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Home My WebLink AboutUS speciality Insurance 2012 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 73 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 8/10/2012 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): PROPERTY Building Contents Year Status I POK I Limit I Limit I Address I CK I Valuation I Built I BF CHANGE FROM 15 $ 229,917 $ 161,963 603 Crestview -Fire Hall 2 R 1960 925 CHANGE TO 15 $ 229,917 603 Crestview -Fire Hall 2 R 1960 925 CHANGE FROM 11 $ 2,812,095 $ 54,590 601 E. Court St.- Stadium /Grandstand 2 R 1940 601 CHANGE TO 11 $ 2,812,095 $ 54,590 601 E. Court St.- Nachand Field House 2 R 1940 601 PREMIUM DUE: $ (72) RETURN ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED C2WAftr CC40 , 64 4 %.„ 0 9/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 9/13/2012 ENTRY PERSON C. Romano Original PKGIL0014 2006 • U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 77 { ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 9/5/2012 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): INLAND MARINE Item I Item IValua4 IM # I Status I DESCRIPTION Serial # Limit tion Deductibl 1 DELETE 2010 Dozer AXAl203 $ 126,714 R $ 2,500 PREMIUM DUE: $ (104) RETURN ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED 9/18/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 9/18/2012 PKGIL0014 2006 ORIGINAL U.S. SPECIALTY INSURANCE COMPANY s ENDORSEMENT NO 56 l 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 7/13/2012 X City of Jeffersonville 99900 a - , 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): PROPERTY Building Contents Year CK I Valuation I Built I BF Limit Limit Address I Status POK Lim I I II CHANGE FROM 11 $ 163,770 $ 5,459 Meijer Park -Press Box 2 R 2001 619 CHANGE TO 11 $ 163,770 $ 10,000 Meijer Park -Press Box 2 R 2001 619 CHANGE FROM 14 $ 545,900 $ 873,440 701 Champion Ave -VWVTP 3 R 1994 903 CHANGE TO 14 $ 545,900 $ 200,000 701 Champion Ave - Administration Bldg 3 R 1994 100 CHANGE FROM 14 $ 54,590 $ 27,295 701 Champion Ave - Storage Bldg 1 R 1994 403 CHANGE TO 14 $ 200,000 $ 27,295 701 Champion Ave - Garage 1 R 1994 403 CHANGE FROM 14 $ 3,275,400 701 Champion Ave -WWTP Aeration Tank # 4 R 1994 903 CHANGE TO 14 $ 4,025,400 701 Champion Ave -WWTP Aeration Basin #1 4 R 1994 903 PREMIUM DUE: $ 57 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Coo* 8/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/10/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original t • U.S. SPECIALTY INSURANCE COMPANY t ENDORSEMENT NO. 57 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 7/13/2012 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): PROPERTY Building Contents Year Address CK I Valuation I Limit Ad I Built BF Status POK Limit I I I I I CHANGE FROM 14 $ 3,275,400 701 Champion Ave- VVVVTP Aeration Tank # 4 R 1994 903 CHANGE TO 14 $ 4,025,400 701 Champion Ave- VVVVTP Aeration Basin #2 4 R 1994 903 CHANGE FROM 14 $ 545,900 $ 109,180 701 Champion Ave -VVWTP Clorination Bldg 4 R 1994 903 CHANGE TO 14 $ 545,900 $ 109,180 701 Champion Ave- VVVVfP Disinfection Bldg 4 R 1994 903 CHANGE FROM 14 $ 327,540 $ 545,900 701 Champion Ave- VVVVTP Maintenance Ga 4 R 1994 401 CHANGE TO 14 $ 1,000,000 $ 100,000 701 Champion Ave -VVWTP Maintenance Ga 4 R 1994 401 CHANGE FROM 14 $ 818,850 701 Champion Ave -WTTP Clarifier #1 4 R 1994 903 CHANGE TO 14 $ 1,100,000 701 Champion Ave -WTTP Clarifier #1 4 R 1994 903 PREMIUM DUE: $ 282 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN C2M10• 7014 . CP6*o„ r „ 8/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/10/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original 0 s • , U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 58 ATTACHED TO AGENCY I I AND FORMING ENDORSEMENT EFFECTIVE A PART OF (Standard time) INSURED AND i. POLICY NUMBER MO DAY YR 12:01 NOON CODE AM PKG80610163 7/13/2012 X City of Jeffersonville 99900 1 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): PROPERTY Contents CK Valuation I Year Built I BF tus POK Limit I Limit I Address I I Sta I I Building CHANGE FROM 14 $ 818,850 701 Champion Ave -VVWTP Clarifier #2 4 R 1994 903 '$ CHANGE TO 14 $ 1,100,000 701 Champion Ave -VWVTP Clarifier #2 4 R 1994 903 CHANGE FROM 14 $ 818,850 701 Champion Ave- VVVVTP Clarifier #3 4 R 1994 903 p CHANGE TO 14 $ 1,100,000 701 Champion Ave- VVVVTP Clarifier #3 4 R 1994 903 CHANGE FROM 14 $ 818,850 701 Champion Ave -VVWTP Clarifier #4 4 R 1994 903 CHANGE TO 14 $ 1,100,000 701 Champion Ave -VWVTP Clarifier #4 4 R 1994 903 CHANGE FROM 18 $ 545,900 701 Champion Ave -VWVTP Lift Station 4 R 1994 905 CHANGE TO 18 $ 250,000 701 Champion Ave- VVVVTP Lift Station 3 R 1994 905 PREMIUM DUE: $ 122 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED , CZUJOIftw eP6* 8/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/10/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original Li U.S. SPECIALTY INSURANCE COMPANY 1 ENDORSEMENT NO. 59 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY i I A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE t AM PKG80610163 7/13/2012 X City of Jeffersonville 99900 1 i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY , 4 In consideration for the premium charged it is hereby understood and agreed the following change(s) have been 4 made to the coverage section(s): PROPERTY Building Contents Year Sta tus 1 POK Limit Limit CK Valuation 1 Built I BF I I Address CHANGE FROM 14 $ 1,091,800 701 Champion Ave -VVWTP Aerobic Digeste 4 R 1994 903 CHANGE TO 14 $ 1,091,800 701 Champion Ave -Aer Digest 2 4 R 1994 903 CHANGE FROM 14 $ 218,360 701 Champion Ave -VVWTP Gravity Thicken 2 R 1994 903 CHANGE TO 14 $ 300,000 701 Champion Ave- VVVVTP Gray Thick 1 2 R 1994 903 CHANGE FROM 14 $ 54,590 701 Champion Ave- VVVVTP Electric Sub St 4 R 1994 903 CHANGE TO 14 $ 500,000 701 Champion Ave- VUVVTP Generator /Elec 4 R 1994 903 i CHANGE FROM 14 $ 1 701 Champion Ave -VVWTP Aerobic Digest 4 R 1994 903 CHANGE TO 14 $ 1,091,800 701 Champion Ave -VVWTP Aer Digest 1 4 R 1994 903 PREMIUM DUE: $ 123 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED akmaz-TA.e&pok..... 8/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/10/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original f U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 60 I ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE ' AM 4 PKG80610163 7/13/2012 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): PROPERTY Building Contents Year Address CK I Valuation I Built I BF Limit Limit I Status POK L I I I I CHANGE FROM 14 $ 218,360 701 Champion Ave -VWVTP Gravity Thicken 4 R 1994 903 CHANGE TO 14 $ 300,000 701 Champion Ave -WWTP Gray Thick 2 4 R 1994 903 CHANGE FROM 14 $ 545,900 701 Champion Ave -WWTP Solids Processi 4 R 1994 903 CHANGE TO 14 $ 2,100,000 701 Champion Ave -WWTP Solids Processi 4 R 1994 903 CHANGE FROM 14 $ 109,180 WWTP Splitter Box #1 4 R 1994 903 CHANGE TO 14 $ 110,000 VWVTP Splitter Box #1 4 R 1994 903 CHANGE FROM 14 $ 1,091,800 $ 1,091,800 701 Champion Ave - Screening & Grit Bld 3 R 1994 903 CHANGE TO 14 $ 1,091,800 $ 1,091,800 701 Champion Ave - Headworks Bld 3 R 1994 903 PREMIUM DUE: $ 367 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED CIA0* - -- M. c ec P6A. 8/10/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/10/2012 ENTRY PERSON C. Romano , PKGIL0014 2006 Original 8`. y e is U.S. SPECIALTY INSURANCE COMPANY 4 ENDORSEMENT NO. 61 4 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY 1 A PART OF (Standard time) INSURED AND 1 POLICY NUMBER MO DAY YR 12:01 NOON CODE I AM PKG80610163 7/13/2012 X City of Jeffersonville 99900 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 4 In consideration for the premium charged it is hereby understood and agreed the following change(s) have been made to the coverage section(s): PROPERTY Building Contents Year CK Valuation I Built I Status BF Limit Address I 1 Limit I Lim I I POK I CHANGE FROM 14 $ 5,000 425 Lewman Way- Lab /Office 4 R 1941 903 1 CHANGE TO 14 $ 5,000 423 Lewman Way- Lab /Office 4 R 1941 903 } CHANGE FROM 14 $ 5,000 425 Lewman Way - Sludge Press Bldg 4 R 2000 903 1 CHANGE TO 14 $ 255,000 423 Lewman Way - Sludge Press Bld 4 R 2000 903 CHANGE FROM 1 $ 5,000 425 Lewman Way- Storage Bldg 4 R 2000 903 3 CHANGE TO 14 $ 5,000 423 Lewman Way- Storage Bldg 4 R 2000 903 CHANGE FROM 14 $ 5,000 425 Lewman Way- Generator Bldg 4 R 2000 903 CHANGE TO 14 $ 30,000 423 Lewman Way- Generator Bldg 4 R 2000 903 1 s PREMIUM DUE: $ 62 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED aumiz-ykeedio,64%,, 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B&F Group DATE: 8/13/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original } U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 62 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 7/13/2012 X City of Jeffersonville 99900 I 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): PROPERTY Building Contents Year Status I POK I Limit Address 1 CK I Valuation I Built BF I 1 L imit DELETE 14 $ 43,672 701 Champion Ave - Storage Bldg 1 R 1994 403 DELETE 14 $ 76,426 701 Champion Ave -WWTP Pole Barn 1 R 1994 403 DELETE 14 $ 54,590 701 Champion Ave -WWTP Collection Box 3 R 1994 903 DELETE 18 $ 54,590 701 Champion Ave -WWTP Lift Station 4 R 1994 905 DELETE 14 $ 5,000 425 Lewman Way - Septage Receiving 4 R 2000 903 ADD 14 $ 500,000 701 Champion Ave - Effluent Flame w /Eq 4 R 2004 903 ADD 14 $ 1,615,000 701 Champion Ave - Clarifier #5 4 R 2010 903 ADD 14 $ 1,615,000 701 Champion Ave - Clarifier #6 4 R 2012 903 PREMIUM DUE: $ 779 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED atAMC eeriii 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/13/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original a U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 63 ATTACHED TO T EFFECTIVE AGENCY ENDORSEMENT AND FORMING INSURED AND A PART OF (Standard time) 1 POLICY NUMBER MO DAY YR 12:01 NOON CODE AM 680610163 7/13/2012 X City of Jeffersonville 99900 1 PKG80610163 t: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ' ' I 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): PROPERTY 1 Building Contents Year 9 CK Valuation I Built I BF i Status POK Limit I Limit I Address I I s Stat I ADD 14 $ 300,000 7 01 Champion Ave- Ras/Was Electric Bldg 4 R 2010 903 000 p 2008 903 ADD 14 $ 300,000 701 Champion Ave - Gravity Thicken #3 4 R ADD 14 $ 110,000 VVWTP Splitter Box #2 4 R 2000 903 ADD 14 $ 110,000 VWVfP Splitter Box #3 4 R 2000 903 ADD 14 $ 110,000 WWTP Splitter Box #4 4 R 2000 903 ADD 14 $ 110,000 VWVfP Splitter Box #5 4 R 2000 903 ADD 14 $ 500,000 WWTP- Influent Channel 4 R 2008 903 ADD 14 $ 1,250,000 .. WWTP -UV Post Aeration 4 R 2008 903 PREMIUM DUE: $ 626 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED aLOWIft C 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/13/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO. 64 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 7/13/2012 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): PROPERTY Building Contents Year Status I POK Address I CK I Valuation I Built I BF I I I Limit Limit ADD 14 $ 490,000 VWVTP- Ras/Was Pump Station 3 R 2011 905 PREMIUM DUE: $ 110 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED adeu..--ykecu,6*%,, 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 8/13/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original • U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 65 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY a A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON i, AM f x Cit of Jeffersonville 99900 PKG80610163 7/16/2012 X City a l I 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 Item Value IM 1 DESCRIPTION I Serial # I Limit I tion Deductible Status DES l # I I 1 ADD 10 Scoreboards @Meijers Park $ 100,000 R $ 2,500 2 CHANGE FROM Fences & Arbors @Meijers Park $ 125,000 R $ 2,500 3 CHANGE TO Fences & Arbors @ Meijers Park $ 145,000 R $ 2,500 I k t i a t i g I I 1 , I PREMIUM DUE: $ 141 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED CIAMAn CrAPO***,„ 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 8/13/2012 ORIGINAL PKGIL0014 2006 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 66 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 7/24/2012 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 coverage section(s): INLAND MARINE Item Item IM # Status I DESCRIPTION Serial # l Limit IValual tionDeductible 1 CHANGE FROM 2006 Hustler Super Z Cut 60" $ 7,500 R $ 2,500 2 CHANGE TO 2006 Hustler Super Z Cut 60" $ 9,500 R $ 2,500 3 CHANGE FROM (3) Golf Carts $ 7,500 R $ 2,500 4 CHANGE TO (2) Golf Carts $ 12,000 R $ 2,500 5 CHANGE FROM Tor Sandpro Tractor $ 8,000 R $ 2,500 6 CHANGE TO Toro Sandpro Utility Vehicle $ 15,000 R $ 2,500 7 CHANGE FROM 2008 Super Z Lawn Mower 25 KW 60XR7 927889 $ 8,179 R $ 2,500 8 CHANGE TO 2008 Super Z Lawn Mower 25 KW 60XR7 927889 $ 9,500 R $ 2,500 PREMIUM DUE: $ 17 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED C. _ " COQ.,,. 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 8/13/2012 ORIGINAL PKGIL0014 2006 a • U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 67 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE 1 POLICY NUMBER MO DAY YR 12:01 NOON AM I PKG80610163 7/24/2012 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 coverage section(s): INLAND MARINE I Item I I Item IValuaI IM i # I Status DESCRIPTION Serial # Limit tion Deductible 1 CHANGE FROM Kawasaki Prairie 4- Wheeler w/ Plow 360 $ 6,000 R $ 2,500 2 CHANGE TO Kawasaki Prairie 4- Wheeler w/ Plow 360 $ 9,000 R $ 2,500 3 CHANGE FROM Lawnmower $ 7,000 R $ 2,500 4 CHANGE TO Lawnmower Hustler Super Z $ 9,500 R $ 2,500 5 CHANGE FROM Kawasaki Mower Hustler Supr 2 25 HP $ 7,500 R $ 2,500 I 6 CHANGE TO Kawasaki Mower Hustler Supr Super Z $ 9,500 R $ 2,500 t 7 CHANGE FROM 2008 Skid Steer Loader Series 3 $ 18,470 R $ 2,500 8 CHANGE TO 2009 Gehl CT665 Skid Loader T8906K01388 $ 18,470 R $ 2,500 1 1 t v i n i t 2 i t ry t at i f PREMIUM DUE: $ 8 ADDITIONAL t P ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED c""'rw. capful,. ; 8/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 8/13/2012 ORIGINAL PKGIL0014 2006 i , U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 68 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 7/24/2012 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 coverage section(s): INLAND MARINE Item Item ua IM # I 1 IVal St atus I DESCRIPTION I Serial # Limit tion Deductible 1 1 CHANGE FROM Kubota 4WD Deck Mower $ 5,000 R $ 2,500 2 CHANGE TO Kutoba Front Deck Mower $ 14,000 R $ 2,500 3 ADD Isco /McElroy Model 145001 Pipe Fusion Mach $ 58,000 R $ 2,500 4 ADD Toro Reel Turf Mower $ 21,000 R $ 2,500 5 ADD Toro Workman 07264 UTV $ 10,000 R $ 2,500 6 ADD Toro Workman 07264 UTV $ 12,000 R $ 2,500 PREMIUM DUE: $ 123 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED 8/13/2012 AUTHORIZED REPRESENTATIVE DATE 1 i AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 8/13/2012 PKGIL0014 2006 ORIGINAL 1 t t 1 U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT 69 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE i POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 7/24/2012 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 I to the coverage section(s): INLAND MARINE Item Item Value IM 4 # Status DESCRIPTION I Serial # I Limit 1 1 tion Deductibl 1 1 1 ADD Hustler Super Z Mower $ 9,500 R $ 2,500 I i 2 ADD Hustler Z Mower $ 8,000 R $ 2,500 3 ADD 1991 John Deere Gator AMT626 UTV W00626X002086 $ 9,000 R $ 2,500 4 ADD Hustler Super Z Mower $ 9,500 R $ 2,500 I 5 ADD Hustler Super Z Mower $ 9,500 R $ 2,500 9 6 ADD Genie Gen. /Light $ 15,000 R $ 2,500 f I i .z I i u ' o I 1 S 1 f_ j E 1 i i i A PREMIUM DUE: $ 68 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED 1` 8/13/2012 A 1. UTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 8/13/2012 r PKGIL0014 2006 ORIGINAL t t 4. U.S. SPECIALTY INSURANCE COMPANY i ENDORSEMENT 71 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND CODE POLICY NUMBER MO DAY YR 12:01 NOON AM PKG80610163 8/1/2012 I X I City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY v 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 I Item Item Valua # I Status I DESCRIPTION Deducts Serial # I Limit tion 1 IM bl 1 DELETE Bulldozer D5C XL 79500800 $ 100,000 R $ 2,500 2 DELETE Caterpillar 289 CXPS Compact w /Attachmts JMP01110 $ 113,400 R $ 2,500 ii }F Y I t l i. kr' PREMIUM DUE: $ (227) RETURN 1 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED atwz-yit ex4pcw„. ,,. 9/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT 40 B &F Group ENTRY PERSON C. Romano DATE: 9/13/2012 PKGIL0014 2006 ORIGINAL i } `i U.S. SPECIALTY INSURANCE COMPANY i ENDORSEMENT NO 72 k 4 ATTACHED TO x AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON AM CODE PKG80610163 8/10/2012 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): PROPERTY Building Contents Year Status I POK l Limit I Limit I Address I CK I Valuation Built I I BF CHANGE FROM 15 $ 81,885 700 11th Street - Vacant 2 R 1960 000 CHANGE TO 15 $ 250,000 700 11th St -Fire Union Hall 2 R 1960 925 CHANGE FROM 10 $ 1,637,700 1613 E. 8th St.- Adminstratiive Office 3 R 1954 100 CHANGE TO 10 $ 1,637,700 1613 E. 8th St. -Cali Building 3 R 1954 100 CHANGE FROM 10 $ 5,459,000 $ 345,511 500 Quarter Master - Administrative Office 2 R 1870 100 CHANGE TO 10 $ 5,459,000 $ 1,000,000 500 Quarter Master - Administrative Office 2 R 1870 100 is , , y t f t t PREMIUM DUE: $ 367 ADDITIONAL t ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED , astr eer4B644%*„, # 9/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B&F Group DATE: 9/13/2012 ENTRY PERSON C. Romano Original PKGIL0014 2006 E U.S. SPECIALTY INSURANCE COMPANY i ENDORSEMENT NO 75 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 8/28/2012 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 Coll # I Status I Year Make Model VIN Type Value Ded D ed I I I Yp I I I } I 1 ADD 2000 Pierce Fire Truck 4P1CTO2UDYA000452 5 $ 250,000 $ 1,000 $ 2,500 3 . Y ; P , t : l ' r I fi ti t k '. i t PREMIUM DUE: $ 241 ADDITIONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED i a ux..--mezahwi•44,,,,, i 9/18/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 9/18/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original U.S. SPECIALTY INSURANCE COMPANY ENDORSEMENT NO 76 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE A PART OF (Standard AGENCY Standard time) INSURED POLICY NUMBER MO DAY YR 12:01 NOON AND CODE AM PKG80610163 9/4/2012 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 # I Status Year Make Comp Coll ke Model odel I VIN I Type I yp Value Ded I D ed I I 1 ADD 2013 Freightliner w/ 31 Yard 1 FVHG3DV2DDFB2866 3 $ 182,115 $ 1 000 $ 2,500 Rear Loading Garbage Packer 2 ADD 2013 Freightliner w/ 20 Yard 1FVACYBSXDDFB2861 3 $ 128,310 $ 1,000 $ 2,500 Rear Loading Garbage Packer ADD AS ADDITIONAL INSURED - LESSOR AS THEIR INTEREST MAY APPEAR IN REGARDS TO VEHICLE # 1 and 2 The Leasing Group LLC 130 St. Matthews Ave, Ste 201 Louisville, KY 40207 ADD FORM PKGCA0022 2006 Additional Insured - Lessor See Attached Forms h r Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ 830 ADDITONAL ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED eroaksAN.,, } 9/18/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 9/18/2012 ENTRY PERSON C. Romano PKGIL0014 2006 Original t vrommi imummium 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 09 04 2012 X City of Jeffersonville 99900 R 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" The Leasing Group LLC 2013 Freightliner w/31 130 St. Matthews Ave, Ste 201 Yard Rear Loader Garbage Packer Louisville, KY 40207 1 FVHG3DV2DDFB2866, $182,115 fi 2013 Freightliner w/31 Yard Rear Loader Garbage Packer 1 FVACYBSXDDFB2861, $128,310 I 1 t 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; [ k 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" ° g i (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) i PKGCA0022 2006 Page 1 of 2 Copyright, Insurance Services Office, Inc., 1996 Nrimir U.S. SPECIALTY INSURANCE COMPANY A. Coverage 3. If we make an y 1. Any "leased auto" designated or described in t obtain his or her rights against an w oth i ll the Schedule will be considered a covered party. Y er "auto" you own and not a covered "auto" you C. Cancellation hire or borrow. For a covered auto that is a "leased auto" Who Is An Insured is changed 1 • If we cancel the policy, we will mail notice to to include as an "insured" the lessor named in the lessor in accordance with the Cancellation the Schedule. Common Policy Condition. 2. If you cancel the policy, we will mail notice to 2. The coverages provided under this endorsement apply to any leased auto" the lessor. described in the Schedule until the expiration 3. Cancellation ends this a reement. date of this policy, or when the lessor or his or g D. The lessor is not liable for payment of your her agent takes possession of the "leased auto," whichever occurs first. premiums. 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 fraudulent acts or omissions on your part. requires you to provide direct primary insurance for the lessor. a I ti { 33 1i x 444,. is ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED September 18, 2012 AUTHORIZED REPRESENTATIVE DATE PKGCA0022 2006 Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 1 U.S. SPECIALTY INSURANCE COMPANY i I ENDORSEMENT NO 74 1 4 ATTACHED TO AND FORMING ENDORSEMENT EFFECTIVE AGENCY A PART OF (Standard time) INSURED AND POLICY NUMBER MO DAY YR 12:01 NOON CODE I AM 1 W 1 PKG80610163 8/30/2012 X City of Jeffersonville 99900 M 1 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 t - Veh # Comp Status I Year Make Model VIN Type Value I Ded p Coll d I P Ded IY I I i d !; T :: f 1 CHANGE FROM 2009 International Camera Van 4UZAAPDU49CAL7117 2 $ 300,000 $ 1,000 $ 2,500 t 2 CAHNGE TO 2009 Freightliner 4UZAAPDU49CAL7117 2 $ 300,000 $ 1,000 $ 2,500 ) I t f ADD AS ADDITIONAL INSURED - LESSOR AS THEIR INTEREST MAY APPEAR IN REGARDS TO: VEHICLE # 2 Republic Bank & Trust Company x; 601 W. Market Street Louisville, KY 40202 ADD FORM PKGCA0022 2006 Additional Insured - Lessor See Attached Forms t Y : E Subject to Terms, Conditions and Exclusions of the policy PREMIUM DUE: $ - WAIVED ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED a L A A • erA4P6***% ' 9/13/2012 AUTHORIZED REPRESENTATIVE DATE AGENT: 40 B &F Group DATE: 9/13/2012 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) POLICY NUMBER MO. DAY YR. 12:01 NOON INSURED AGENCY AND CODE j A.M. PKG80610163 08 30 2012 X City of Jeffersonville 99900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR i This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception nception date of the policy unless another date is indicated v i SCHEDULE Additional Insured (Lessor) & Address Designation Or Description Of "Leased Vehicle" Republic Bank & Trust Company 601 W. Market Street 2009 Freightliner Louisville, KY 40202 4 UZAAPDU49CAL7117, $300.000 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 WHI CHEVER IS LESS; MINUS: $ 1,000 For Each Covered "Leased Auto" Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEV MINUS: $ 2,500 For Each Covered "Leased Auto" ER IS LESS; Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER MINUS. $ N/A For Each Covered "Leased Auto" IS LESS; (If no entry appears above, information required to complete this endorsement will be applicable to this endorsement.) shown in the Declarations as 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 a men to 1. Any "leased auto" designated or described in obtain his or her rights against any other the Schedule will be considered a covered party. I "auto" you own and not a covered "auto" you C. Cancellation hire or borrow. For a covered "auto" that is a "leased auto" Who Is An Insured is changed 1 • If we cancel the policy, we will mail notice to Y to include as an "insured" the lessor named in the lessor in accordance with the Cancellation the Schedule. Common Policy Condition. 2. If you cancel the policy, we will mail notice to ,ill' 2. The coverages provided under this endorsement apply to any "leased auto" the lessor. t described in the Schedule until the expiration 3. Cancellation ends this agreement. date of this policy, or when the lessor or his or I" her agent takes possession of the "leased D. The lessor is not liable for payment of your auto," whichever occurs first. premiums. 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 needs, under a leasing or rental agreement that lessor unless the "loss" results from fraudulent acts or omissions on your part. requires you to provide direct primary insurance for the lessor. i s i r 1 i i ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Cam. - m C adal. , September 13, 2012 AUTHORIZED REPRESENTATIVE DATE PKGCA0022 2006 Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996