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Home My WebLink AboutU.S. Specialty Insurance Company U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 2 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND 1 POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY i In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Com Model VIN Type Value Ded I CoII Ded Make Yp I Ma I I Status Year I I I 1 1 CHANGE FROM 1989 Peterbilt Packer Garbage Truck 1XPZL5OX 1 KD704257 3 $ 20,000 $ 1,000 $ 2,500 2 CHANGE TO 1989 Peterbilt Packer Garbage Truck 1XPZL50X1KD704256 3 $ 20,000 $ 1,000 $ 2,500 3 CHANGE FROM 1989 Peterbilt Packer Garbage Truck 1XPZL5OXKD704257 3 $ 80,000 $ 1,000 $ 2,500 4 CHANGE TO 1989 Peterbilt Packer Garbage Truck 1 XPZL50X1 KD704257 3 $ 80,000 $ 1,000 $ 2,500 5 CHANGE FROM 2008 Ford Crown Vic 2FAFP71V48X164555 11 $ 20,796 $ 1,000 $ 2,500 6 CHANGE TO 2008 Ford Crown Vic 2FAFP71V28X164555 11 $ 20,796 $ 1,000 $ 2,500 PREMIUM DUE: $ - WAIVED 1 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED CIAA C440 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original qq i 3 4 U.S. SPECIALTY INSURANCE COMPANY 1 ENDORSEMENT NO. 3 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ) In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Comp CoII # I I Type I Status I Year I Make Model VIN T e Value Ded Ded I I { 1 ADD 2011 Eager Beaver Trail King 112H8V321BL075879 13 $ 20,000 $ 1,000 $ 2,500 2 ADD 2009 Trail King Tilt 1TKUO20239M059198 13 $ 20,000 $ 1,000 $ 2,500 3 ADD 2012 Chevrolet Traverse 1GNKRJED9CJ189785 2 $ 37,809 $ 1,000 $ 2,500 4 ADD 1996 Peterbuilt Dump Truck 1XPNLF9X1TN413891 7 5 ADD 2005 Ford E450 1FDXE45S95HB04315 2 $ 6,500 $ 1,000 $ 2,500 6 ADD 1996 Dodge Pick Up 1B7HC16Y7TJ170626 2 7 ADD 2002 Chevrolet Pick Up 1GCHK24UO2E232903 2 $ 15,000 $ 1,000 $ 2,500 8 ADD 2003 Dodge Pick Up 1D7HA18N33J603583 2 $ 23,000 $ 1,000 $ 2,500 PREMIUM DUE: $ 2,250 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED a......,--me..,64..„ 1 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original q f i U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 4 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Com Model VIN Type Value Ded I Coll Ded Make p I Year Ma l Y I Status I I I 1 ADD 2012 Ford Escape 1FMCU9C78CKA34206 2 $ 21,494 $ 1,000 $ 2,500 2 ADD 1997 GMC 2500 1GTFC24M4VZ536785 2 3 ADD 2007 Chevrolet Flat Bed Truck 1GBE4C1267F409739 2 $ 44,626 $ 1,000 $ 2,500 4 ADD 2000 Ford F550 1 FDAF56F9YEC72083 2 5 ADD 2000 Dodge Ram 2B7JB21ZOYK11350 2 6 ADD 2006 Dodge Dakota 1D7HW48NX6S514952 2 $ 22,845 $ 1,000 $ 2,500 7 ADD 2008 GMC Sierra 1GTHK24K98E125100 5 $ 32,500 $ 1,000 $ 2,500 8 ADD 2007 Chevrolet Suburban 2GNGK26K47G267944 2 $ 38,914 $ 1,000 $ 2,500 PREMIUM DUE: $ 2,726 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED CIAA* CC404 , 6***,, 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original 1 SPECIALTY INSURANCE COMPANY U.S. SPECIAL ENDORSEMENT NO. 5 AGENCY A TTACHED TO AND AND FORMING ENDORSEMENT EFFECTIVE INSURED (Standard time) CODE A PART OF 12:01 NOON MO DAY YR POLICY NUMBER AM PKG80610163 3/15/2012 X City of Jeffersonville THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY it is hereby understood and agreed the following change(s) have been In consideration for the premium charge made made to the coverage section(s): Comp CoII - Model NM Type MEM Ded Ded 14 000 $ 1,000 $ 2,500 Crown Victoria 2FAFP71W04X157686 1 $ 2,500 ADD 2004 Ford 143,900 $ 1,000 $ 1 Ster ling 7 $ 1,000 $ 2,500 2 ADD 2007 Dump Truck 49HAADBV67DX61568 10,000 $ 1 991 Ford L8000 1 FDYW82A9MVA 2 $ 7,500 $ 1,000 $ 2,500 3 ADD 4700 1 HTSCAARXSH634328 2 $ 4 ADD 1994 International 1 Ford Crown Victoria 2FAFP71W21X138522 1 $ 34,708 $ 1,000 $ 2,500 5 6 ADD ADD 200 2011 Ford F350 1 FDRF3GT3BEC 6 2 004 Ford Crown Victoria 2FAFP71W04X157686 11 $ 14,000 $ 1,000 $ 2,500 7 ADD 3 Ford Crown Victoria 2FAFP71W93X176381 1 8 ADD 200 1 4,962 ADDITIONAL PREMIUM DUE: ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED i auo.... ecApeate 3/29/2012 AUTHORIZED REPRESENTATIVE DATE 40 B &F Group AGENT: 3/29/2012 DATE: C. Romano ENTRY PERSON Original PKGIL0014 2006 t U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 6 ATTACHED TO AGENCY AND FORMING ENDORSEMENT EFFECTIVE A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Comp Coll VIN Type Value I Ded Ded I Yp I Model I Make I Year I # Status I 1 ADD 2004 Chevrolet 2500 1GCGC24U54Z165025 2 $ 25,000 $ 1,000 $ 2,500 2 ADD 2001 GMC Sierra 1GTEK14T91Z219580 2 3 ADD 2008 Dodge 2500 3D7LT2EL8BG581092 2 $ 29,214 $ 1,000 $ 2,500 4 ADD 2010 Ford F150 1 FTFX1 EV2AFD31208 2 $ 26,932 $ 1,000 $ 2,500 5 ADD 2009 Dodge Ram 1D3HB16K29J522915 2 $ 15,496 $ 1,000 $ 2,500 6 ADD 1991 Ford Semi 1 FDYW82A7MVA24306 2 7 ADD 1991 Ford Semi 1F DYW82A6MVA24307 2 8 ADD 2011 Ford Van NMOKS9BN1CT075113 2 $ 20,468 $ 1,000 $ 2,500 PREMIUM DUE: $ 2,652 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED i auoz-m.extpaki,4„, 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original i U.S. SPECIALTY INSURANCE COMPANY t ENDORSEMENT NO. 7 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF INSURED AND (Standard time) POLICY NUMBER MO DAY YR CODE 12:01 NOON PKG80610163 3 /15/2012 « City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE ii Comp CoII Status Year Make Mode I Type Value Ded Ded .... 1 ADD 1970 Unknown 12 13 BoX Trailer 2 ADD TBD , 26 -34337 13 A DD T BD ,fob Trailer 3 Miller HK325422 1 eltler 4 ADD 2009 Gator2 ' '; le 4Z10616249S006503 1 5 ADD TBD 6 ADD 2010 Econ II'�� ti ller 1 Baro'�, il�° 430HD1622AMO27300 4BXUE12259S007078 1 7 ADD 2009 G �� ::: i�� 4Z1 CB16209S0059 13 8 ADD 2008 St% x; 1S9F7162X8K087183 13 ' k 4 41 b i PREMIUM DUE: __ _. � 442 ADDITIONAL ALL OTHER TERMS AND CONCI ', ' UNCHANGED C 1/41,4"4„,,....YV1/4. , ..---,-, = T 3/29/2012 AUTHORIZED RE DATE AGENT: t DATE: �_. ENTRY PERSON ' PKGIL0014 2006 ' t i U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 8 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE Veh Comp Model VIN Type Value Ded I Coll Ded Make M p I Mak Y I Year I Status Yea I I 1 ADD 2008 Wells Cargo Trailer 1WC200J1198500123 13 2 ADD 2008 Wells Cargo Trailer 1WC200J1185001332 13 3 ADD TBD 4X8 Single Axle Trailer TR001 13 4 ADD 1987 PSI Trailer G1W70773 13 5 ADD 2011 MSG Trailer 16MPF081XBD060365 13 6 ADD 2011 MSG Trailer 16MPF081XBD060412 13 7 ADD TBD Trailer 16MPF9241D92952 13 8 ADD TBD Trailer 16MPF1127YD023032 13 PREMIUM DUE: $ 442 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED i aumirm, exa.16444, 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original i I U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 9 A TO AND FORMING E NDORSEMENT EFFECTIVE AGENCY A PART OF (Standar time) INSURED AND POLICY NUMBER MO DA Y R 12 NOON CODE A M PK 3/15/2 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Comp Model VIN Type Value Ded I Coll Ded Mod P I Make Y I Status Year I I # Stat I 1 ADD 2008 ASM Trailer MVIN311891IND 13 2 ADD TBD Hot Box Trailer 3528 13 3 DELETE 1998 Dodge Van P45 1 B4GP45GXWB711089 2 $ 15,000 $ 1,000 $ 2,500 4 DELETE 2003 Crown Vic 2FAFP71W63X176385 11 $ 32,000 $ 1,000 $ 2,500 5 DELETE 2000 Crown Vic 2FAFP71 WXYX167695 11 $ 24,500 0 0 6 DELETE 2000 Ford Expedition 1FMPU16L3YLB37675 2 $ 24,000 $ 1,000 $ 2,500 7 DELETE 2006 Chevy Impala 2G1WD58C169146277 11 $ 21,246 $ 1,000 $ 2,500 8 DELETE 2007 Crown Vic 2FAFP71W87X152529 13 $ 35,000 $ 1,000 $ 2,500 PREMIUM DUE: $ (2,760) RETURN ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED , alUAL71%., aia)6**** 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original i I U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 10 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE _ AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE IVehl Comp VIN Type Value Ded I Coll Ded Model Yp I I Make I Year Ma I Status I I 1 DELETE 1988 Ford F700 Dump 1FDNF70H7JVAl2875 7 $ 32,500 $ 1,000 $ 2,500 2 DELETE 1989 Cadillac Brown 4S 1G6DW51Y5KR703757 1 3 DELETE e 2C3KA33G9 1 $ ,000 $ 1,000 $ 2,500 4 DELETE 2008 2006 Chevrolet Chryslr Impala 300 2G1WC581869203677 8H129947 11 $ 20 $ 1,000 $ 2,500 5 DELETE 1998 Ford Crown Victoria 2FAFP71 WX146885 11 $ 24,000 $ 1,000 $ 2,500 6 ADD 2011 Ford Taurus 1FAHP2FW38G125239 1 $ 26,879 $ 1,000 $ 2,500 7 ADD 2011 Atm 4W Trailer 1A9FB1629CL429003 13 8 ADD 2000 Cp Trailer 4MJUB1621TE027389 13 1 PREMIUM DUE: $ (2,278) RETURN ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED 1 a ees4P6**** 3/29/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 3/29/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original 1 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 11 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 3/15/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been $' made to the coverage section(s): AUTOMOBILE Comp CoII IVehl VIN Type Value I Ded Ded Model Yp I Year Make I I Status I # I I 1 CHANGE FROM 2011 MSG Trailer 16MPF081XBD060365 13 2 CHANGE TO 2011 MGS Trailer 16MPF081XBD060365 13 3 CHANGE FROM 2011 MSG Trailer 16MPF081XBD060412 13 4 CHANGE TO 2011 MGS Trailer 16MPF081XBD060412 13 PREMIUM DUE: $ - WAIVED ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED agag ersAP6A) 4/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 4/13/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 12 ATTACHED TO EFFECTIVE AGENCY ENDORSEMENT EF AND FORMING A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 3/23/2012 I X I City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): INLAND MARINE Item Value IM Item I Serial # I Limit I tion Deductibl # Status DESCRIPTION I 1 ADD Caterpillar Dozer D6 D6R2184976 CATOOD6RTGJB00553 $ 358,000 R $ 2,500 2 ADD 1984 Terex Earthmover 17UOT 11548 $ 250,000 R $ 2,500 3 ADD 1984 Terex Earthmover 17UOT9255217 17UOT $ 250,000 R $ 2,500 4 ADD 2010 Kamatsu Excavator PC88MR8 KMTPC205E01005392 $ 100,000 R $ 2,500 I PREMIUM DUE: $ 1,893 ADDITIONAL - ALL OT TERMS AND C ONDITIONS OF THIS POLICY REMAIN UNCHANGED 5/10/2012 AUTHORIZED RE PRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 5/10/2012 PKGIL0014 2006 ORIGINAL i U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 13 ATTACHED TO AGENCY AND FORMING ENDORSEMENT EFFECTIVE AND CODE A PART OF (Standard time) INSURED POLICY NUMBER MO DAY YR 12:01 NOON AM 99900 i PKG80610163 3/23/2012 X City of Jeffersonville THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): INLAND MARINE Item IM # Status I Item Serial # Limit IValual tionDeductibl DESCRIPTION I S I 1 ADD 2010 Kamatsu Excavator PC88MR8 KMPTC205A01005579 $ 100,000 R $ 2,500 2 ADD C ase Backhoe 580L JJG0235932 $ 80,000 R $ 2,500 3 ADD Ingersoll Rand Air Compressor 160073U87139 $ 10,000 R $ 2,500 4 ADD (2) Aluminum Trench Boxes $ 30,000 R $ 2,500 5 ADD (1) Aluminum Trench Box $ 9,000 R $ 2,500 6 ADD (2) Large Steel Trench Boxes $ 40,000 R $ 2,500 I PREMIUM DUE: $ 531 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED OAMLnlk CCAPtie%.,. 5/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 5/10/2012 PKGIL0014 2006 ORIGINAL i t U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 14 ATTACHED TO AGENCY AND FORMING ENDORSEMENT EFFECTIVE A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 6/15/2012 I X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY I In consideration for the premium charged it is hereby understood and agreed the following change(s) have been P made to the indicated coverage section(s): GENERAL LIABILITY ADD THE FOLLOWING ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN REGARDS TO: Smokin' on the River Event at 100 Riverside Drive, Jeffersonville, IN 47130 ADD Kansas City BBQ 11514 Hickman Mills Drive Kansas City, MO 64134 * *COVERAGE FOR THE PERIOD OF JUNE 15, 2012 THOUGH JUNE 16, 2012 ONLY ** ADD FORM # PKGLI0039 2006 Additional Insured - By Contract, Agreement or Permit Subject to Terms, Conditions and Exclusions of the policy - WAIVED PREMIUM DUE: ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED 0A04 eX4P6S***, 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 ENTRY PERSON C. Romano ORIGINAL PKGIL0014 2006 i I U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 15 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 4/16/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE Veh Comp CoII l VIN T e Value Ded I Ded Model YP I Make I Year Ma I Status I # I I I 1 ADD 2008 Wells Cargo Trailer 1 WCZ00N2281121795 13 $ 300,000 $ 1,000 $ 2,500 PREMIUM DUE: $ 1,402 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED awaz-n1/4,ex4p64,4%, 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group • DATE: 5/14/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 16 ATTACHED TO AGENCY AND FORMING ENDORSEMENT EFFECTIVE A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 5/20/2012 I X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the indicated coverage section(s): GENERAL LIABILITY ADD THE FOLLOWING ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN REGARDS TO: Booth at Convention Hall; Las Vegas, Nevada ADD Global Experience Specialists Exhibitor Services 700 Lindell Road Las Vegas, NV 89118 * *COVERAGE FOR THE PERIOD 05/20/2012 THROUGH 05/24/2012 ONLY ** ADD FORM # PKGLI0043 2006 Additional Insured - Managers or Lessors of Premises Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ - WAIVED I ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED GLIAAn CeAP611%*•• 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 ENTRY PERSON C. Romano ORIGINAL PKGIL0014 2006 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 17 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 4/21/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the indicated coverage section(s): AUTOMOBILE and GENERAL LIABILITY ADD THE FOLLOWING ADDITIONAL INSURED and LOSS PAYEE AS THEIR INTEREST MAY APPEAR IN REGARDS TO: 1995 Mack Truck Model DM690S, 1 M2B209COSM016450, $30,000 for Thunder Over Louisville Event ADD Kentuckiana Premier Truck Center 1606 Progress Way Clarksville, IN 47129 * *COVERAGE FOR THE PERIOD OF 04/21/2012 THROUGH 04/27/2012 ONLY ** ADD FORM # PKGCA0022 2006 Additional Insured - Lessor Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ - WAIVED ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED (24041Aanikr Ce4,0,66.4 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 ENTRY PERSON C. Romano PKGIL0014 2006 ORIGINAL ) U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE POLICY NUMBER MO. DAY YR. 12:01 NOON A.M. PKG80610163 04 21 2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated above. SCHEDULE Additional Insured (Lessor) & Address Designation Or Description Of "Leased Vehicle" Kentuckiana Premier Truck Center 1995 Mack Truck, Model DM690S 1606 Progress Way 1 M2B209COSM016450, $30,000 Clarksville, IN 47129 Coverages Limit Of Insurance Liability $ 1,000,000 Each "Accident" Personal Injury Protection (or equivalent no -fault coverage) $ N/A Comprehensive ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ 1,000 For Each Covered "Leased Auto" Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ 2,500 For Each Covered "Leased Auto" Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ N/A For Each Covered "Leased Auto" (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PKGCA0022 2006 Page 1 of 2 Copyright, Insurance Services Office, Inc., 1996 U.S. SPECIALTY INSURANCE COMPANY A. Coverage 3. If we make any payment to the lessor, we will 1. Any "leased auto" designated or described in obtain his or her rights against any other the Schedule will be considered a covered party. "auto" you own and not a covered "auto" you C. Cancellation hire or borrow. For a covered "auto" that is a 1. If we cancel the policy, we will mail notice to "leased auto" Who Is An Insured is changed the lessor in accordance with the Cancellation to include as an "insured" the lessor named in Common Policy Condition. the Schedule. 2. The coverages provided under this 2 . If you cancel the policy, we will mail notice to the lessor. endorsement apply to any "leased auto" described in the Schedule until the expiration 3. Cancellation ends this agreement. date of this policy, or when the lessor or his or D. The lessor is not liable for payment of your her agent takes possession of the "leased premiums. auto, 11 whichever occurs first. E. Additional Definition B. Loss Payable Clause 1. We will pay, as interest may appear, you and As used in this endorsement: the lessor named in this endorsement for "Leased auto" means an "auto" leased or rented "loss" to a "leased auto ". to you, including any substitute, replacement or 2. The insurance covers the interest of the extra "auto" needed to meet seasonal or other lessor unless the "loss" results from needs, under a leasing or rental agreement that fraudulent acts or omissions on your part. requires you to provide direct primary insurance for the lessor. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED May 14, 2012 AUTHORIZED REPRESENTATIVE DATE PKGCA0022 2006 Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 18 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 4/21/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the indicated coverage section(s): INLAND MARINE and GENERAL LIABILITY ADD THE FOLLOWING ADDITIONAL INSURED and LOSS PAYEE AS THEIR INTEREST MAY APPEAR IN REGARDS TO: 2010 Bennche Utility All Terrain Vehicle, LWGMDYZ4XBA000515, $8,800 ADD Southern Indiana Equipment 4433 Cory Dr., NE p'. Lanesville, IN 47136 * *COVERAGE FOR THE PERIOD OF 04/21/2012 THROUGH 04/23/2012 ONLY ** ADD FORM # PKGIM0020 2006 Inland Marine Loss Payee Endorsement & PKGLI0046 2006 Additional Insured - Lessor of Leased Equipment Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ - WAIVED ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED at&C CC( PeaN* 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 ENTRY PERSON C. Romano PKGIL0014 2006 ORIGINAL U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE POLICY NUMBER MO. DAY YR. 12:01 NOON A.M. PKG80610163 04 21 2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INLAND MARINE LOSS PAYEE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the INLAND MARINE section (s) of this policy: A. LOSS PAYABLE For Covered Property in which both you and a b. The Loss Payee has the right to receive Loss Payee shown in the Schedule or in the loss payment even if the Loss Payee has Declarations have an insurable interest, we will: started foreclosure or similar action on the Covered Property. 1. Adjust losses with you; and 2. Pay any claim for loss or damage jointly to c. If we deny your claim because of your acts you and the Loss Payee, as interests may or because you have failed to comply with appear. the terms of the Coverage Part, the Loss Payee will still have the right to receive B. LENDER'S LOSS PAYABLE payment if the Loss Payee: (1.) Pays any premium due under this 1. The Loss Payee shown in the schedule or Coverage Part at our request if you in the Declaration is a creditor, including a have failed to do so; mortgage - holder or trustee, whose interest (2.) Submits a signed, sworn proof of in Covered Property is established by such loss within 60 days after receiving written instruments as: notice from us of your failure to do so; and a. Warehouse Receipts; (3.) Has notified us of any change in b. A contract for deed; ownership, occupancy or c. Bills of lading; substantial change in risk known d. Financing Statements; or to the Loss Payee. e. Mortgages, deeds of trust, or security agreements. All of the terms of this Coverage Part will then apply directly to the Loss Payee. 2. For Covered Property in which both you and a Loss Payee have an insurable d. If we pay the Loss Payee for any loss or interest: damage and deny payment to you because of a. We will pay for covered loss or your acts or because you have failed to comply damage to each Loss Payee in with the terms of this Coverage Part: order of proceeding, as interests (1.) The Loss Payee's rights will be may appear. transferred to us to the extent of the amount we pay; and PKGIM0020 2006 Page 1 of 2 U.S. SPECIALTY INSURANCE COMPANY (2.) The Loss Payee's rights to recover C. CONTRACT OF SALE the full amount of the Loss Payee's claim will not be impaired. 1. The Loss Payee shown in the Schedule or in the Declarations is a person or At our option, we may pay to the Loss Payee the organization you have entered a contract whole principal on the debt plus any accrued with for the sale of Covered Property. interest. In this event, you will pay your remaining 2. For Covered Property in which both you debt to us. and the Loss Payee have an insurable interest we will: 3. If we cancel this policy, we will give written a. Adjust losses with you; and notice to the Loss Payee at least: b. Pay any claim for loss or damage a. 10 days before the effective date of the jointly to you and the Loss Payee, cancellation if we cancel for your non- as interests may appear. payment of premium; or 3. The following is added to the OTHER b. 30 days before the effective date of INSURANCE Condition: cancellation if we cancel for any other reason. For Covered Property that is the subject of a 4. If we elect not to renew this policy, we will give contract of sale, the word "you" includes the Loss written notice to the Loss Payee at least 10 Payee. days before the expiration date of the policy. Interest: 2010 Bennche Utility All Terrain Vehicle LWGMDYZ4XBA000515 $8,800 Loss Payee: Southern Indiana Equipment 4433 Cory Dr., NE Lanesville, IN 47136 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED awAnit May 14, 2012 AUTHORIZED REPRESENTATIVE DATE PKGIM0020 2006 Page 2 of 2 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 19 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 4/24/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the indicated coverage section(s): AUTOMOBILE and GENERAL LIABILITY ADD THE FOLLOWING ADDITIONAL INSURED and LOSS PAYEE AS THEIR INTEREST MAY APPEAR IN REGARDS TO 2012 Chevrolet Traverse, 1 GNKRJED9CJ189785, $37,809 ADD AIIy Financial Insurance Service Center P.O. Box 618 Minneapolis, MN 55440 -0618 ADD FORM # PKGCA0022 2006 Additional Insured Lessor z =, Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ - WAIVED ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED aumaZ Ce4P64§, 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 ENTRY PERSON C. Romano PKGIL0014 2006 ORIGINAL U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE POLICY NUMBER MO. DAY YR. 12:01 NOON A.M. PKG80610163 04 24 2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated above. SCHEDULE Additional Insured (Lessor) & Address Designation Or Description Of "Leased Vehicle" Ally Financial Insurance Service Center 2012 Chevrolet Traverse P.O. Box618 1GNKRJED9CJ189785, $37,809 Minneapolis, MN 55440 -0618 Coverages Limit Of Insurance Liability $ 1,000,000 Each "Accident" Personal Injury Protection (or equivalent no -fault coverage) $ N/A Comprehensive ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ 1,000 For Each Covered "Leased Auto" Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ 1,000 For Each Covered "Leased Auto" Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; MINUS: $ N/A For Each Covered "Leased Auto" (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) • PKGCA0022 2006 Page 1 of 2 Copyright, Insurance Services Office, Inc., 1996 t` U.S. SPECIALTY INSURANCE COMPANY A. Coverage 3. If we make any payment to the lessor, we will 1. Any "leased auto" designated or described in obtain his or her rights against any other the Schedule will be considered a covered p art y . "auto" you own and not a covered "auto" you C. Cancellation hire or borrow. For a covered "auto" that is a 1. If we cancel the policy, we will mail notice to "leased auto" Who Is An Insured is changed the lessor in accordance with the Cancellation to include as an "insured" the lessor named in Common Policy Condition. the Schedule. 2. The coverages provided under this 2 . If you cancel the policy, we will mail notice to the lessor. endorsement apply to any "leased auto" described in the Schedule until the expiration 3. Cancellation ends this agreement. date of this policy, or when the lessor or his or D. The lessor is not liable for payment of your her agent takes possession of the "leased premiums. auto," whichever occurs first. B. Loss Payable Clause E. Additional Definition 1. We will pay, as interest may appear, you and As used in this endorsement: the lessor named in this endorsement for "Leased auto" means an "auto" leased or rented "loss" to a "leased auto ". to you, including any substitute, replacement or 2. The insurance covers the interest of the extra "auto" needed to meet seasonal or other lessor unless the "loss" results from needs, under a leasing or rental agreement that requires you to provide direct primary insurance fraudulent acts or omissions on your part. for the lessor. i s ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED May 14, 2012 AUTHORIZED REPRESENTATIVE DATE PKGCA0022 2006 Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 } U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 20 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 5/8/2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): AUTOMOBILE Veh Com Coll # I Status I Year I Make I Model I VIN I Type I Value I Ded I Ded 1 DELETE 2008 Wells Cargo Trailer 1 WCZ00N2281121795 13 $ 300,000 $ 1,000 $ 2,500 PREMIUM DUE: $ (1,283) RETURN ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED ast AiC CC4P6.ekt%,. 5/14/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 5/14/2012 , ENTRY PERSON C. Romano PKGIL0014 2006 Original