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Certificates of Insurance THE PORTER-ALLEN CO., INC. ] 115 ~n ranee SINCE 1891 WILLIAM A. FREEMAN. SR. WILLIAM A. FREEMAN, JR. DAVID W. FREEMAN February t7, L97t Mr. Earl R. Adams Clerk, (~ircuit Court MOl1roe County Courthouse l(ey West, FL 33040 R E: Burton C. Brooks Liability I11sural1ce Ol1 Miniature Railroad located on Monroe COUl1ty Beach Dear Eclrl: 513 SOUTHARD STREET KEY WEST, FLORIDA 33040 PHONE: 305 - 294-2542 I am el1lcLosing a copy of the Binder for coverage for Mr. Brooks. The polic)T will be forth coming as soon as it comes, I w ill forward a copy ()f it to you for your records. Thank you. David W. Freemal1 DWF /ITll1 E nc 10Stlre ~.......Q..O.O..O, .1 aLltllc:dl lEt.(Q):IE 1b~ .fr-~ X <:G-- Ir ~s 1LT IB.. PX. ~ <C ].~ - ][~C:;.- I .. 9 2 F 0 U R T H S T. N O. e P. O. BOX I 2 7 6 9 0 5 T. PET E R 5 BUR G . F LOR I D A 3 3 7 3 3 B I ~J [t] [E ~~ In consideration of a premium of . $442.00 DAY AND ROEHR.IG INSURANCE, INC., this day binds for: ........................ .. . .... ......BurtQn...C..~...~r.q9.~~.... . . . . .... ....... Insured's Name ......................... .... ....... ...~~.'7. ..~.~y.~. ~... .~~.~~~.~.~. ..~.~.Y.. .~J~.S ~.~ ..F..l. ~~.~ .~~..... ~.?~~~ Insured's Address - Street, City, State The following cove.rages: .. ...... ....... .~.9~JJ.Y ...t~j.~~'y.. .~.~~.. .~~~.~. r.~Y.. P.~~~9~...~. i.~.~ .i..l. .i. ~.Y. ..~.~.~.~r.ance On property described lts: ....... M.~.~ .i. ~.~ Y.~~.. .~.~.~..~ .~~.~q .(~~ ~.<?~. i .~~.>... ~.~~.~.. ~ ~ .9. ~.................................. ........... ....... ~........, .......... ...................................... .......................... .......... .. ... ......,..... . ... ..... ...............0 .... .......... .... ......... ....~.~. limit of liability: ...~~~~;.oei~Z~.1~i~i.:~s~i~~~~.~.::$5bl~.~~u~i~br:n~:~1 ~~.~b~~Op:~o~~~~y ..................... ...................as...respec.ts..Bl 'and PO ....................................................... ... .... National Indemnity Company of Omaha, Nebraska Such coverage to be provided by: . . .. . .. .. .. .. .. .. . . .. . . ~ .. . .. .. .. .. . .. .. .. .. . .. . . .. . . . .. .. .. . .. . .. .. .. .. .. .. . .. . . .. . .. . .. . .. .. .. .. .. .. . . . .. .. .. . .. .. .. .. . .. .. .. ~ .. .. .. .. .. .. .. . .. .. .. .. .. ~ .. .. .. .. .. .. . ~ .. .. . .... ........... .. . .. .. . . .. . . . . .. .. .. .. .. .. .. .. .. . .. .. . . . .. . . . .. . . .. .. .. '" ..................... ........... .... For a term not to exceed .. ........ .~~.. ..... .days from date and hour of this binder, subiect to all terms and conditions of the a.m.. Company's policy. Dated: ..... ........... .............. ..............~.~~.~.~ 7.~... .... ....... ..... ...... ......... Binder To Take Effect 2-13-]1 at 12:01 A.M. Time p.m.. IN NO EVENT SHAUL THIS BINDER BE EFFECTIVE FOR ~ORE THAN 30 DAYS FROM DATE AND HOUR HEREOF. .' , . , DAY AND' ROEHRI~I SURANCE. INC. By......W .~D' ~R D-h. ~~ . afi~ oe r.lg -1 -'r: ,.r ...f ~ . ..,,,,.,.!,,~'~ ..,..~........, (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) LIABILITY G 319 EXCLUSION (Named Insured's Products) L 9156 (Ed. 10-66) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE This endorsement, effective l/13/7'1 (12:01 A. M" standard time) , forms a part of policy No. GlA 19714 issued to B:ilrton C. Brooks by National Indemnity Company .~....~~...._---.. .. .. ' DAY & ROEHRIGA~N ..._..t.~........ -........ -............ ......... Description of Operations: ~4.iniature Train It is agreed that such insurance as is afforded by the Bodily Injury liabil ity Coverage and the Property Damage liabil ity Coverage for the operations described in this endorsement does not apply to bodily injury or property damage arising out of (1) the named insured's products, or (2) rei iance upon a representation or warranty made with respect thereto if the bodily injury or property damage occurs after physical possession of such products has been relinquished to others whether such bodily injury or property damage occurs on premises owned by or rented to the named insured or elsewhere. o A.~f-i~'~ ~~ICO "''''0 SUPPLY OI'IJIS\O" (The Attaching. Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) LIABILITY IRB.G 335 EXCLUSION (Contamination or Pollution) L 8481 (Ed. 6-70) Th is enaorsement modifies such insurance as is afforded by the provisions of the pol icy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE COMPLETED OPERATIONS AND PRODUCTS LIABILITY INSURANCE CONTRACTUAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE OWt{ERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE SPECIAL PROTECTJVE AND HlGHWAY LIABILITY INSURANCE - NEW YORK DEPARTMENT OF PUBLIC WORKS STOREKEEPER'S INSURANCE Th is endorsement, effect ive 2/13171 (12:01 A. M., standard time) , forms a part of policy No. GLA 1 9714 issued to Burton C. Brooks by National Indellmfty CoItpany ~.'&:(i~ :1W~:......m.h._mh__.h__....mhh_h_- It is agreed that the insurance does not apply to bodily injury or property damage arising out of the discharge, dis rsal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or . pollutants into or upon land, the atmosphere or any watercourse or body of water; but this exclusion does not apply if such discharge, dispersal, release or escape is sudden and accidental. oA.~'i~~~~icO ".0 SU....Ly D'''\~\O. /~ U-1832 11/52 ASSAULT EXCLUSION ENDORSEMENT It is agreed that as of the effective date hereof the policy is changed in the following particulars: In consideration of the prelnium for which this policy is written, it is hereby understood and agreed that this policy does not cover in respect to any loss caused or alleged to have been caused by an assault, provoked or unprovoked, committed by an insured or by an enlployee or agent of the insured. All other terms, conditions and agreements of the policy shall remain unchanged. This endorsement forms a part of Policy No. GlA 19714 issued to Burton C. BNOta by the NATIONAL INDEMNITY COMPAN'Y of Omaha, Nebraska. and is effective fronl 2/13(71 ( 2:01 A. M. Standard Time) NAnONAL INDIMNITY COMPANY Countersigned at St. 'etersbupt .fla. By -\1'). ~""{\()) \{l\.Q~' \ n. DAY & ROtRWlg\~~_tiVe) tf~,<l ~. Secretary . ~ ........... .... .. ........ .." ..... ... .......... Ie .... ~ to preparatJon of the" policy.) UAIUIY __ au 9238a (Ed. 11-69) _..- ~IIJ __ f(Jr , 1tr1f I Tbia,~ ___ _ lMlI*1Cl. . .. ..... ., lie provisions of the policy relating to the fullowlitI: UlM;I ItISIIAICI MANaFACTIRDS' AID CONTRACTORS' LIABILITY INSURANCE OWIEIS', LMILOID~, AIID nltANTS' LIABILITY INSURANCE PREMISES MEDICAL PAYMENTS INSURANCE ltI is endorsement, effective 2/1 (~,o? 1. M., standard time) Burton C. Brooks , forms a part of policy No. GLi\ 1971.1 issued to by National Indemnity Company i0_!n}~~QJ__~ c4. ?L ? m--"i-.--.---------------m------------m---m.- . .. DAY . ROrHRIc; .fiijff1.~. .,. ........ does not apply to "'ddy Injury or property damage arising out of the ownership, maintenance, o peraTiiin , use, loading or unloading of any ....., It premises owned, rented or controlled by the named insured; but this exclusion does not apply to an escalator at premises which the named .... 0WftS, rents or controls only in part unless the named insured operates, maintains or controls the escalator. ~~ ~.. 11I~Il~Y D'''\~\(). GENER~. ~IABI~ITY.AUTOMOBILE. ME.W RENEWAL OF NUMBER ~ ~ I'-- en or-! Item 1. Named Insured and Address: NATIONAL INDEMNITY COMPANY 3024 Harney Street OMAHA, NEBRASKA 68131 cc 8UI1WI c. 1-*5 cE 1317 IllYat Street ~ West. Aerida Item 2. Policy Period: (Mo. Day Yr.) From 1/1W71 to2l1J/72 12:01 Al1., standard time at the address of the namel insured as stated herein. (No., street, Town or City, County, state) THE PORTER-ALLEN COMPANY T 294 - 2~42 P. o. .oX 1490 113 SOUTHARD ITIIIT - KEY WEST, Pl._A 33040 The named insured is: []] Individual D Partnership Business of the named insured is: (ENTER BELOW) MfntatItN T,..,.. Item 3. The insurance afforded is only with respect to the Coverage Part(s) indicated below by specific premium charge(s) and attached to and forming a part of th is pol icy. D Corporation D Joint Venture D Other: Audit Period: Annual, unless otherwise stated. (ENTER BELOW) Advance Coverage Coverage Part(s) Advance Coverage Coverage Part(s) Premiums Part No(s). Premiums Part No(s). $ Automobile Medical Payments Insurance $ Manufacturers' and Contractors' liabi lity $ Automobile Physical Damage Insurance Insurance (Dea lers) $ Owner's and Contractor's Protective Liability $ Automobile Physical Damage Insurance Insurance (Fleet Automatic) $ Owners', landlords' and Tenants' Liability $ Automobile Physical Damage Insurance 442.00 l 6186 Insurance (Non-Fleet) $ Personal Injury Liability Insurance $ Completed Operations and Products Liabi lity $ Physicians', Surgeons' and Dentists' Professional Insurance Liability Insurance $ Comprehensive Automobile Liability Insurance $ Premises Medical Payments Insurance $ Comprehensive General Liability Insurance $ Protection Against Uninsured Motorists Insurance $ Comprehensive Personal I nsurance $ Storekeeper's Insurance $ Contractual Liability Insurance $ $ Druggists' Liability Insurance $ Elevator Collision Insurance $ $ Farm Employers' Liability and Farm Employees' Medica I Payments Insurance $ Farmer's Comprehensive Personal Insurance $ $ Farmer's Medical Payments Insurance $ Garage Insurance $ $ Hospital Professional Liability Insurance Form numbers of endorsements, NI 947a.;L 6186;11 913;L 9181;l ..;1 1832;1. 6481;l 9156 other than those entered on $ Coverage Part(s), attached at issue $ 44Z.OD Total Advance Premium for this policy. I * If the Policy Period is more than one year and the premium is to be paid in installments, premium is payable on: Effective Date 1st Anniversary 2nd Anniversary $ $ $ Item 4. During the past three years no insurer has cancelled insurance, issued to the named insured, similar to that afforded hereunder, unless otherwise stated herein: Countersigned: St. PetersburG,' ..FlI. PI 093 3/17/71 0" \ By ~0 ~~\"C....)'~~'\.:~~ 0. Ptd. in U.S.A. Authorized Representat~ *Not applicable in Texas OKD6300-X-D (2-1-66) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) LIABILITY L 9187 (Ed. 7-66) G 604 DEDUCTIBLE LIABILITY INSURANCE This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', lANDLORDS' AND TENANTS' LIABILITY INSURANCE This endorsement,effective 2/13/71 (12:01 A. M., standard time) , forms a part of pol icy No. &LA 19714 issued to Burton C. Brooks by National Indemnity Company Amount and Basis of Deductible Cove'rage $ 50.00 per claim Bodily Injury Liability $ per occurrence $ 50.00 per claim Property Damage Liability $ per occurrence -\0~.llimoJ....... ...... . DAY I ROEHRIG SCHEDULE ......... .... ............................................................-..................... ................-.. ....... ....... ;!Mt. APPLICATION OF ENDORSEMENT (Enter here any limitations on the application of this endorsement. If no limitation is entered, the deductibles apply to all loss however caused):- It is agreed that: 1. The company's obligation under the Bodily Injury Liability and Property Damage Liability Coverages to pay damages on behalf of the insured applies only to the amount of damages in excess of any deductible amounts stated in the schedule above as applicable to such coverages. 2. The deductible amounts stated in the schedule apply as follows: (a) PER CLAIM BASIS-If the deductible is on a "per claim" basis, the deductible amount applies under the Bodily Injury Liability or Property Damage Liability Coverage, respectively, to all damages because of bodily injury sustained by one person, or to all property damage sustained by one person or organization, as the result of anyone occurrence. (b) PER OCCURRENCE BASIS-If the deductible is on a "per occurrence" basis, the deductible amount applies under the Bodily Injury Liability or Property Damage Liability Coverage, respectively, to all damages because of all bodily injury or property damage as the result of anyone occurrence. 3. The terms of the policy, including those with respect to (a) the company's rights and duties with respect to the defense of suits and (b) the insured's duties in the event of an occurrence apply irrespective of the application of the deductible amount. 4. The company may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken, the named insured shall promptly reimburse the company for such part of the deductible amount as has been paid by the company. OA~i~'i~;;:iCO "'''0 SUPPLY u,,,,!.\o'" CONSTRUING ENDORSEMENT FOR GLA POLICIES (Applicable only with respect to Bodily Injury Liability and Property Damage Liability Insurance Coverages) Whenever the word "accident" appears in any endorsement form attached to this policy, it shall be construed as "accident and/or occur- rence", so far as insurance is provided by the policy as respects an occurrence. All other terms, conditions and agreements of the policy shall remain unchanged. This endorsement forms a part of Policy No. GlA 19714 issued to nurblB C~ Brt)Bki by the NATIONAL INDEMNITY COMPANY of Omaha, Nebraska, and is effective from 2/13/11 (12:01 A.M. Standard Time) NATIONAL INDEMNITY COMPANY ~~-A/,a ~ Countersigned at St. P@ti~r~bu"i ,F1 it = By 'h"\, ~~'\\.\ . \0.. DAY I~ltlz ,....UI~jNC. NI 913 (10/66) Secreta ry COVEIlH PART OWNERS', LANDLORDS' AND TENANTS' LIABIUTY INSURANCE COVERAGE FOR DESIGNATED PREMISES AND RELATED OPERATIONS IN PROGRESS OTHER THAN STRUCTURAL ALTERATIONS, NEW CONSTRUCTION AND DEMOLITION L 6186 (Ed. 11-69) For attachment to Policy No. GLA 19714 , to complete said policy. ADDITIONAL DECLARA liONS Location of insured premises (ENTER "SAME" IF' SAME LOCATION AS ADDRESS SHOWN IN ITEM I OF' DECLARATIONS) s. Interest of nall.d insured in insured preMises (CHI::CK BELOW) ~ OWNER D GENERAL LESSEE 0 TENANT 0 Other Part occupied by named insured (ENTER BELOW) SCHEDULE The insurance afforded is only with respect to such of the following Coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto. Limits of Liability each person each occurrence Coverages $ $ $ Advance Premiulls Bldily Injury Pr.perty Damlle A Bodily Injury Liability B-Property Damage liability Rates 1.1. P.O. Premium Bases C.de No. Description of Hazards Premises - Operations 394.00 MP 48.00 MP 6.57 .80 d) to be 1nfature Ratlroad (glsoltne) determine (a) Per 100 Sq. Ft. of Area (b) Per Linear Foot (c) Per 100 Admissions (d) Per $100 of Re:eipts (e) Per Unit Per landing (a) Area (Sq. Ft.) (b) Frontage (c) Admissions (d) Receipts (e) Units Number Insured Escalators (Number at Premises) Nle 1$ 48.00 I Tltal AdvanceB.I. and P.O. Premiums I FI,. n.....n If end.ne..nts IttIcIl.d at iss. T,tal Advance Premium When used as a premium basis: 1_ uad.issilns" means the total number of persons, other than employees of the na.ed insured, aumitted to the event insured or to events conducted on the insured pre.ises whether on paid admission tickets, complimentary tickets or passes. 2. "receipts" means the gross amount of money charged by the nalned insured for such operations by the na.ed insured or by others during the policy periOd I as are rated on a receipts basis other than receipts from telecasting, broadcasting or motion pictures, and includes taxes, other than taxes which the na.ed insured collects as a separate item and remits directly to a governmental division. (over) ~ Af\~ lISEr\~ ENT Pp\RKS & A~\i1 USErv'ENT DEVIC ES AMENDATORY ENDORSErv1ENT RELATING TO CANCELLATION It is agreed that the provls IOns relating to earned premilulI computation appearing in the Cancellation Condition are deleted and the fo 1I0wing is sub stituted therefor: It is agreed that I if the insurance afforded under the policy is cancelled by the named insured or by the Company I the Company shall be entitled to earned premium calculated in accordance with the Schedule of rates in the policy or in accordance with the follo\ving table I whichever is the greater. EARNED PERCENTAGE OF PERIOD COVERAGE IN FORCE MINIMUM PREMIUMS Insurance in force up to but not exceeding 30 days ..................................................... 20'1. Insurance in force over 30 days but not exceeding 40 days ........................................... 25'1. Insurance in force over 40 days but not exceeding 50 days ........................................... 30'1. Insurance in force over 50 days but not exceeding 60 days ........................................... 35'1- Insurance in force over 60 days but not exceeding 70 days ........................................... 40'1. Insurance in force over 70 days but not exceeding 80 days ............................................ 45'1. Insurance in force over 80 days but not exceeding 90 days ........................................... 50'1. Insurance in force over 90 days but not exceeding 100 days ........................................... 55'1. Insurance in force over 100 days but not exceeding 110 days ...................................,....... 60'/. Insurance in force over 110 days but not exceeding 120 days ........................................... 65'1. Insurance in force over 120 days but not exceeding 130 days ........................................... 70'1. Insurance in force over 130 days but not exceeding 140 days ........................................... 75'1. Insurance in force over 140 days but not exceeding 150 days ........................................... 80'1. Insurance in force over 150 days but not exceeding 160 days ........................................... 85';'. Insurance in force over 160 days but not exceeding 1 70 days ........................................... 90'1. Insurance in force over 170 days but not exceeding 180 days ........................................... 95'1. Insurance in force over 18 0 day s ...................................................................... 100'1. All other terms I conditions and agreements of the policy shall remain unchanged. I This endorsement forms a part of Policy tIc. is sued to by the NATIONAL INDEMNITY COMPANY of Omaha I N ebra ska, and is effective from (12.: 01 A. M. STANDARD TIME) Countersigned at NATIOi\lAL INDiU~NIVY COIJlPANY By (DULY AUTHORIZED REPRESENTATIVE) ~~A ~/ Secretary NI 947a (3/67)