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<br />"MERICAN INDEMNITY COMPANY <br />po BOX.73909, CEDAR RAPIDS, IA52407 <br /> <br />ACCOUNT NUMBER: <br />POLICY NUMBER: 88-055 073 <br /> <br />'I <br /> <br />(2) <br /> <br />PREMISES COMMERCIAL UNI.SAVER COVERAGE PART <br /> <br />DIRECT BILL - <br />ISSUEDATE 12-19-2000 LS6 REPLACEMENT OF NEW <br />NAMED MILLERS LEAP OF FAITH <br />INSURED MIL L E R J ERR Y & SUE L Y N N DBA <br />AND <br />MAILING 3 84 3 0 5 T H A V E <br />ADDRESS ZEPHYRHI LLS <br /> <br />POLICY 12:01 A.M. Standard time <br />PERIOD: <br /> <br />DECLARATIONS <br /> <br />AGENCY & CODE <br /> <br />75-4281 <br /> <br />FL 33540-4329 <br />FROM: 12-01-2000 <br /> <br />C & N INSURANCE AGENCY, <br />38434 FIFTH AVENUE <br />ZEPHYRHILLS FL <br />12-01-2001 <br /> <br />33540 <br /> <br />TO: <br /> <br />And for successive Policy Periods as stated below. <br />We will Provide the. insurance described in tt)/.s Policy in. return for the Premium and. comPliance with <ill aPPlicable Policy provisions, <br />If we elect to continue this Insurance, we WI I renew this policy If You pay the required renewal premium for each successive PolICY <br />Period subject to our premiums, rules and forms then in effect You must pay us prror to the end of the current policy Penod or else <br />this olic will terminate after an statutorily re uired notices aremailedtoou.Aninsufficient funds check is not considered payment. <br />FORM OF BUSINESS: .x Individual _ Joint Venture _ Partnership _ CorPoration _ Other <br />..."................................. <br />:;::~:pREMj;~:~; :~~:~~::i~;~~~:~!~!:tiMlt;~;iOf;;:;;::::i;:;i~i: <br />"EllDG.i.INSURANCE) <br />01 0 38430 5TH AVE <br />ZEPHYRHILLS FL 33540 <br />JOISTED MASONRY <br />BOOK OR MAGAZINE STORES <br /> <br /> <br />...'.'.........-."................. <br />.. .-- ........... ,"..... <br />........................... <br />......-....................... <br />...........-................. <br />..-....,...................... <br />....-... .................... <br />.........--.................. <br />............................... <br />.....--........................ <br />. "p' REM" '. '1' U....M............ <br />... . .... <br />. . . .. . . <br />>::::::<:;: '.', - '. .:;;;:;: <br /> <br />YOUR BUSINESS PERSONAL PROPERTY <br />Special Causes of Loss <br />Replacement Cost <br /> <br />60,00 <br /> <br />1.693 <br /> <br />1,016 <br /> <br />ADDITIONAL INTEREST - Loss Payable <br />FIRST NATIONAL BANK OF PASCO <br /> <br />)ROPERTY DEDUCTIBLE $ 5 0 0 GLASS DEDUCTIBLE (Included in Property Unless Specified) $ <br /> <br />>ERSONAL PROPERTY INFLATION GUARD % "Ii <br />~BBREVIA TIONS: BLDG = BUILDING OED = DEDUCTIBLE PREM = PREMISES MC = MERIT CREDIT INCL = INCLUDED <br />:OMMERCIAL GENERAL LIABILITY LIMITS OF INSURANCE <br />GENERAL AGGREGATE LIMIT PRODUCTS-COMPLETED PERSONAL AND EACH <br />lther than Products-Completed Operations) OPERATIONS AGGREGATE ADVERTISING INJURY OCCURRENCE <br /> <br />CRIME DEDUCTIBLE $ 2 5 0 <br /> <br />i, <br />i <br />r <br />[ <br />t <br />t <br />t <br />! <br />" <br />l <br />~ <br />, <br />[ <br />~ <br />t. <br />r' <br />~ <br /> <br />13315 US HIGHWAY 301 <br />DADE CITY FL 33525-5435 <br /> <br />600,000 <br />Premium Charge Forms <br /> <br />$ <br /> <br />FIRE DAMAGE <br />(Any One Fire) <br /> <br />(Any One Person) <br /> <br />600,000 $ <br />Advance Premium <br /> <br />300,000 $ 300,000 $ <br />Premium Charge Forms <br /> <br />100,000 $ 5,000 <br />Advance Premium <br /> <br />)ther Forms <br /> <br />SEE UW7002 <br /> <br />\/lEND REASON: <br /> <br />IEMIUM FOR THIS COVERAGE PART $ 1,016 + 4.00 EMP&A TRUST FUND SURCHARGE = 1,020.00 <br />Endorsement Adjustment Premium $ <br />is Declarations Page sUPersedes and replaces any preceding X <br />claratlons Page bearing the same policy number for this Policy <br />nod. (COUNTERSIGNED BY AUTHORIZED REPRESENT A TIVEJ <br />: 70 01 12 92 <br /> <br /> <br />*05004961* <br /> <br />III"" ""I "'" """"" '1"'11"""" 111111'1 <br />