurrence. Electronic Media and Records are: (1) Electronic data processing, recording or storage media such as films, tapes, discs, drums or cells; (2) Data stored on such media; or (3) Programming records used for elec- tronic data processing or electronically controlled equipment. Example No.1: A Covered Cause of Loss damages a com- puter on June 1. It takes until September 1 to replace the computer, and until October 1 to restore the data that was lost when the damage occurred. We will only pay for the Business Income loss sustained during the period June 1 - September 1. Loss during the period September 2 - October 1 is not covered. Example No.2: A Covered Cause of Loss results in the loss of data processing programming records on August 1. The records are replaced on Oc- tober 15. We will only pay for the Business Income loss sustained during the period August 1 - September 29 (60 consecutive days). Loss during the period September 30 - October 15 is not covered. 4. Loss Determination a. The amount of Business Income loss will be determined based on: (1) The Net Income of the business before the direct physical loss or damage oc- curred; (2) The likely Net Income of the business if no physical loss or damage had oc- curred, but not including any Net Income that would likely have been earned as a result of an increase in the volume of business due to favorable business con- ditions caused by the impact of the Cov- ered Cause of Loss on customers or on other businesses; (3) The operating expenses, including pay- roll expenses, necessary to resume "op- erations" with the same quality of service that existed just before the direct physi- calloss or damage; and ( ( (4) Other relevant sources of information, including: (a) Your financial records and account- ing procedures; (b) Bills, invoices and other vouchers; and (c) Deeds, liens or contracts. b. Resumption Of Operations We will reduce the amount of your Business Income loss to the extent you can resume your "operations", in whole or in part, by us- ing damaged or undamaged property (in- cluding merchandise or stock) at the de- scribed premises or elsewhere. c. If you do not resume "operations", or do not resume "operations" as quickly as possible, we will pay based on the length of time it would have taken to resume "operations" as quickly as possible. 5. Loss Payment We will pay for covered loss within 30 days af- ter we receive the sworn proof of loss, if you have complied with all of the terms of this Cov- erage Part and: a. We have reached agreement with you on the amount of loss; or b. An appraisal award has been made. E. Additional Condition COINSURANCE If a Coinsurance percentage is shown in the Dec- larations, the following condition applies in addition to the Common Policy Conditions and the Com- mercial Property Conditions. We will not pay the full amount of any loss if the Limit of Insurance for Business Income is less than: a. The Coinsurance percentage shown for Business Income in the Declarations; times b. The sum of: (1) The Net Income (Net Profit or Loss before income taxes), and (2) Operating expenses, including payroll expenses, that would have been earned or incurred (had no loss occurred) by your "operations" at the described premises for the 12 months following the inception, or last pre- vious anniversary date, of this policy (whichever is later). Page 4 of 7 Copyright, Insurance Services Office, Inc., 1999 o CP 00 32 10 00 (- Instead, we will determine the most we will pay us- ing the following steps: 1. Multiply the Net Income and operating expense for the 12 months following the inception, or last previous anniversary date, of this policy by the Coinsurance percentage; 2. Divide the Limit of Insurance for the described premises by the figure determined in Step 1; and 3. Multiply the total amount of loss by the figure determined in Step 2. We will pay the amount determined in Step 3 or the limit of insurance, whichever is less. For the remainder, you will either have to rely on other in- surance or absorb the loss yourself. In determining operating expenses for the purpose of applying the Coinsurance condition, the follow- ing expenses, if applicable, shall be deducted from the total of all operating expenses: 1. Prepaid freight - outgoing; 2. Returns and allowances; 3. Discounts; - 4. Bad debts; 5. Collection expenses; 6. Cost of raw stock and factory supplies con- sumed (including transportation charges); 7. Cost of merchandise sold (including transporta- tion charges); 8. Cost of other supplies consumed (including transportation charges); 9. Cost of services purchased from outsiders (not employees) to resell, that do not continue under contract; 10. Power, heat and refrigeration expenses that do not continue under contract (if Form CP 15 11 is attached); 11. All ordinary payroll expenses or the amount of payroll expense excluded (if Form CP 15 10 is attached); and 12. Special deductions for mining properties (royal- ties unless specifically included in coverage; actual depletion commonly known as unit or cost depletion - not percentage depletion; wel- fare and retirement fund charges based on tonnage; hired trucks). ( Example, No.1 (Underinsurance): When: The Net Income and operating expenses for the 12 months following the inception, or last previous anniversary date, of this policy at the described premises would have been $400,000 The Coinsurance percentage is 50% The Limit of Insurance is $150,000 The amount of loss is $ 80,000 Step 1: $400,000 x 50% = $200,000 (the mini- mum amount of insurance to meet your Coinsurance requirements) Step 2: $150,000 + $200,000 = .75 Step 3: $ 80,000 x .75 = $60,000 We will pay no more than $60,000. The remain- ing $20,000 is not covered. Example No.2 (Adequate Insurance): When: The Net Income and operating expenses for the 12 months following the inception, or last previous anniversary date, of this policy at the described premises would have been $400,000 The Coinsurance percentage is 50% The Limit of Insurance is $200,000 The amount of loss is $ 80,000 The minimum amount of insurance to meet your Coinsurance requirement is $200,000 ($400,000 x 50%). Therefore, the Limit of Insurance in this Ex- ample is adequate and no penalty applies. We will pay no more than $80,000 (amount of loss). F. Optional Coverages If shown as applicable in the Declarations, the fol- lowing Optional Coverages apply separately to each item. 1. Maximum Period Of Indemnity a. The Additional Condition, Coinsurance, does not apply to this Coverage Form at the described premises to which this Optional Coverage applies. b. The most we will pay for loss of Business Income is the lesser of: (1) The amount of loss sustained during the 120 days immediately following the be- ginning of the "period of restoration"; or (2) The Limit of Insurance shown in the Declarations. CP 00 32 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 5 of 7 o 2. Monthly Limit Of Indemnity a. The Additional Condition, Coinsurance, does not apply to this Coverage Form at the described premises to which this Optional Coverage applies. b. The most we will pay for loss of Business Income in each period of 30 consecutive days after the beginning of the "period of restoration" is: (1) The Limit of Insurance, multiplied by (2) The fraction shown in the Declarations for this Optional Coverage. Example When: The Limit of Insurance is The fraction shown in the Declarations for this Optional Coverage is The most we will pay for loss in each period of 30 consecutive days is: $120,000 x 1/4 = $30,000 If, in this example, the actual amount of loss is: Days 1-30 Days 31-60 Days 61-90 $120,000 1/4 c $40,000 20,000 30.000 $90,000 We will pay: Days 1-30 Days 31-60 Days 61-90 ( $30,000 20,000 30.000 $80,000 The remaining $10,000 is not covered. 3. Business Income Agreed Value a. To activate this Optional Coverage: (1) A Business Income ReportlWork Sheet must be submitted to us and must show financial data for your "operations": (a) During the 12 months prior to the date of the Work Sheet; and (b) Estimated for the 12 months imme- diately following the inception of this Optional Coverage. (2) The Declarations must indicate that the Business Income Agreed Value Optional Coverage applies, and an Agreed Value must be shown in the Declarations. The Agreed Value should be at least equal to: (a) The Coinsurance percentage shown in the Declarations; multiplied by (b) The amount of Net Income and op- erating expenses for the following 12 months you report on the Work Sheet. b. The Additional Condition, Coinsurance, is suspended until: (1) 12 months after the effective date of this Optional Coverage; or (2) The expiration date of this policy; whichever occurs first. c. We will reinstate the Additional Condition, Coinsurance, automatically if you do not submit a new Work Sheet and Agreed Value: (1) Within 12 months of the effective date of this Optional Coverage; or (2) When you request a change in your Business Income Limit of Insurance. d. If the Business Income Limit of Insurance is less than the Agreed Value, we will not pay more of any loss than the amount of loss multiplied by: (1) The Business Income Limit of Insur- ance; divided by (2) The Agreed Value. Example When: The Limit of Insurance is The Agreed Value is The amount of loss is $100,000 + $200,000 = .50 .50 x $80,000 = $40,000 $100,000 $200,000 $80,000 Step (a): Step (b): We will pay $40,000. The remaining $40,000 is not covered. 4. Extended Period Of Indemnity Under Paragraph A.3.d., Extended Business Income, the number "30" in Subparagraphs (1)(b) and (2)(b) is replaced by the number shown in the Declarations for this Optional Coverage. G. Definitions 1. "Finished Stock" means stock you have manu- factured. "Finished stock" also includes whiskey and al- coholic products being aged, unless there is a Coinsurance percentage shown for Business Income in the Declarations. "Finished stock" does not include stock you have manufactured that is held for sale on the premises of any retail outlet insured under this Coverage Part. Page 6 of 7 Copyright, Insurance Services Office, Inc., 1999 CP 00 32 1000 o 2. "Operations" means: a. Your business activities occurring at the described premises; and b. The tenantability of the described premises, if coverage for Business Income including "Rental Value" or "Rental Value" applies. 3. "Period of Restoration" means the period of time that: a. Begins 72 hours after the time of direct physical loss or damage caused by or re- sulting from any Covered Cause of Loss at the described premises; and b. Ends on the earlier of: (1) The date when the property at the de- scribed premises should be repaired, rebuilt or replaced with reasonable speed and similar quality; or (2) The date when business is resumed at a new permanent location. "Period of restoration" does not include any in- creased period required due to the enforce- ment of any ordinance or law that: (1) Regulates the construction, use or re- pair, or required the tearing down of any property; or c- ( (2) Requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants" . The expiration date of this policy will not cut short the "period of restoration". 4. "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 5. "Rental Value" means the: a. Total anticipated rental income from tenant occupancy of the premises described in the Declarations as furnished and equipped by you,and b. Amount of all charges which are the legal obligation of the tenant(s) and which would otherwise be your obligations, and c. Fair rental value of any portion of the de- scribed premises which is occupied by you. 6. "Suspension" means: a. The slowdown or cessation of your busi- ness activities; or b. That a part or all of the described premises is rendered untenantable, if coverage for Business Income including "Rental Value" or "Rental Value" applies. CP 00 3210 00 Copyright, Insurance Services Office, Inc., 1999 Page 7 of 7 o FLORIDA MUNICIPAL INSURANCE TRUST EQUIPMENT BREAKDOWN COVERAGE SCHEDULE COMMERCIAL PACKAGE POLICY Subject to any applicable limits on the Declarations of Building and Personal Property Coverage Form FMIT PROP DEC 1002, the Equipment Breakdown Limit is the most we will pay for loss or damage arising from anyone Accident. These coverages apply to all locations covered on the policy, unless otherwise specified. I. Coverages Limits Equipment Breakdown Limit Subject to the Real and Personal Property Limit described on FMIT PROP DEC 1002 or $50,000,000, whichever is less. Property Damage Included in above Business Income Not covered unless CP 00 32 10 00 (Business Income Coverage Form) is attached. If covered, then this schedule follows form. Extra Expense $50,000 per location to a maximum of $500,000 per member per occurrence Data Restoration $200,000 $100,000 $100,000 $100,000 $100,000 $200,000 Expediting Expense ( Hazardous Substances Spoilage Computer Equipment CFC Refrigerants Service Interruption Follows business income, extra expense, and spoilage limits as applicable. Demolition & Increased Cost of Construction $500,000 II. Deductibles Direct Coverages Subject to the Real and Personal Property deductible shown on FMIT PROP DEC 1002. Indirect Coverages Subject to the appropriate Time Element deductible shown on the FMIT PROP DEC 1002. III. Other Conditions Unless the interruption exceeds 24 hours, we will not pay for any loss under Service Interruption. ( "Covered equipmenf' does not include equipment primarily used to generate electric power, however, this exclusion does not apply to emergency generators. FMIT EBC 1002 Page 10f6 THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY. EQUIPMENT BREAKDOWN ENDORSEMENT This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CAUSES OF LOSS-BASIC FORM CAUSES OF LOSS--SPECIAL FORM A. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM is modified as follows: ADDITIONAL COVERAGES The following is added to 4. ADDITIONAL COVERAGES: Equipment Breakdown (1) We will pay for loss caused by or resulting from an "accidenr to "covered equipment." As used in this Additional Coverage, an "accidenr means direct physical loss as follows: (a) mechanical breakdown, including rupture or bursting caused by centrifugal force; (b) artificially generated electrical current, including electric arcing, that disturbs electrical devices, appliances or wires; (c) explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control; (d) loss or damage to steam boilers, steam pipes, steam engines or steam turbines caused by or resulting from any condition or event inside such equipment; or (e) loss or damage to hot water boilers or other water heating equipment caused by or resulting from any condition or event inside such boilers or equipment. ( (2) ( Unless otherwise shown in a Schedule, the following coverages also apply to loss caused by or resulting from an "accident" to "covered equipment." These coverages do not provide additional amounts of insurance. (a) Expediting Expenses With respect to your damaged Covered Property, we will pay, up to $200,000 unless otherwise shown in a Schedule, the reasonable extra cost to: (i) make temporary repairs; and (ii) expedite permanent repairs or permanent replacement. (b) Hazardous Substances We will pay for the additional cost to repair or replace Covered Property because of contamination by a "hazardous substance." This includes the additional costs to clean up or dispose of such property. Additional costs mean those beyond what would have been required had no "hazardous substance" been involved. The most we will pay for loss or damage under this coverage, including actual loss of Business Income you sustain, necessary Extra Expense you incur and loss under Spoilage coverage, if shown as covered, is $100,000 unless otherwise shown in a Schedule. (c) Spoilage (i) We will pay for your loss of "perishable goods" due to spoilage. (ii) We will also pay for your loss of "perishable goods" due to contamination from the release of refrigerant, including but not limited to ammonia. (iii) We will also pay any necessary expenses you incur to reduce the amount of loss under this coverage. We will pay for such expenses to the extent that they do not exceed the amount of loss that otherwise would have been payable under this coverage. FMIT EBC 1002 Page 2 of6 ( ( (3) f!"1 i ?,\~'1":', (d) (iv) If you are unable to replace the "perishable goods" before its anticipated sale, the amount of our payment will be determined on the basis of the sales price of the "perishable goods" at the time of the "accident," less discounts and expenses you otherwise would have had. Otherwise our payment will be determined in accordance with the Valuation condition. The most we will pay for loss or damage under this coverage is $100,000 unless otherwise shown in a Schedule. Computer Equipment We will pay for loss or damage caused by or resulting from an "accident" to "computer equipment." The most we will pay for loss or damage under this coverage, including actual loss of Business Income you sustain and necessary Extra Expense you incur, if shown as covered, is $100,000 unless otherwise shown in a Schedule. Computers used primarily to control or operate "covered equipment" are not subject to this limit. Data Restoration We will pay for your cost to research, replace and restore data, including programs and operating systems, that is lost or corrupted due to an "accident." The most we will pay for loss or damage under this coverage is $100,000 unless otherwise shown in a Schedule. CFC Refrigerants We will pay for the additional cost to repair or replace Covered Property because of the use or presence of a refrigerant containing CFC (chlorofluorocarbon) substances. This means the additional cost to do the least expensive of the following: (i) Repair the damaged property and replace any lost CFC refrigerant; (ii) Repair the damaged property, retrofit the system to accept a non-CFC refrigerant and charge the system with a non-CFC refrigerant; or (iii) Replace the system with one using a non-CFC refrigerant. Additional costs mean those beyond what would have been required had no CFC refrigerant been involved. The most we will pay for loss or damage under this coverage, including actual loss of Business Income you sustain, necessary Extra Expense you incur and loss under Spoilage coverage, if shown as covered, is $200,000 unless otherwise shown in a Schedule. Service Interruption Any insurance provided for Business Income, Extra Expense and Spoilage is extended to apply to loss caused by or resulting from an "accident" to equipment that is owned by a utility, landlord, or other supplier with whom you have a contract to provide you with any of the following services: electrical power, communications, waste disposal, air conditioning, refrigeration, heating, gas, air, water or steam. (e) (f) (g) CONDITIONS (a) Suspension When any "covered equipment" is found to be in, or exposed to a dangerous condition, any of our representatives may immediately suspend the insurance against loss from an "accident" to that "covered equipment." We can do this by mailing or delivering a written notice of suspension to your address as shown in the Declarations, or at the address where the equipment is located. Once suspended in this way, your insurance can be reinstated only by an endorsement for that "covered equipment." If we suspend your insurance, you will get a pro rata refund of premium. But the suspension will be effective even if we have not yet made or offered a refund. (b) Jurisdictional Inspections If any property that is "covered equipment" under this endorsement requires inspection to comply with state or municipal boiler and pressure vessel regulations, we agree to perform such inspection on your behalf. (c) Environmental, Safety and Efficiency Improvements If "covered equipmenf' requires replacement due to an "accident," we will pay your additional cost to replace with equipment that is better for the environment, safer or more efficient than the equipment being replaced. FMIT EBC 1002 Page 3 of6 ( (4) .( (d) FMIT EBC 1002 However, we will not pay more than 125% of what the cost would have been to repair or replace with like kind and quality. This condition does not increase any of the applicable limits. This condition does not apply to any property to which Actual Cash Value applies. Coinsurance If indicated in a Schedule, specified coverages may be subject to coinsurance. We will not pay for the full amount of your loss if the applicable limit is less than the product of the specified coinsurance percentage times the value of the property subject to the coverage at the time of the loss. Instead, we will determine what percentage this calculated product is compared to the applicable limit and apply that percentage to the gross amount of loss. We will then subtract the applicable Deductible. The resulting amount, or the applicable limit, is the most we will pay. We will not pay for the remainder of the loss. EXAMPLE 1 (Underinsurance) When: The value of "perishable goods" at the location of loss at the time of the "accidenr is $200,000. The Spoilage Limit is $100,000 @ 80% Coinsurance. The actual loss under Spoilage Coverage resulting from the "accidenr is $40,000. The Spoilage Deductible is $5,000. Step 1: $200,000 X 80% = $160,000 Step 2: $100,000/$160,000 = .625 Step 3: $40,000 x.625 = $25,000 Step 4: $25,000 - $5,000 = $20,000 The total Spoilage loss recovery, after deductible, would be $20,000. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. EXAMPLE 2 (Adequate insurance) When: The value of "perishable goods" at the location of loss at the time of the "accidenr is $100,000. The Spoilage Limit is $100,000 @ 80% Coinsurance. The actual loss under Spoilage Coverage resulting from the "accidenr is $40,000. The Spoilage Deductible is $5,000. Step 1: $100,000 X 80% = $80,000 Step 2: $100,000/$80,000 = 1.25 Coinsurance does not apply. Step 3: $40,000 - $5,000 = $35,000 The total Spoilage loss recovery, after deductible, would be $35,000. DEDUCTIBLE The deductible in the Declarations applies unless a separate Equipment Breakdown deductible is shown in a Schedule. If a separate Equipment Breakdown deductible is shown, the following applies. Only as regards Equipment Breakdown Coverage, provision D. DEDUCTIBLE is deleted and replaced with the following: If deductibles vary by type of "covered equipmenr and more than one type of equipment is involved in any "one accident," the highest deductibles will apply. (a) Direct and Indirect Coverages Unless otherwise shown in the Schedule, the Direct Coverages Deductibles apply to all loss or damage covered by this endorsement, with the exception of those coverages subject to the Indirect Coverages Deductibles as noted below. Unless more specifically indicated in the Schedule, the Indirect Coverages Deductibles apply to Business Income and Extra Expense. (b) Application of Deductibles (i) Dollar Deductibles We will not pay for loss or damage resulting from any "one accidenr until the amount of loss or damage exceeds the applicable Deductible shown in the Schedule. We will then pay the amount of loss or damage in excess of the applicable Deductible, up to the applicable Limit of Insurance, after any deduction required by the Coinsurance condition or the Agreed Value Optional Coverage. (ii) Time Deductible Page 4 of6 If a time deductible is shown in the Schedule, we will not be liable for any loss occurring during the specified number of hours or days immediately following the "accident." If a time deductible is expressed in days, each day shall mean twenty- four consecutive hours. (iii) Multiple of Average Daily Value (ADV) If a deductible is expressed as a number times ADV, that amount will be calculated as follows: The ADV (Average Daily Value) will be the Business Income (as defined in any Business Income coverage that is part of this policy) that would have been earned had no "accidenr occurred during the period of interruption of business divided by the number of working days in that period. No reduction shall be made for the Business Income not being earned, or in the number of working days, because of the "accidenf' or any other scheduled or unscheduled shutdowns during the period of interruption. The ADV applies to all locations included in the valuation of the loss. The number indicated in the Schedule shall be multiplied by the ADV as determined above. The result shall be used as the applicable deductible. (iv) Percentage of Loss Deductibles If a deductible is expressed as a percentage of loss, we will not be liable for the indicated percentage of the gross amount of loss or damage (prior to any applicable deductible or coinsurance) insured under the applicable coverage. If the dollar amount of such percentage is less than the indicated minimum deductible, the minimum deductible will be the applicable deductible. (5) DEFINITIONS (a) "Boilers and Vessels" means: ( ( FMIT EBC 1002 (i) (ii) Any boiler, including attached steam, condensate and feedwater piping; and Any fired or unfired pressure vessel subject to vacuum or internal pressure other than the static pressure of its contents. This term does not appear elsewhere in this endorsement, but may appear in a Schedule. "Computer equipmenr means Covered Property that is electronic computer or other data processing equipment, including "media" and peripherals used in conjunction with such equipment. "Covered equipment," unless otherwise specified in a Schedule, means Covered Property built to operate under vacuum or pressure, other than weight of contents, or used for the generation, transmission or utilization of energy. "Hazardous substance" means any substance other than ammonia that has been declared to be hazardous to health by a governmental agency. "Media" means all forms of electronic, magnetic and optical tapes and discs for use in any electronic computer or electronic data processing equipment. "One accidenr means: If an initial "accidenr causes other "accidents," all will be considered "one accident." All "accidents" that are the result of the same event will be considered "one accident." "Perishable Goods" means personal property maintained under controlled conditions for its preservation, and susceptible to loss or damage if the controlled conditions change. "Production Machinery" means any machine or apparatus that processes or produces a product intended for eventual sale. However, "production machinery" does not mean any fired or unfired pressure vessel other than a cylinder containing a movable plunger or piston. This term does not appear elsewhere in this endorsement, but may appear in a Schedule. (b) (c) (d) (e) (f) (g) (h) Page 5of6 B. THE CAUSES OF LOSS - BASIC FORM or SPECIAL FORM is modified as follows: (1 ) (2) (3) ( ( \ (4) All exclusions and limitations apply except: (a) In the Causes of Loss-- Special Form: (i) Exclusions B.2.a., B.2.d.(6) and B.2.e.; and (ii) Limitations C.1.a. and C.1.b. (b) In the Causes of Loss-- Basic Form: Exclusions B.2.a., B.2.d. and B.2.e. The exclusions are modified as follows: (a) If the Causes of Loss - Basic Form applies, the following is added to Exclusion B.2.: Depletion, deterioration, corrosion, erosion, wear and tear, or other gradually developing conditions. But if loss or damage from an "accident" results, we will pay for that resulting loss or damage. (b) The following is added to Exclusion B.1.g.(1): However, if electrical "covered equipmenf' requires drying out because of the above, we will pay for the direct expenses of such drying out subject to the applicable Limit of Insurance and deductible for Building or Business Personal Property, whichever applies. (c) If the Causes of Loss-Special Form applies, as respects this endorsement only, the last paragraph of Exclusion B.2.d. is deleted and replaced with the following: But if an excluded cause of loss that is listed in 2.d.(1) through (7) results in an "accident," we will pay for the loss or damage caused by that "accident." None of the following is "covered equipment": (a) structure, foundation, cabinet, compartment or air supported structure or building; (b) insulating or refractory material; (c) sewer piping, underground vessels or piping, or piping forming a part of a sprinkler system; (d) water piping other than boiler feedwater piping, boiler condensate return piping or water piping forming a part of a refrigerating or air conditioning system; (e) vehicle, aircraft, floating vessel or any equipment mounted on such vehicle, aircraft or floating vessel. However, any property that is stationary, permanently installed at a covered location and that receives electrical power from an external power supplier will not be considered a vehicle, aircraft or floating vessel; (f) dragline, excavation or construction equipment; or (g) equipment manufactured by you for sale. We will not pay under this endorsement for loss or damage caused by or resulting from: (a) your failure to use all reasonable means to protect the "perishable goods" from damage following an "accidenf'; (b) any defect, virus, loss of data or other situation within "media." But if loss or damage from an "accident" results, we will pay for that resulting loss or damage; or (c) any of the following tests: a hydrostatic, pneumatic or gas pressure test of any boiler or pressure vessel; or an insulation breakdown test of any type of electrical equipment. With respect to Service Interruption coverage and, if shown as covered, Spoilage coverage, we will also not pay for loss or damage caused by or resulting from: fire; lightning; windstorm or hail; explosion (except for steam or centrifugal explosion); smoke; aircraft or vehicles; riot or civil commotion; vandalism; sprinkler leakage; falling objects; weight of snow, ice or sleet; freezing or collapse. With respect to Service Interruption coverage and, if shown as covered, Business Income and Extra Expense coverages, we will also not pay for delay in resuming operations due to the need to reconstruct or rein put data or programs on "media." (5) (6) The most we will pay for loss or damage under this endorsement is the applicable Limit of Insurance shown in the Declarations. Coverage provided under this endorsement does not provide an additional amount of insurance. FMIT ESC 1002 Page 6of6 '1ti,'d "~:i''{~?J~~'f;:\~'", ( INLAND MARINE FLOATER Various provisions in this Agreement restrict coverage. Read the entire Agreement carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and ''your" refer to the Designated Member shown in the Declarations. The words "we," "us," and "our" refer to the Company providing this insurance. A. COVERAGE We will pay for direct physical loss of or damage only to Covered Property, which is described in the schedule and for which a Limit of Insurance is shown, except those Causes of Loss listed in the Exclusions. 1. Covered Property. Covered property as used in this Coverage Part, means the following types of property for which a limit is shown: a) Miscellaneous Equipment, b) Antiques and Objects of Art. 2. Property Not Covered. ( a) b) c) d) e) f) Property that you rent or lease to others; Property that is waterbome except scheduled watercraft and accessories; Property that is or will be a permanent part of a building or structure; Self-propelled vehicles that are designed for highway use; Aircraft; . Contraband or property in the course of illegal transportation or trade. B. EXCLUSIONS 1. We will not pay for a "loss" caused directly or indirectly by any of the following. Such "loss" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss." a) Earth Movement Any earth movement (other than sinkhole collapse) such as an earthquake, landslide, mine subsidence or earth sinking, rising or shifting. We will pay for loss or damage by fire or explosion. b) Govemmental Action Seizure or destruction of property by order of governmental authority. But we will pay for acts of destruction ordered by govemmental authority and taken at the time of a fire to prevent its spread will be paid for if the fire would be covered under this Coverage Part. ( FMIT PROP 02 1002 Page 1 of4 c) Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. We will pay for loss or damage caused by fire. d) War and Military Action 1) War, including undeclared or civil war; 2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any govemment, sovereign or other authority using military personnel or other agents; or 3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 2. We will not pay for loss or damage caused by or resulting from any of the following: a) Artificially generated electric current, including electric arcing, that disturbs electrical devices, appliances or wires. b) But if loss or damage by fire results, we will pay for that resulting loss or damage. ( 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Wear and tear; Rust, corrosion, fungus, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; Smog; Settling, cracking, shrinking or expansion; Animals and vermin, including animals, birds and fish and vermin such as moths, mice and insects; Mechanical breakdown, including rupture or bursting caused by centrifugal force; Dampness or dryness of atmosphere; Changes in or extremes of temperature; Marring, scratching, pitting, or other affects of normal use; or Erosion, dry rot, or mold. c) Explosion of steam boilers, steam pipes, steam engines, or steam turbines owned or leased by you, or operated under your control. We will pay for resulting loss or damage if loss or damage by fire or combustion explosion results. We will also pay for loss or damage caused by or resulting from the explosion of gases or fuel within the furnace of any fired vessel or within the flues or passages through which the gases of combustion pass. d) Dishonest or criminal acts by you, any of your partners, employees, directors, trustees, authorized representatives, or anyone to whom you entrust the property for any purpose; acting alone or in collusion with others; whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction by your employees. Theft by employees is not covered. ( Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. FMIT PROP 02 1002 Page 2 of4 '.'.'--::!'~'1<,''''t',~"::\-''7 m':~f~-~\"-~? ( ~ e) Rain, snow, ice or sleet to covered property in the open. f) Neglect. You must take all reasonable steps to protect your property when it is threatened with loss or damage. After a loss, you must also take all reasonable steps to protect your property from further loss or damage. If you fail to do so, we won't cover any loss that results from your "neglect." g) Property being worked on. We won't cover loss or damage to "personal property" that is being worked on, altered or repaired if the loss or damage is the direct result of the work that is being performed. h) Pollution and Contamination. We won't cover loss or damage caused by or resulting from the release, discharge or dispersal of "pollutants" unless the release, discharge or dispersal is itself caused by fire, lighting, windstorm or hail, "explosion", riot or civil commotion, vehicles or aircraft, vandalism and malicious mischief, "sprinkler leakage", water damage, freezing, collapse of a building, rain or snow, or falling objects. But if loss or damage results, we will pay for resulting damage caused by a cause of loss specified above. i) Glass breakage and surface damage. We will not cover breakage of glass or other fragile property or any loss or damage from chipping, marring, breaking, cracking or scratching. However, we will cover: c- 1) 2) 3) Breakage of lenses or scientific instruments; Breakage or damage to cameras, musical instruments and stained glass; and Breaking, chipping, marring or scratching caused directly by fire, lightning, windstorm, "explosion," aircraft, strike, riot and civil commotion, vandalism or malicious mischief, "flooding," "theft" or attempted "theft," collapse of a building or other structure or an "accident" to a vehicle carrying the Covered Property . j) Antiques and Fine Arts. We will not cover any property which has been removed or on joint account with or belonging to others for which you may be liable in the event of loss or damage while on your premises, in transit or on exhibition. k) Mysterious Disappearance. We will not cover losses caused by or resulting from the mysterious disappearance of property or an inventory shortage. C. LIMITS OF INSURANCE The most we will pay for loss or damage in anyone occurrence is the applicable Limit of Insurance shown in the schedule. If the schedule shows a coverage limit for one item, the limit shown is agreed to be the value of the item and the most we will pay if the item is lost or totally destroyed. We will also pay reasonable expenses you incur in removing the damaged Covered Property if debris removal is necessary after a "Covered Cause of Loss." ( FMIT PROP 021002 Page 3 of4 ';!'i!; ~,fI"F'" ,< '7';t tq!"ii!~liw "',,:, The most we will pay for debris removal is 25% of the amount we pay for direct loss or damage to Covered Property before the application of any deductible. And payment of debris removal will not increase the applicable coverage limit. D. DEDUCTIBLE We will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds the Deductible shown in the Declarations. We will then pay the amount of loss or damage in excess of the Deductible, up to the applicable Limit of Insurance. E. ADDITIONAL CONDITIONS 1. Newly Acquired Special Property. If you acquire any additional special property of the kind already described in the Declarations for this Policy, we will automatically cover that property for up to $10,000. We will cover the additional items for up to 30 days after you acquire them or until the policy ends, whichever is sooner. You agree to notify us as soon as possible of the value of the additional items and pay an additional premium from the date you acquire them. 2. Policy Period, Coverage Territory. Under this Coverage Part: a) We cover loss or damage commencing: ( 1) 2) During the policy period shown in the Declarations; and Within the coverage territory. b) The coverage territory is: 1) The United States of America (including its territories and possessions); 2) Puerto Rico; and 3) Canada. ( FMIT PROP 021002 Page 4 of 4 COMMERCIAL INLAND MARINE CM 00 01 09 00 COMMERCIAL INLAND MARINE CONDITIONS The following conditions apply in addition to the Common Policy Conditions and applicable Additional Conditions in Commercial Inland Marine Coverage Forms: LOSS CONDITIONS A. Abandonment There can be no abandonment of any property to us. ( B. Appraisal If we and you disagree on the value of the property or the amount of 1055, either may make written demand for an appraisal of the 1055. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an um- pire. If they cannot agree, either may request that selection be made by a judge of a court having ju- risdiction. The appraisers will state separately the value of the property and amount of 1055. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: 1. Pay its chosen appraiser; and 2. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. C. Duties In The Event Of Loss You must see that the following are done in the event of 1055 or damage to Covered Property: 1. Notify the police if a law may have been bro- ken. 2. Give us prompt notice of the 1055 or damage. Include a description of the property involved. 3. As soon as possible, give us a description of how, when and where the 1055 or damage oc- curred. 4. Take all reasonable steps to protect the Cov- ered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent 1055 or damage resulting from a cause of 1055 that is not a Covered Cause of Loss. Also, if feasible, set the dam- aged property aside and in the best possible order for examination. 5. You will not, except at your own cost, voluntarily make a payment, assume any obligation, or in- cur any expense without our consent. ( CM 00 01 09 00 6. As often as may be reasonably required, permit us to inspect the property proving the 1055 or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. 7. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured's books and re- cords. In the event of an examination, an in- sured's answers must be signed. 8. Send us a signed, sworn proof of 1055 contain- ing the information we request to settle the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. 9. Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or suit. 10. Cooperate with us in the investigation or set- tlement of the claim. D. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the 1055 or damage. E. Loss Payment 1. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. 2. We will not pay you more than your financial interest in the Covered Property. 3. We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claim against us for the owners' property. We will not pay the owners more than their financial interest in the Covered Property. 4. We may elect to defend you against suits aris- ing from claims of owners of property. We will do this at our expense. Copyright, Insurance Services Office, Inc., 1999 o Page 1 of 3 c- 5. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss if you have complied with all the terms of this Coverage Part and: a. We have reached agreement with you on the amount of the loss; or b. An appraisal award has been made. 6. We will not be liable for any part of a loss that has been paid or made good by others. F. Other Insurance 1. You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Cover- age Part bears to the Limits of Insurance of all insurance covering on the same basis. 2. If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of cov- ered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. G. Pair, Sets Or Parts 1. Pair Or Set In case of loss or damage to any part of a pair or set we may: a. Repair or replace any part to restore the pair or set to its value before the loss or damage; or b. Pay the difference between the value of the pair or set before and after the loss or dam- age. 2. Parts In case of loss or damage to any part of Cov- ered Property consisting of several parts when complete, we will only pay for the value of the lost or damaged part. H. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, the property will be returned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the recov- ered property, subject to the Limit of Insurance. ( Page 2 of 3 "';T<1';'t':!'!I I. Reinstatement Of Limit After Loss The Limit of Insurance will not be reduced by the payment of any claim, except for total loss or dam- age of a scheduled item, in which event we will re- fund the unearned premium on that item. J. Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything neces- sary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered Property. 2. After a loss to your Covered Property only if, at time of loss, that party is one of the following: a. Someone insured by this insurance; or b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you. This will not restrict your insurance. GENERAL CONDITIONS A. Concealment, Misrepresentation Or Fraud This Coverage Part is void in any case of fraud, in- tentional concealment or misrepresentation of a material fact, by you or any other insured, at any time, concerning: 1. This Coverage Part; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this Coverage Part. B. Control Of Property Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at anyone or more locations will not affect cover- age at any location where, at the time of loss or damage, the breach of condition does not exist. C. Legal Action Against Us No one may bring a legal action against us under this Coverage Part unless: 1. There has been full compliance with all the terms of this Coverage Part; and 2. The action is brought within 2 years after you first have knowledge of the direct loss or dam- age. Copyright, Insurance Services Office, Inc., 1999 o CM 00 01 09 00 ~F~"-":;}_ D. No Benefit To Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. E. Policy Period We cover loss or damage commencing: 1. During the policy period shown in the Declara- tions; and 2. Within the coverage territory. F. Valuation The value of property will be the least of the follow- ing amounts: 1. The actual cash value of that property; ( ( " eM 00 01 09 00 2. The cost of reasonably restoring that property to its condition immediately before loss or damage; or 3. The cost of replacing that property with sub- stantially identical property. In the event of loss or damage, the value of prop- erty will be determined as of the time of loss or damage. Copyright, Insurance Services Office, Inc., 1999 o Page 3 of 3 COMMERCIAL INLAND MARINE CM 00 66 09 00 ACCOUNTS RECEIVABLE COVERAGE FORM c Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section E - Definitions. A. Coverage 1. We will pay: a. All amounts due from your customers that you are unable to collect; b. Interest charges on any loan required to offset amounts you are unable to collect pending our payment of these amounts; c. Collection expenses in excess of your nor- mal collection expenses that are made nec- essary by the loss or damage; and d. Other reasonable expenses that you incur to re-establish your records of accounts re- ceivable; that result from Covered Causes of Loss to your records of accounts receivable. 2. Property Not Covered Coverage does not apply to: a. Records of accounts receivable in storage away from the "premises" shown in the Declarations; or b. Contraband, or property in the course of illegal transportation or trade. 3. Covered Causes Of Loss Covered Causes of Loss means RISKS OF DIRECT PHYSICAL LOSS OR DAMAGE to your records of accounts receivable except those causes of loss listed in the Exclusions. ( CM 00 66 09 00 4. Additional Coverage - Collapse We will pay for direct loss or damage caused by or resulting from risks of direct physical loss or damage involving collapse of all or part of a building or structure caused by one or more of the following: a. Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riot; civil commo- tion; vandalism; leakage from fire extin- guishing equipment; sinkhole collapse; vol- canic action; breakage of building glass; falling objects; weight of snow, ice or sleet; water damage; earthquake; all only as in- sured against in this Coverage Form; b. Hidden decay; c. Hidden insect or vermin damage; d. Weight of people or 'personal property; e. Weight of rain that collects on a roof; f. Use of defective materials or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation. This Additional Coverage does not increase the Limits of Insurance provided in this Coverage Form. 5. Coverage Extension REMOVAL If you give us written notice within 10 days of removal of your records of accounts receivable because of imminent danger of loss or dam- age, we will pay for loss or damage while they are: a. At a safe place away from your "premises"; or b. Being taken to and returned from that place. This Coverage Extension is included within the Limit of Insurance applicable to the "premises" from which the records of accounts receivable are removed. B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes con- currently or in any sequence to the loss. Copyright, Insurance Services Office, Inc., 1999 o Page 1 of 4 ( - a. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction or- dered by governmental authority and taken at the time of a fire to prevent its spread if the fire would be covered under this Cover- age Form. b. Nuclear Hazard (1) Any weapon employing atomic fission or fusion; or (2) Nuclear reaction or radiation, or radioac- tive contamination from any other cause. But if nuclear reaction or radiation, or radioactive contamination results in fire, we will pay for the direct loss or damage caused by that fire if the fire would be covered under this Coverage Form. c. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, includ- ing action in hindering or defending against an actual or expected attack, by any government, sovereign or other au- thority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power or action taken by gov- ernmental authority in hindering or de- fending against any of these. Exclusions B.1.a. through B.1.c. apply whether or not the loss event results in widespread damage or affects a substantial area. 2. We will not pay for loss or damage caused by or resulting from any of the following: a. Delay, loss of use, loss of market or any other consequential loss. b. Dishonest or criminal act committed by: (1) You, any of your partners, employees, directors, trustees, or authorized repre- sentatives; (2) A manager or a member if you are a limited liability company; (3) Anyone else with an interest in the prop- erty, or their employees or authorized representatives; or ( Page 2 of 4 (4) Anyone else to whom the property is entrusted for any purpose. This exclusion applies whether or not such persons are acting alone or in collusion with other persons or such acts occur during the hours of employment. This exclusion does not apply to Covered Property that is entrusted to others who are carriers for hire or to acts of destruction by your employees. But theft by employees is not covered. c. Alteration, falsification, concealment or destruction of records of accounts receiv- able done to conceal the wrongful giving, taking or withholding of money, securities or other property. This exclusion applies only to the extent of the wrongful giving, taking or withholding. d. Bookkeeping, accounting or billing errors or omissions. e. Electrical or magnetic injury, disturbance or erasure of electronic recordings that is caused by or results from: (1) Programming errors or faulty machine instructions; (2) Faulty installation or maintenance of data processing equipment or compo- nent parts; (3) An occurrence that took place more than 100 feet from your "premises"; or (4) Interruption of electrical power supply, power surge, blackout or brownout if the cause of such occurrence took place more than 100 feet from your "prem- ises". But we will pay for direct loss or damage caused by lightning. f. Voluntary parting with any property by you or anyone entrusted with the property if in- duced to do so by any fraudulent scheme, trick, device or false pretense. g. Unauthorized instructions to transfer prop- erty to any person or to any place. h. Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. 3. We will not pay for loss or damage that re- quires any audit of records or any inventory computation to prove its factual existence. Copyright, Insurance Services Office, Inc., 1999 o eM 00 66 09 00 c - 4. We will not pay for 1055 or damage caused by or resulting from any of the following. But if 1055 or damage by a Covered Cause of Loss re- sults, we will pay for the 1055 or damage caused by that Covered Cause of Loss. a. Weather Conditions. But this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph 1. above to produce the 1055 or damage. b. Acts or decisions, including the failure to act or decide, of any person, group, organiza- tion or governmental body. c. Faulty, inadequate or defective: (1) Planning, zoning, development, survey- ing, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remod- eling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property wherever lo- cated. d. Collapse except as provided in the Addi- tional Coverage - Collapse Section of this Coverage Form. C. Limits Of Insurance The most we will pay for 1055 or damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations. D. Additional Conditions 1. Determination Of Receivables General Condition F. Valuation in the Com- merciallnland Marine Conditions is replaced by the following: a. If you cannot accurately establish the amount of accounts receivable outstanding as of the time of 1055 or damage, the follow- ing method will be used: (1) Determine the total of the average monthly amounts of accounts receivable for the 12 months immediately preceding the month in which the 1055 or damage occurs; and (2) Adjust that total for any normal fluctua- tions in the amount of accounts receiv- able for the month in which the 1055 or damage occurred or for any demon- strated variance from the average for that month. ( CM 00 66 09 00 b. The following will be deducted from the total amount of accounts receivable, however that amount is established: (1) The amount of the accounts for which there is no 1055 or damage; (2) The amount of the accounts that you are able to re-establish or collect; (3) An amount to allow for probable bad debts that you are normally unable to collect; and (4) All unearned interest and service charges. 2. Recoveries The following is added to Loss Condition H. Recovered Property in the Commercial Inland Marine Conditions: You will pay us the amount of all recoveries you receive for 1055 or damage paid by us. But any recoveries in excess of the amount we have paid belong to you. 3. The following conditions apply in addition to the Commercial Inland Marine Conditions and the Common Policy Conditions: a. Coverage Territory We cover records of accounts receivable: (1) Within your "premises"; and (2) Away from your "premises" while in transit or within premises of others if those premises are located or the transit is within: (a) The United States of America (including its territories and posses- sions ); "\ (b) Puerto Rico; and (c) Canada. b. Coinsurance If a Coinsurance percentage is shown in the Declarations, the following condition ap- plies. Copyright, Insurance Services Office, Inc., 1999 o Page 3 of 4 "':'F~,?'~ }~"l.~}'- We will not pay the full amount of any 1055 if the value of all accounts receivable, except those in transit, at the time of 1055 times the Coinsurance percentage shown for it in the Declarations is greater than the Limit of In- surance for Coverage Applicable at All Lo- cations. Instead, we will determine the most we will pay using the following steps: (1) Multiply the value of all accounts receiv- able, except those in transit, at the time of 1055 by the Coinsurance percentage; (2) Divide the Limit of Insurance for Cover- age Applicable at All Locations by the figure determined in Step (1); and (3) Multiply the total amount of 1055 by the figure determined in Step (2). l Page 4 of 4 We will pay the amount determined in Step (3) or the Limit of Insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the 1055 yourself. This condition will not apply to records of accounts receivable in transit, interest charges, excess collection expenses or ex- penses to re-establish your records of ac- counts receivable. c. Protection Of Records Whenever you are not open for business, and except while you are actually using the records, you must keep all records of ac- counts receivable in receptacles that are described in the Declarations. E. Definitions "Premises" means that interior portion of the build- ing at the address shown in the Declarations that you occupy for your business. Copyright, Insurance Services Office, Inc., 1999 o eM 00 66 09 00 COMMERCIAL INLAND MARINE CM 00 67 09 00 VALUABLE PAPERS AND RECORDS COVERAGE FORM (~- Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section F - Definitions. A. Coverage We will pay for direct physical loss of or damage to Covered Property from any.of the Covered Causes of Loss. 1. Covered Property, as used in this Coverage Form, means "valuable papers and records" that are your property or property of others in your care, custody or control. 2. Property Not Covered Covered Property does not include: a. Property not specifically declared and de- scribed in the Declarations if such property cannot be replaced with other property of like kind and quality; b. Property held as samples or for delivery after sale; c. Property in storage away from the "prem- ises" shown in the Declarations; or d. Contraband, or property in the course of illegal transportation or trade. 3. Covered Causes Of Loss Covered Causes of Loss means RISKS OF DIRECT PHYSICAL LOSS OR DAMAGE to Covered Property except those causes of loss listed in the Exclusions. ( CM 00 67 09 00 4. Additional Coverage - Collapse We will pay for direct loss or damage caused by or resulting from risks of direct physical loss or damage involving collapse of all or part of a building or structure caused by one or more of the following: a. Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riot; civil commo- tion; vandalism; leakage from fire extin- guishing equipment; sinkhole collapse; vol- canic action; breakage of building glass; falling objects; weight of snow, ice or sleet; water damage; earthquake; all only as in- sured against in this Coverage Form; b. Hidden decay; c. Hidden insect or vermin damage; d. Weight of people or personal property; e. Weight of rain that collects on a roof; f. Use of defective materials or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation. This Additional Coverage does not increase the Limits of Insurance provided in this Coverage Form. 5. Coverage Extensions a. Removal If you give us written notice within 10 days of removal of your "valuable papers and re- cords" because of imminent danger of loss or damage, we will pay for loss or damage while it is: (1) At a safe place away from your "prem- ises"; or (2) Being taken to and returned from that place. This Coverage Extension is included within the Limits of Insurance applicable to the "premises" from which the Covered Prop- erty is removed. Copyright, Insurance Services Office, Inc., 1999 o Page 1 of 4 ( - b. Away From Your Premises We will pay up to $5,000 for loss or damage to Covered Property while it is away from your "premises". But if a higher Limit of Insurance is speci- fied in the Declarations, the higher limit will apply. The limit for this Coverage Extension is ad- ditional insurance. B. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes con- currently or in any sequence to the loss. a. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction or- dered by governmental authority and taken at the time of a fire to prevent its spread if the fire would be covered under this Cover- age Form. b. Nuclear Hazard (1) Any weapon employing atomic fission or fusion; or (2) Nuclear reaction or radiation, or radioac- tive contamination from any other cause. But if nuclear reaction or radiation, or radioactive contamination results in fire, we will pay for the direct loss or damage caused by that fire if the fire would be covered under this Coverage Form. c. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, includ- ing action in hindering or defending against an actual or expected attack, by any government, sovereign or other au- thority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power or action taken by gov- ernmental authority in hindering or de- fending against any of these. ( Page 2 of 4 Exclusions B.1.a. through B.1.c. apply whether or not the loss event results in widespread damage or affects a substantial area. 2. We will not pay for loss or damage caused by or resulting from any of the following: a. Delay, loss of use, loss of market or any other consequential loss. b. Dishonest or criminal act committed by: (1) You, any of your partners, employees, directors, trustees, or authorized repre- sentatives; (2) A manager or a member if you are a limited liability company; (3) Anyone else with an interest in the prop- erty, or their employees or authorized representatives; or (4) Anyone else to whom the property is entrusted for any purpose. This exclusion applies whether or not such persons are acting alone or in collusion with other persons or such acts occur during the hours of employment. This exclusion does not apply to Covered Property that is entrusted to others who are carriers for hire or to acts of destruction by your employees. But theft by employees is not covered. c. Errors or omissions in processing or copy- ing. But we will pay for direct loss or damage caused by resulting fire or explosion if these causes of loss would be covered by this Coverage Form. d. Electrical or magnetic injury, disturbance or erasure of electronic recordings. But we will pay for direct loss or damage caused by lightning. e. Voluntary parting with any property by you or anyone entrusted with the property if in- duced to do so by any fraudulent scheme, trick, device or false pretense. f. Unauthorized instructions to transfer prop- erty to any person or to any place. g. Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. Copyright, Insurance Services Office, Inc., 1999 o eM 00 67 09 00 { 3. We will not pay for loss or damage caused by or resulting from any of the following. But if loss or damage by a Covered Cause of Loss re- sults, we will pay for the loss or damage caused by that Covered Cause of Loss. a. Weather Conditions. But this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph 1. above to produce the loss or damage. b. Acts or decisions, including the failure to act or decide, of any person, group, organiza- tion or governmental body. c. Faulty, inadequate or defective: (1) Planning, zoning, development, survey- ing, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remod- eling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property wherever lo- cated. d. Collapse except as provided in the Addi- tional Coverage - Collapse Section of this Coverage Form. e. Wear and tear, any quality in the property that causes it to damage or destroy itself, gradual deterioration; insects, vermin or ro- dents. C. Limits Of Insurance The most we will pay for loss or damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations. D. Deductible We will not pay for loss or damage in anyone oc- currence until the amount of the adjusted loss or damage before applying the applicable Limits of Insurance exceeds the Deductible shown in the Declarations. We will then pay the amount of the adjusted loss or damage in excess of the Deducti- ble, up to the applicable Limit of Insurance. E. Additional Conditions 1. Valuation - Specifically Declared Items The following is added to General Condition F. Valuation in the Commercial Inland Marine Conditions: The value of each item of property that is spe- cifically declared and described in the Declara- tions is the applicable Limit of Insurance shown in the Declarations for that item. (~ ( 2. Recoveries The following is added to Loss Condition H. Recovered Property in the Commercial Inland Marine Conditions: If either you or we recover any property atter loss settlement, that party must give the other prompt notice. At your option, the property will be returned to you. If so, your loss or damage will be readjusted based on the amount you re- ceived for the property recovered, with allow- ance for recovery expenses incurred. 3. The following conditions apply in addition to the Commercial Inland Marine Conditions and the Common Policy Conditions: a. Coverage Territory We cover property: (1) Within your "premises"; and (2) Away from your "premises" while i~ transit or within premises of others If those premises are located or the transit is within: (a) The United States of America (including its territories and posses- sions ); (b) Puerto Rico; and (c) Canada. b. Protection Of Records Whenever you are not open for business, and except while you are actually using the property, you must keep all "valuable pa- pers and records" in receptacles that are described in the Declarations. F. Definitions 1. "Valuable papers and records" means in- scribed, printed or written documents, manu- scripts or records, including abstracts, books, deeds, drawings, films, maps or mortgages. But "valuable papers and records" does not mean "money" or "securities", converted data, programs or instructions used in your data processing operations, including the materials on which the data is recorded. 2. "Premises" means that interior portion of the building at the address shown in the Declara- tions that you occupy for your business. 3. "Money" means: a. Currency, coins and bank notes whether or not in current use; and b. Travelers checks, register checks and money orders held for sale to the public. Page 3 of 4 o CM 00 67 09 00 Copyright, Insurance Services Office, Inc., 1999 ~)"'''::_~:-!'l!'"TT- ,-,,-;,-," .,.- 4. "Securities" means negotiable and non- negotiable instruments or contracts represent- ing either "money" or other property and in- cludes: a. Tokens, tickets, revenue and other stamps whether or not in current use; and b. Evidences of debt issued in connection with credit or charge cards, which cards are not of your own issue; but does not include "money". ( ( Page 4 of 4 Copyright, Insurance Services Office, Inc., 1999 eM 00 67 09 00 o PUBLIC EMPLOYEES BLANKET BOND The Trust, 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 Declarations, 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 Declarations applicable to this Insuring Agreement 1. Honesty Blanket Position Bond Coverage 2. Loss sustained by the Insured through any fraudulent or dishonest acts 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 Declarations 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 Declarations applicable to this Insuring Agreement 3. ( Faithful Performance Blanket Position Bond Coverage 4. Loss caused to the Insured through the failure of any Employee, 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 such Employees being the amount stated in the Declarations 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 predecessor in interest of the Insured which prior bond is terminated, canceled or allowed to expire as of the time of such substitution, the Trust 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 cancellation 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: FMIT PROP 05 1002 Page 1 of4 ( (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, conditions 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 Section 1. The following terms, as used in this Bond, shall have the respective meanings stated in this Section: ( "Employee" as used in Insuring Agreements 1 and 2 means a person while in the employ of the Insured during the Bond Period who is not required by law to give bond conditioned for the faithful performance of his duties and who is a member of the staff or personnel of the Insured, but does not mean any Treasurer, Finance Officer, or Tax Collector by whatever title known. "Employee" as used in Insuring Agreements 3 and 4 means a person while in the employ of the Insured during the Bond Period who is not required by law to furnish an Individual Bond to qualify for office and who is a member of the staff or personnel of the Insured but does not mean any Treasurer, Finance Officer, Law Enforcement Officer, or Tax Collector by whatever title known. Unidentifiable Employee Section 2. In case a loss is alleged to have been caused to the Insured through acts or defaults by an Employee covered under an applicable Insuring Agreement of this Bond, while such Insuring Agreement is in full force and effect and the Insured shall be unable to designate the specific Employee causing such loss, the Insured shall nevertheless have the benefit of such Insuring Agreement provided that the evidence submitted reasonably establishes that the loss was in fact caused by such Employee through such acts or defaults and provided, further, that regardless of the number of such Employees concerned or implicated in such loss, the aggregate liability of the Trust for any such loss shall not exceed the amount stated in the Declarations applicable to such Insuring Agreement. Exclusion ( Section 3. This Bond does not cover any loss sustained by, or caused to, the Insured under circumstances whereby and to the amount which the Obligee or the Insured voluntarily undertakes or is obligated by law to exonerate or indemnify any of the Employees against liability incurred by them in the performance of their duties. This bond does not cover damages for which the Insured is legally liable as a result of (a) the deprivation or violation of the civil rights of any person by an Employee; or (b) the tortious conduct of an Employee, except conversion of property of other parties held by the Insured in any capacity. FMIT PROP 05 1002 Page 2 of 4 The Trust shall not be liable under the Bond for loss sustained by any party other than the Insured as a result of any act or omission of an Employee whether or not such act or omission occurred in the performance of the duties by the Employee. Limits of Liability Section 4. Indemnification by the Trust for any loss under Insuring Agreement 1 or 3 shall not reduce the Trust's liability for other losses under the applicable Insuring Agreement, whenever sustained; provided, however, that the Trust's total liability under each such Insuring Agreement for any loss caused by any Employee or in which such Employee is concerned or implicated is limited to the applicable amount of indemnity specified in the Declarations. Indemnification by the Trust for any loss under Insuring Agreement 2 or 4 shall not reduce the Trust's liability for other losses under the applicable Insuring Agreement, whenever sustained; provided, however, the Trust's total liability under each such Insuring Agreement as to each Employee is limited to the applicable amount of indemnity specified in the Declarations. Regardless of the number of years this Bond shall continue in force and the number of premiums which shall be payable or paid, the limit of the Trust's liability as specified in the Declarations shall not be cumulative from year to year or period to period. Limit of Liability Under This Bond and Any Prior Bond ( Section 5. With respect to loss under Insuring Agreement 1 or 3 caused by any Employee or in which such Employee is concerned or implicated for which is chargeable to such Employee as provided in Section 2 of this Bond and with respect to loss under Insuring Agreement 2 or 4 caused by any Employee or which is chargeable to such Employee as provided in Section 2 of this Bond and with respect to loss under any Insuring Agreement which occurs partly during the Bond Period and partly during the period of other bonds issued by the Trust to the Insured or to any predecessor in interest of the Insured and terminated or cancelled or allowed to expire and in which the period specified therein for bringing suit, action or proceeding of any kind, or if no such period is specified therein, then within the period prescribed by the applicable statute of limitations, has not expired at the time such loss thereunder is discovered, the total liability of the Trust under this Bond and under such other bonds shall not exceed, in the aggregate, the amount carried under this applicable Insuring Agreement of this Bond on such loss or the amount available to the Insured under such other bonds, as limited by the terms and conditions thereof, for any such loss if the latter amount be larger. Deductibles Section 6. It is agreed that: (a) The Trust shall not be liable under Insuring Agreement 1 or 3 on account of loss through acts or defaults committed at any time, whether before or after this endorsement is effective, by any Employee or in which such Employee is concerned or implicated, unless the amount of such loss, after deducting the net amount of all reimbursement and recovery, including any cash deposit taken by the Insured, obtained or made by the Insured, other than from any bond or policy of insurance issued by a surety or insurance company and covering such loss, or by the Trust on account thereof prior to payment by the Trust of such loss, shall be in excess of SEE DECLARATIONS PAGE and then for such excess only, but in no event for more than the amount of insurance carried under Insuring Agreement 1 or 3 on such loss. (b) The Trust shall not be liable under Insuring Agreement 2 or 4 on account of loss through acts or defaults committed at any time, whether before or after this endorsement is effective, by any Employee, unless the amount of such loss, after deducting the net amount of all reimbursement and recovery, including any cash deposit taken by the Insured, obtained or made by the Insured, other than from any bond or policy of insurance issued by a surety or FMIT PROP 051002 Page 3 of 4 ~"Y:,? Y""I;J.,'.'~""'~~'-,, insurance company and covering such loss, or by the Trust on account thereof prior to payment by the Trust of such loss, shall be in excess of SEE DECLARATIONS PAGE and then for such excess only, but in no event for more than the amount of insurance carried on such Employee under Insuring Agreement 2 or 4. If more than one Employee is concemed or implicated in such loss, such deductible amount shall apply to each Employee so concerned or implicated. (c) In no event shall the Trust be liable under any Insuring Agreement, as modified by this endorsement, for more than the amount specified in the Declarations as applicable to such Insuring Agreement subject. (d) The Insured shall, within the time and in the manner prescribed in the Policy, give the Trust notice of any loss of the kind covered by Insuring Agreement 1, 2, 3, or 4, whether or not the Trust is liable therefor or for any part thereof, upon the request of the Trust shall file with it a brief statement giving the particulars concerning such loss. Cancellation Section 7. This Bond shall be deemed canceled as to any Employee: (a) Immediately upon discovery by the Obligee or the Insured of any act on the part of such Employee which would constitute a liability of the Trust under the applicable Insuring Agreement covering such Employee; (b) Upon the death, resignation or removal of such Employee; or (c) At 12:01 a.m. upon the effective date specified in a written notice mailed to the Obligee and the Insured. Such date shall be not less than thirty days after the date of mailing. The mailing by the Trust of notice as aforesaid to the Obligee and the Insured shall be sufficient proof of notice. Delivery of such written notice by the Trust shall be equivalent to mailing. ( This Bond may be canceled by the Obligee or the Insured by mailing to the Trust written notice stating when thereafter the cancellation shall be effective. This Bond maybe canceled by the Trust by mailing to the Obligee and the Insured written notice stating when, not less than thirty days thereafter, such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. Delivery of such written notice either by the Obligee or the Insured or by the Trust shall be equivalent to mailing. If the Obligee or the Insured cancels, earned premium shall be computed pro-rata. If the Trust cancels, earned premium shall be computed pro rata. Premium adjustments may be made at the time cancellation is effective or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. If any of the cancellation provisions set forth in either or both of the foregoing paragraphs of this Section are prohibited or made void by any law controlling the construction of this Bond, such provisions to the extent they are so prohibited or made void shall be deemed to be nullified and of no effect. Legal Proceedings ( Section 8. No suit, action or proceeding of any kind to recover on account of loss under this Bond shall be brought after the expiration of three years from the cancellation of this Bond as an entirety provided, however, that if such limitation for bringing suit, action or proceeding is prohibited or made void by any law controlling the construction of this Bond, such limitation shall be deemed to be amended so as to be equal to the minimum period of the limitation permitted by such law. FMIT PROP 051002 Page 4 of 4 FLORIDA MUNICIPAL INSURANCE TRUST WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE AGREEMENT DECLA RATIONS Agreement No.: FMIT #0648 I. DESIGNATED MEMBER: City of Winter Springs II. Government Description Municipality III. COVERAGE PERIOD From October 1, 2002 to October 1, 2003 12:01 A.M. Standard Time at the address of the Designated Member. IV. A. Wor~ers Compensation Insurance: Part One of the Agreement applies to the Workers Compensation Law of the state of Florida: ( B. Employers Liability Insurance: Part Two of the Agreement applies to work in each state listed in item IVA The limits of our liability under Part Two are: Bodily Injury by Accident$ 1,000,000 each accident Bodily Injury by Disease $ 1, 000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: if any D. This Agreement includes these endorsements and schedules: See Schedule D V. ESTIMATED ANNUAL PREMIUM Florida Municipal Insurance Trust (FMIT) Normal Premium $546,655 Expense Constant $200 Incentive Credit $142,214 Net Premium $404,641 Florida League of Cities Sponsored Insurance Programs Since 1977 THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS. TOGETHER VV1TH THE COMMON CONDITIONS. COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERE:O AGREEMENT. ( FMIT we DEC 1002 Page 1 of2 12/13/02 ( ( ~~CC:i-~_..~. FMIT WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGES October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List City of Winter Springs, FMIT #0648 Schedule D Form Number: FMIT IND 1002 FMIT WC EL 1002 WC 00 00 01 EXT FMIT we DEe 1002 Description: Indemnity Agreement Coverage Agreement Workers Compensation and Employers Liability Item 4 - Extension of Information Page Page 2 of2 FLORIDA MUNICIPAL INSURANCE TRUST INDEMNITY AGREEMENT THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own selection. These members of the Florida Municipal Insurance Trust, all local government entities, have organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained, which are given to and accepted by each member hereof to the other, the parties to this instrument covenant, stipulate and agree as follows: RESPONSIBILITIES OF MEMBER Each member of the Trust agrees to abide by the following rules and regulations: I. GENERAL CONDITIONS A. The member agrees the Board of Trustees, the governing body of the Trust, comprised entirely of local elected officials, will set up, operate and enforce its own administrative rules, regulations and by-laws as between the individual members of the Trust and shall otherwise direct the affairs of the Trust; B. The member and the Trust agree all members of the Trust hereby agree that the Board may admit as members of this Trust only acceptable employers in the state of Florida who have common governmental interest. The Board or its designee shall be sole judge of whether or not an applicant shall be admitted to membership; ( C. The member agrees to maintain a reasonable loss prevention program in order to provide the maximum in safety and lawful practices as such may relate to the potential liability assumed by the Trust under this Agreement or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement; D. The member agrees to provide immediate notification of such occurrence to the Trust in the event of an occurrence likely to give rise to a claim within the scope of this Agreement, or any other agreement, certificate, document or other instrument executed by the Trust and the member pursuant to this Agreement; E. The member agrees to promptly make all contributions for coverages arising under this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to this Agreement at the time and in the manner directed by the Board of Trustees. Said contributions may be reduced by any discount, participation credit, or other contribution reduction program established by the Board of Trustees; F. The member agrees in the event of payment of any loss by the Trust on behalf of the member, the Trust shall be subrogated to the extent of such payment to all the rights of the member against any party or other entity legally responsible for damages resulting from said loss, and in such event, the member hereby agrees, on behalf of itself, its officers, employees, and agents to execute and deliver such instruments and papers as is required, and do whatever else is reasonably necessary, to secure such right to the Trust, and to cooperate with and otherwise assist the Trust as may be necessary to effect any recovery sought by the Trust pursuant to such subrogated rights; FMIT IND 1002 Page 1 of4 ~---"--~"-',~' _..~.... ""~~'----'-'- ;:'.1' G. The member agrees the Board of Trustees, its Administrator, and any of their other agents, servants, employees or attorneys, shall be permitted at all reasonable times and upon reasonable notice to inspect the property, work places, plants, works, machinery and appliances covered pursuant to this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and shall be permitted at all reasonable times while the member participates in the Trust, and up to and including two (2) years following the termination of its membership in the Trust, to examine the members' books, vouchers, contracts, documents and records of any and every kind which show or tend to show or verify any loss that may be paid or may have been paid by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, or which show or verify the accuracy of any contribution which is paid or payable by the member pursuant to the terms of this Agreement, or any other agreement, certification, document or any other instrument executed by the Trust and the member pursuant to this Agreement; H. The members hereby delegate to the Board of Trustees the responsibility to contract for handling the administrative and servicing functions of the Trust. The Board may pay a reasonable fee for such, which shall be negotiated from time to time by the Board of Trustees. These fees shall be in consideration of all services and expenses contracted for with the Trust, which services or expenses may include the collecting, disbursing, and accounting for monies collected, counseling with members as to the safety hazards, claims handling and investigations, and legal services, actuarial services and accounting services and for the purpose of providing for excess insurance coverage. Books and records of all contractors employed by the Trust are to be open to inspection by the Board of Trustees or their agents at all reasonable times and as otherwise required by law; ( I. The member and the Trust agree the administrator, to be appointed by the Board, shall deposit to the account of the Trust, at any bank or banks designated by the Board, all contributions or other monies, as and when collected and said monies shall be disbursed only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules, regulations and by-laws of the Board, and (2) the Agreement between the Board and the administrator; J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of the member any claims, suits or other legal proceedings which may at any time be instituted against the member on account of bodily injury liability, property damage liability, errors and omissions liability, civil rights liability, personal injury liability or any other such liability, monetary or otherwise, to the extent such defense and liability has been assumed by the Trust pursuant to this Agreement or any other agreement, certificate, documents, or other instrument executed by the Trust and the member pursuant to this Agreement, subject to any and all of the definitions, terms, conditions and exclusions contained in said agreements, certificates, documents or other instruments, although such claims, suits, allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed against the member in any such legal proceedings defended by the Trust or the members, all interest accruing after entry of judgement in such proceedings, and all expenses incurred in the investigation, negotiation or defense of such claims, suits, allegations or demands. Such defense shall be subject to the control of the Trust and its Administrator, which may make such investigation and settlement of any such claim, suit, or other legal proceeding, monetary or otherwise, as they deem expedient; K. The member agrees the liability of the Trust is specifically limited to the discharge of the liability of its members assumed pursuant to this Agreement or any other agreement, certificate, document, or any other instrument executed by the member and the Trust pursuant to this Agreement; ( FMIT IND 1002 Page 2 of 4 L. The member agrees the coverage of the Trust does not apply to punitive or exemplary damages; M. The Trust shall operate on a fiscal year from 12:01 a.m. October 151 to 12:01 October 151 of the succeeding year. Application for continuing membership, when approved in writing by the Board or their designee, shall constitute a continuing contract for each succeeding fiscal period unless cancelled by the Board or unless the member shall have resigned or withdrawn from said Trust by written notice; N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees coverage by the Trust for a member under the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of September of each calendar year; O. Except as otherwise provided herein, the member and the Trust agree such member's coverage may be canceled by the Trust or the member at any time upon no less than forty- five (45) days prior written notice by the Board of Trustees or the Administrator to the member and to the Division of VVorkers' Compensation, if applicable, or by the member to the Trust, stating the date such cancellation shall be effective; however, cancellation by the member after the initial effective date of coverage (October 1), shall be conditioned upon Member's payment of an amount equal to ten (10) percent of the premium that is unearned by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice of cancellation to the member 10 days before the effective date of cancellation; P. The member agrees excess monies remaining after the payment of claims and claim expenses, and after provision has been made for the payment of open claims and outstanding reserves, may be distributed by the Board of Trustees to the members participating in the Trust in such manner as the Trustees shall deem to be equitable; ( Q. The member agrees there will be no disbursements out of the reserve fund established by the Trust by way of dividends or distributions of accumulated reserves to members until provision has been made for all obligations against the Trust and except at the discretion of the Board of Trustees; R. The member agrees to permit qualified service providers, including attomeys selected by the Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits, allegations or demands that may result in liability assumed by the Trust on behalf of the member pursuant to this Agreement, or any other agreement, certificate, document, or other instrument executed by the Trust or the member pursuant to this Agreement; S. The member shall make prompt payment of all contributions as required by the Board of Trustees, said contributions to be determined by said Board. The member shall fully cooperate with auditors of the Trust to promptly determine final audited contributions. Any disputes conceming contributions shall be resolved after payment. Any objections concerning the final audited contribution shall be filed within 60 days of billing of the final audited contributions. After that time, the audit shall be considered to be final; T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for late payment of contributions required under this Agreement, or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement; U. The member, through the Board of Trustees, does hereby appoint the Administrator of the Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and other documents reasonably necessary to accomplish the purposes and to fulfill the FMIT IND 1002 Page 3 of4 ~:;:;;:;:!:-.J~'2-.:;;;;' , responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses, medical expenses, and all other matters required or necessary insofar as they affect the member's liability under federal or Florida law and insofar as such matters are covered pursuant to the terms of this Agreement or any other agreement, certificate, document, or other instrument executed by the member and the Trust pursuant to this Agreement, and by the rules and regulations now or hereafter promulgated by the Board of Trustees; V. The Trust shall determine all questions of the scope of liability coverage, eligibility methods of providing or arranging for benefits, and all other related matters. It shall have full power to construe the provisions of this agreement and the other program documents in the terms used here and therein. Any such determination and any such construction adopted by the Trust in good faith shall be binding upon all parties hereto and the members, provided such determination or such construction is consistent with the laws of the State. The member agrees to abide by all the terms and conditions of this Agreement, the Participation Agreement, the Trust's By-laws, the rules and regulations, and any other agreement, certificate, document, or other instrument executed by the Trust and the member pursuant to the Agreement; W. The member and the Trust agree the Trust will maintain an excess coverage program and reserve evaluation to protect the financial stability of the Trust in an amount and manner determined by a qualified and independent actuary; X. The member and the Trust agree the Trust will submit to the appropriate governmental agency annually an audited fiscal year-end financial statement prepared by an independent certified public accountant; Y. ( The member and the Trust agree that any member who formally applies for membership in this Trust and is accepted by the Board of Trustees shall thereupon become a party to the Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions contained therein, and said application shall constitute a counterpart of said Agreement and Declaration of Trust; and Z. Members duties after loss: FMIT IND 1002 1. give the Trust prompt written notice of any accident, occurrence or potential claim along with all relevant information concerning the claim. The member shall have a continuing duty to provide to the Trust all relevant information promptly as the member becomes aware of such information; and cooperate fully with the Trust in defense or settlement of claims or opposition to claims bills, and in the enforcement of any right of contribution or indemnity; and forward to the Trust every notice, demand, summons or other process served upon the member relating to any occurrence, and take no further action concerr1ing the occurrence without the approval of the Trust or the servicing agent; and take reasonable steps to prevent additional or cumulative bodily injury, personal injury or property damage from or arising out of the same or similar conditions or circumstances; and not engage in settlement negotiations as to any claim or suit, and the Trust shall have no obligation to pay the amount of any settlement negotiated or agreed upon by a member without prior written approval by the Trust or the servicing agent; and agree to take all reasonable actions, where appropriate, which shall facilitate settlement of claims; and agree to responsible counsel selected by the Trust to defend the claim and agree not to use the designated member's counsel in defense of said action. 2. 3. 4. 5. 6. 7. Page 4 of 4 FLORIDA MUNICIPAL INSURANCE TRUST COVERAGE AGREEMENT WORKERS COMPENSATION AND EMPLOYERS LIABILITY I. In consideration of the payment of the contributions and the covenants and agreements set forth in the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the statements of the APPLICATION, the DECLARATIONS, and all terms, conditions, limits and other provisions of the COVERAGE AGREEMENT, the Trust agrees with the member as to the following: LIMITS OF LIABILITY Regardless of the number of (1) members under this Agreement, (2) persons or organizations who sustain injury or damage, or (3) claims made or suits brought on account of bodily injury, property damage or personal injury, the liability of the Trust is limited as follows: The total liability of the Trust applicable to "each person" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by one person or organization as the result of anyone occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. ( The total liability of the Trust applicable to "each occurrence" under all coverages and endorsements for all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than one person or organization as the result of anyone occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto. For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence. DEFENSE AND SETTLEMENT In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers appropriate, any claim or suit demanding money damages covered by this Agreement. The Trust will defend any suit against a member which alleges a claim for money damages covered by this Agreement even if such suit is groundless, false or fraudulent. However, the Trust has no duty to defend a member in any action which on its face alleges facts excluded or not covered by this Agreement. In the event a suit or other action contains allegations which allege damages which the Trust has a duty to defend and other allegations which allege damages or other relief that the Trust does not have a duty to defend, the Trust will defend all allegations subject to the terms, conditions, limits of liability and exclusions of the Agreement; however, undertaking such defense shall not obligate the Trust to pay any judgments, settlements or awards which a member becomes legally obligated to pay for allegations to which coverage does not apply. The Trust's duty to defend ends when applicable Limits of Insurance have been exhausted. ( FMIT we EL 1002 Page 1 of 5 II. WORKERS COMPENSATION A. The member and the Trust agree that the Trust will pay any sum a member becomes legally obligated to pay under the workers compensation laws of the state of Florida, including Employers liability as discussed within Coverage B attached hereto for accidents which occur during the period of this Agreement; and the Trust further agrees to pay all administration assessments as may be required in accordance with Florida Law; B. The Trust is to defend in the name of and on behalf of the members any suits or other proceedings which may at any time be instituted against them on account of injuries or death within the purview of the Florida Workers Compensation Law or on the basis of Employers liability, including suits or other proceedings alleging such injuries and demanding damages or compensation therefore, although such suits, other proceedings, allegations or demands are wholly groundless, false, or fraudulent, and to pay all costs taxed against members in any legal proceeding defended by the members, all interest accruing after entry of judgment and all expenses incurred for investigation, negotiation or defense; C. Liability of the Trust to the employees of any employer is specifically limited to such obligations as are imposed by the Florida law against the employer for workers compensation and/or employers liability as provided in Coverage B. The Trust's liability is further limited to only the obligations it assumes under this Agreement; D. The member agrees the Trust shall not be liable for any additional compensation imposed by Section 440.54, and Section 440.15 (12), Florida Statutes; and D. The member agrees that the Board is authorized to set aside from the contributions and monies collected a reasonable sum for the operating or administrative expenses of the Trust. All remaining funds collected during anyone fiscal year of the Trust shall be set aside and shall be used only for the following purposes: payment of a fee for the administrator and claims agent for said Trust; payment for claims, expenses, payments of compensation to employees covered by this contract, including but not limited to settlements, awards, judgements, legal fees, and costs in contested cases; payment of administrative and other assessments as required by Florida law; payment of cost of all bonds; actuarial, and auditing expenses required of the Trust or its agency or employees under Florida law; or other reasonable operating costs or expenses necessary for the administration of the Trust. ( E. Other States Coverage: The Trust will reimburse the member for the benefits required by the Workers Compensation law of that state. If the member has worked on the effective date of this Agreement in any state other than Florida, coverage will not be afforded for that state unless the Trust is notified within thirty (30) days. F. This agreement requires you to release certain employment and wage information maintained by the State of Florida pursuant to federal and state unemployment compensation laws except to the extent prohibited or limited under federal law. By entering into this agreement, you consent to the release of the information. We will safeguard the information and maintain its confidentiality. We will limit use of the information to verifying compliance with the terms of the agreement. FMIT we EL 1002 Page 2 of 5 III. COVERAGE B - EMPLOYERS LIABILITY AGREEMENT A. The member and Trust agree the following definitions apply to the Employers Liability Agreement unless modified or excluded: 1. "Bodily Injury" means bodily injury, disability, disfiguration, sickness or disease or death resulting there from sustained by any person, and any loss, injury or damages sustained by any other person because of bodily injury, which occurs during the period of this Agreement; 2. "Designated Member" means the entity or organization named in this application. Designated member does not include employees or agents of the entity or organization; and 3. The term "Member" as used in this part means: (a) The designated member; (b) V\hlile acting within the scope of his employment, any officer, employee, or volunteer of the designated member; 4. Occurrence, means an event or accident, including continuous or repeated exposure to conditions which result in bodily injury, property damage or personal injury and not arising from any form of intentional misconduct. B. The member and the Trust agree the Trust will pay all sums which a member becomes legally obligated to pay as damages because of bodily injury to an employee of the designated member arising out of and in the course of the injured employee's employment by the designated member, provided said bodily injury is covered by this Employers Liability Agreement; ( C. The member and the Trust agree the Trust will pay damages only to the extent where recovery is permitted by Chapter 440.11, Florida Statutes, and Section 768.28, Florida Statutes, including damages: 1. For which a member becomes liable to a third party by reason of claim or suit against the member by the third party to recover the damages claimed against the member as result of injury to an employee of the designated member; 2. For care of loss and loss of services; and 3. For consequential bodily injury to spouse, child, parent, brother, or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by the member; D. In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers appropriate, any claim or suit demanding money damages covered by this Agreement. However, the Trust has no duty to defend a member in any action, which on its face alleges facts excluded or not covered by this Agreement; E. The member and the Trust agree regardless of the number of (1) members under this Agreement, (2) persons or organizations who sustain injury or damage, or (3) claims made or suits brought on account of bodily injury or property damage or personal injury, the liability of the Trust is limited as follows: 1. The total liability of the Trust under all coverages and endorsements for all damages, including, but not limited to, damages for derivative claims, or FMIT we EL 1002 Page 3 of 5 taxable costs, attorneys fees, and prejudgment interest or post-judgment interest, sustained by one person or organization as the result of anyone occurrence shall not exceed $1,000,000 bodily injury by accident per accident, $1,000,000 bodily injury by disease per disease, and $1,000,000 bodily injury by disease aggregate limits; 2. The total aggregate liability of the Trust under all coverages for all damages, including, but not limited to damages for derivative claims, or taxable costs, attorneys' fees, and prejudgment interest or post-judgment interest sustained by more than one person or organization as the result of anyone occurrence shall not exceed the limit of liability as stated herein as applicable to "each accident or disease;" and 3. For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occurrence; F. The member and the Trust agree that no liability is afforded by the Trust as follows: 1. To liability assumed by a member under any contract or agreement; 2. To any liability arising in whole, or in part out of: (a) Any act or omission of a member committed while acting outside the course and scope of his employment, or committed in bad faith with malicious purpose, or in a manner exhibiting wanton and willful disregard of human rights, safety or property; (b) Any member obtaining remuneration or financial gain to which the member was not legally entitled; ( (c) The willful violation of any federal, state or local law, ordinance or regulation committed by or with the knowledge or consent of any member; or (d) Malfeasance by any member; Except that any fact pertaining to anyone member shall not be imputed to any other member for the purpose of determining the application of these exclusions; 3. To any liability or injury, sickness, disease, death, or destruction due to the rendering of or failure to render any professional service by any doctor, surgeon, dentist, nurse or agents or employee of a designated member; 4. To any liability for punitive or exemplary damages; or any non- compensatory damages or penalties imposed pursuant to any federal or state anti-trust, civil rights, anti-discrimination, or racketeer influence and corrupt organization (RICO) laws; 5. To any damages imposed by act of the Legislature; 6. To bodily injury or property damage for which the member or his indemnitee may be held liable; (a) As a person or organization engaged in the business or manufacturing, distributing, selling or serving alcoholic beverages, or FMIT we EL 1002 Page 4 of 5 (b) If not so engaged, as an owner or lessor of premises used for such purposes, if such liability is imposed: i. By, or because of the violation of any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any alcoholic beverages, or ii. By reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol or which causes or contributes to the intoxication of any person. 7. To any liability arising out of any actual or alleged sexual action, abuse, communicable disease or employment related claim, defined for purposes of this exclusion as: (a) Sexual action includes, but is not limited to, any verbal or non- verbal communication, behavior or conduct with sexual connotations or purposes, whether for sexual gratification, discrimination, intimidation, coercion or other purpose, and regardless of whether such action is alleged to be intentional or negligent; (b) Abuse shall include, but is not limited to, the negligent or intentional infliction of physical, emotional or psychological injury or harm to any person or persons in the care, custody, or control of any member; (c) Communicable disease includes, but is not limited to, Acquired Immune Deficiency Syndrome (AIDS) and any venereal disease; and ( (d) Employment related claim includes, but is not limited to, claims, accusations or charges of negligent or intentional hiring, placement, training or supervision arising from or related to actual or alleged sexual action, or any other type of actual or alleged abuse, or a communicable disease; 8. To any liability for injury, loss or damage sustained by any person or entities as a result of exposure to asbestosis or any other disease including mesothelioma and cancer related to asbestos exposure; 9. Bodily injury which is intentionally caused or aggravated by the member or members. Coverage is also excluded for any claim alleging gross negligence. Further, cover is also excluded for claims in which it is alleged that the Designated Member or a fellow employee acted in such a manner that it was substantially certain that injury or death would result; 10. Bodily injury to any employee while employed in violation of the law or engaged in any conduct in violation of law with the actual knowledge of any of the executive officers of the designated member; and 11. To any obligation imposed by a workers compensation, occupational disease, unemployment compensation or disability benefits law or any similar law. FMIT we EL 1002 Page 5 of 5 V\ORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFORMATION PAGE ITEM 4. CONTINUED CLASSIFICATION OF OPERATIONS FL-9 LOC. 1 Total Payroll: FL 8,769,360 From 10/01/2002 To 10/01/2003 STREET or Road MAINTENANCE OR BEAUTIFICATION & Drivers WATERWORKS OPERATION & Drivers SEWAGE DISPOSAL PLANT OPERATION & Drivers FIREFIGHTERS & Drivers POLICE OFFICERS & Drivers ( AUTOmobile SERVICE OR REPAIR CENTER 1& Drivers CLERICAL OFFICE EMPLOYEES NOC PARK NOC - ALL EMPLOYEES & Drivers MUNICIPAL, TOWNSHIP, COUNTY OR STATE EMPLOYEE NOC Employer Safety Premium Credit Drug-Free Workplace Credit Total After Credits Experience Modification Final STANDARD PREMIUM Advance Discount Normal Premium Expense Constant Incentive Credit ( '- -. Net Premium we 00 00 01A CODE NO. 5509 7520 7580 POLICY NO. FMIT #0648 PAGE NO. 1 Estimated Total Annual Remuneration Rates Per $100 of Remun- eration 487,47E 11.08 724,622 6.24 557,45E 4.5C - 7704 1,645,062 10.6E 7720 2,563, 92C 10. 6E 8380 108,262 6.95 8810 1,922,00~ 0.65 9102 9410 9765 9841 9898 006:3 0900 439,74E 10.01 320,BOE 15.01 0.020 0.050 0.980 Estimated Annual Premiums Subject to Modification All Other 54,013 45,21E 25,08E 175,693 273,827 7,524 12,493 44,019 48,153 -13,720 -33,615 638,689 -12,774 625,915 -79,260 546,655 20C -142,214 404,641 12/13/02 0 Administration/ Marketing 0 Risk Control if Underwriting Property & Casualty Health Post Office Box 530065 125 East Colonial Drive Orlando, FL 32853-0065 800-445-6248 407-425-9142 Suncom 344-0725 Fax 407-425-9378 0 Health Claims Post Office Box 538140 Orlando, FL 32853-8140 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 0 Workers' Compensation Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 0 Property & Liability Claims Post Office Box 538135 Orlando, FL 32853-8135 800-756-3042 407-245-0725 Suncom 344-0725 Fax 407-425-9378 FLORIDA LEAGUE OF CITIES, INC. PUBLIC RISK SERVICES October 18, 2002 Mr. Ronald W. McLemore City of Winter Springs 1126 East State Road 434 Winter Springs, FI. 32708 Re: Signed Application Dear Mr. McLeMore: ./--------.. / \ ~ Enclosed is your signed application to the Florida Municipal Insurance Trust. Please keep this with your Insurance Package. We will also be keeping one in our file. Thank You, 9Il~t. ~ Margaret E. Gross, CPCU Public Risk Service Enclosure Florida Municipal Insurance Trust