EFTA01221709.pdf

First Insurance: Port of Sale P.O. Box 306359 St. Thomas VI 00803-6359 340-779-1799 ENCLOSURE RENEWAL AGREEMENT Named Insured: Financial Trust Co. Insurance Company: Tyser MM04 Expiring Policy Number: MM04-0374 Expiring Policy Date: 11/10/10 Renewal Effective Date: 11/10/10 Renewal Premium: $8811.25 IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS HEREBY UNDERSTOOD AND AGREED THAT THE INSURANCE COVERAGE PROVIDED BY THE RENEWAL OF THE ABOVE POLICY IS SUBJECT TO THE SAME TERMS AND CONDITIONS AS THE EXPIRING POLICY. THESE TERMS AND CONDITIONS INCLUDE THE DECLARATIONS MADE AT THE TIME THE PREVIOUS APPLICATION WAS TAKEN AND THAT INFORMATION IS HEREIN INCORPORATED AS THE BASIS FOR THE RENEWAL OF THIS POLICY OF INSURANCE. ACCEPTED (NAMED INSURED) DATE EFTA01221709  COMMERCIAL INSURANCE APPLICATION DATE (MWOO(YYTY) APPLICANT INFORMATION SECTION OP ID SH AGEtICY CARRIER NAM CODE: UNDERWRITER ri fdAIRigR'gr, Certain Underwriters I Lloyd's First Insurance: Port of Sale lARMIEFOWFROZIO:R1LEZWEgTEr P.O. Box 306359 St. Thomas VI 00803-6359 14404-0374 for First Insurance Agency INDICATE SECTIONS ATTACHED EQUIPMENT FLOATER GARAGE AND DEALERS moot PROPERTY INSTALLATION/BUILDERS RISK VEHICLE SCHEDULE na tio,,Exit 340-779-1799 ow, 340-779-1926 GLASS AND SIGN ELECTRONIC DATA PROC BOILERS MACHINERY inc Nog 1.444:' - COUNTS RECEIVABLE/ AL WORKERS COMPENSATION ADDRESS: VALUABLE PAPERS COMMER GENERALCIIABILITY L COOS: SUB CODE: CRIMERAISCEUANEOUS CRIME BUSINESS AUTO UMBRELLA AGENCY CUSTOMER 10: TRANSPORTATION? TRUCKERS/MOTOR CARRIER FINAN-1 MOTOR TRUCK CARGO STATUS OF TRANSACTION PACKAGE POLICY INFORMATION 0J011 I j ISSUE POLK* J RENEW ENTER THIS *FORMATION WHEN COMMON DA ES AND TERMS APPLY TO SEVERAL LINES. OR FOR MONOUNE POLICIES. 12:00 IXIPM PA4 BOUND (Ova Dale *Foci Allach Copyh PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN AUDIT CIIMRE DATE I TIME DIRECT BILL CANCEL 11/10/10 11/10/11 AGENCY BK.I. X APPLICANT INFORMATION VAMI: (rks! Named Insured & Other Named Insureds) rem UN hub ael., I 55 INCL ZIP /4 of Firs! Named Insured) (or First Named Insuied): Financial Trust Co. OVE— letcsys,pn9: 340-775-2528 6100 Red Hook Plaza Ste 83 St. Thomas VI 00802 E-MAIL wEeasR. AIRNIESSLESL ADDRESSIES)e St/SOUPIER LLC —arBIIREAU ID NUMBER 7- 011E1AIS STARTED INUiviDUAL I I CORPORMX)N CORPORATION NAME NOT FOR PAM NEILEMV L JOINT vanuft •- PROFIT ORG i i lattfir INSPECTION CONTACT ACCOUNTING RECORDS CONTACT 'PHONE - (NC, No, ERIK ADDRESS: INC. No, Er* ADDRESS: PREMISES INFORMATION LOCI SLOE STREET, CRY, COUNTY, STATE,21144 CITY LUSTS INTEREST YR 9 ANNUAL PART OCCUPIED BUILT EMPLOYEES REVENUES American Yatch Harbor STE B-3 INSIDE — OWNER St. Thomas VI -- X ansmc --X TENANT — /SIDE — OWNER OUTSIDE TENANT NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S) FINANCIAL SERVICES OFFICE GENERAL INFORMATION EXPLAIN ALL 'YES' RESPONSES YES NO EXPLAIN AU."YES" RESPONSES YES; NO - IN0 TO StXuAL AIIVSt 00 '11 IS VII APPI *CAM A SUILSIDIARY OF ANOTHER ERTEN ? ' h IXTI i DIEWIN-JCANI cl/b/E.AEW SMBSIOLARIES? - "X -. -7 - -ASOLACTIII&PAELtEGACIONS (tRImiWOIONOR NITA ICENT HIRING? x S. DURING THE LAST FIVEYEA/th (LENIN RI). HAS Na APPLICANT IX oX BEEN DONVICTED OF ANY DEGREE OE M+ CRIME OF ARSON? ? IS A FORMAL RNA TY PROGRAM 94 OPERA DON? X on quesoon must be answcted by any am lOr properly insurance. Failure to d,sclo, On applcon is a 3 MIT E XPOSURE TO I LAMMABLES. EXPLOSIVES CHEMICALS? X punishable by 8 sews " of up to one year of kno ionmenou _ -I AW CALMI ROPIIE EXPOSURE? x 9. ANY UNCORRECTED FIRE CODE VIOLATIONS? _ X S AW OTHER INSURANCE MN DRS COMPANY OR BEING sustarrEm firAFIYIlallikUPTCTE3W, CM CREOMLIENS-A0rw(STTRCAPPECANT-- --- " " X IN THE PAST5YEARS? X A - toti POLICY ORCOVERAMSECURFD OR N . Er It. HAS ISUSINL5blibtfi PLACED IN Al RUS i? DIMING ME PRIOR] YEARS? (Rol_eppkallo in MO IF YES. NAME OF TRUST- X REMARKSIPROCESSING INSTRUCTIONS (Attach additional sheets II more space Is requIred) AW slit-SONVA If/KNOWINGLY AND WITH INTENT TO DEFRAU0 ANY INSURANCE COMPANY OR ANOTHER PERSON [It I'S MIAPPTIC.A HON FOR INSURANCE :)It S :A II MI NI O' CA NM CONTAINING ANY MAIEIUALLY FALSE INFORMA fION. OR CONCEALS FOR THE PURPOSE OF MISI EADING. INFORMATION P.OFAI ItNING ANY FACI MATE/UM IIIERE l(). COMB IS A FRAUDUL ENI INSURANCE ACT. WINCH IS A CRIME AND SUBJECTS THE PERSON TO CRIMMAL AND NY: PIS MMIMICMI PENALTIES. (No applicable in CO. HI IE. Oil. OK. OR. or VT: in DC. LA. ME. TN and VA. insurance bene5ls may also bo denied) • • It WAX RSIGNEI) IS AN AL MI IORVED REPRESENTATIVE OF THE APPLICANT AND CERTIFIES THAT REASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN TIC t NSW! 'LS 10 GUEST IONS ON TIM APPLICATION. IIEWHE CERTWIES THAT THE ANSWERS ARE TRUE. CORRECT ANL) COMPLETE TO THE BEST OF HISMER 2,10vA 'DCA.. APPI ICANTS SIGNATURE DATE PRODUCER'S SIGNATURE for First Insurance N/WN4§mucER NUMBER ACORO 125( 004/03) PLEASE COMPLETE REVERSE SIDE ACORD CORPORATION 1993 EFTA01221710 PRIOR CARRIER INFORMATION FINAN- 1 LINE 1 CATEGORY CARRIER _ _ _ _ .___. _. __. _.___ _ ........___ ..._ _. _.. _.. . I 'IX ICY la.IMIIIR I - . . . . _. . . .. . . ... .. . . 1 I KR ICY I YPT ! 'Il.litOlIAll. [ ucwrm 1 FL"..D4L [ c.141 [ F.— —.1-t:'; 1 1— ic= I 1.--- 1.°=.. L I--- . . . . . . ... _. . - . . e L . , I If I Xif DAII' . . . .. . GI NI RN nooRredar .. .. . .. ._ .. . . c t midxfc rS dooms ols 0 R ACCIWCAII MA i PI ItSONM. B AMIN/ m L L F.ADI OCCURRENCE R i c I i ENE DAMAGE A M 8 MEDICAL EXPENSE i I i L S nookr OCCURRENCE I INJURY AGGREGATE 7 Y piton mThOCCURRENCE DAMAGE AGGREGATE COMIWRI)SINGIF LIMIT MOILIFICAIION I AC1OR POI AL PHI MIUM ---- 'AMBER POI ICY NUMIN It A L ; V LILY I YPE I flE1 XV DATE - I: A . _ _ ... .. .... -- — u8 (ANNUM I) SING If L IMF! a IL noon r I A PERSON ._. . . _ _... . _. . 1 L v INJURY ACCIDENT E Y PROPFJUY DAMAGE . .. ._ . ... _ MOINFIC.AlION I ACTOR . . _ . . _ . . .. . ._. . . . .. . TOTAL MB.MIUM CARRIER - _ "MCI KIMBER P R IIXICY I YPE 0 p I IF I XV DATE E R I WILIVIG ... _ AMT T v I PI RSPROP AMT W3IXFICAIION FACTOR I OIAL PRI MIUM GAMER POLICY NUMBER POLICY TYPE II+ I Xlf DATE F ISM MOILIFICAI ION F ACIOR 101AL IfItIMIUM LOSS HISTORY 4 AI t. UN I Obbtb pil•UNIULtbb IN I -Alt I ANU VYtit IIIFJIVHNUI iNbURI:Lpant DI.IUIINF.l1ptS INA, MAY OlVt It bt It/ LLAMAS I tAilk Mitt Mt AIIAVItD • 0! 'IN !MDR S YE ARS(JY8AFIS.N XS IS NY). I XIF NON I kOM OMMAItY 1 'LATE OF DATE AMOUNT AMOUNT CLAIM OCCURRENCE UNE TYPEMESCRIPTION OF OCCURRENCE OR CLAIM DE CLMM PAID RESERVED STATUS _ • -1 ^ • . I LmA lamp - - • -. - . _.•._ . _ • - - arm ...I ;or . REMARKS NOTE' FIDELITY REQUIRES A FIVE YEAR LOSS HISTORY ATTACHMENTS STATE SUPPLEIMENTIS)Ill epobeatio COPY 01 IHE NO I CC or IntORAIATION PRACTICES (PRIVACY) HAS LW EN GIVEN TO THE APPLICANT. (NS **able in talLattS. Consult )•eAt agent pc broker for yoix slate's requiem., 1 401 .11 OF INSURANCE INFORMATION PRACTICES PERSONAL INFORMATION ABOUT YOU, INCLUDING INFORMATION FROM A CREDIT REPORT. MAY SE COL ECTED FROM REOMS OTIII R MAIM YOU IN CONNECTION WITH THIS APPLICATION FOR INSURANCE AM) SUBSEQUENT POLICY RENEWALS. SUCH WE ORMA I ION AS WELL AS 011IER RSONAL AND PIM.' GLI) INEORIAATK)N COLLECTED BY US OR OUR AGENIS MAY IN CFRINN CIRCUMSTANCES BE DISCLOSED TO MIRO PATTIIES WITHOUT YOUR AJII Old/A IION. YOU HAVE DIE 10011T (0 REVIEW YOUR PERSONAL. IM-011MA TION IN OUR FILES ANOCAN REQUEST CORRECTPDN OF ANY INACCURACIE . A MORE ') Mil I) DESCRIPTION OF YOUR RICHES AND OM PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST. CONTACT YOUR AGENT 044 BROKER FOR NSTRUCT IONS ONHOW10 SUBMIT A RWUEST TO US. AGGRO 125 (2004103) EFTA01221711  DATE (MWDONYYTI ACORD PROPERTY SECTION FINAN-1 OP ID SHI 09/28/10 AGE‘CY PlIcirp.;!„): . . 340.77797.1799 . APPLICANT IFIrt_ , . (LTA. Net . ..._1.40-_779-1926 .._______ rue° Financial Trust Co. .._ _ _ ___ ..... .________ _._ ___._____ _ First Insurance: Port of Sale EFFECTIVE DATE EXPIRATION DATE 1 PAnatirt PTAH - --- -Mioll I DIRECT BEL P.O. Box 306359 -- St. Thomas VI 00803-6359 11/10/10 11/10/11 X AGENCY mu for First FOR Insurance Agency _ COMPAIff COOL.: I SUB CODE: USE ONLY AGENCY CtaJOAFR ID' FINAN-1 PREMISES I: STREET ADDRESS: PREMISES INFORMATION BUILDING i: BLDG bileriiiiiiiii INHA RUN MA i SUBJECT OF INSURANCE AMOUNT COINS % VALUADO CAUSES OF LOSS GUARD % DEDUCTIBLE Gov FORMS ME CONDEMNS TO APPLY IMPROVE & BET 350000. _ . Anoinomm. INFORMATION I I BUSINESS INCOME l EXTRA EXPENSE I I BUSINESS INCOME WIC EXTRA EXPENSE i I EXTRA EXPENSE Off OF BUSINESS ORDINARY PAYROLL POWEWHEAT EXT PEFOOD _TTUITION FEES I OF PREM POWER DEPEND PROP RIN Mit irxci. I ..1 ma. S DEO DAYS $ STUDENTS POWER %COIN . . --- %I G !- I I wows ELEC MEDIA MO PERIOD $ OTHER ED WATER CONY LOC A AIRING I . ISO DAYS DAYS LMT SERVAL — COMA NEC LOC -- (DESCR BELOW) _ . % CODA I. - $ _________ ORO OR LAW _I MAX PERIOD MFG LOC — DAYS LIM LOC WESC UELOVO NAM: AND ADDRESS ES) FOR OFF PREM POWER OR DEPENDPROP .. _ EXPENSE DAYS PERTOD REST American YatCh Harbor ••rs B - 3 mar LOSS PAY it. Thomas VI ADD. TONAL COVERAGES. OPTIONS. RESTRICTIONS. ENDORSEMENTS AND RATING INFORMATION CONSTRUCTOR TYPE - INSTANCE TO FIRE DISTRICT/CODE NUMBER PROT CL TCT-ORIES]: BASMITSI YR BUILT TOTAL AREA HYDRANT FIRE STA1 STEEL/CON. F d ,1 ,3 3 I 1992 2800 BOLDING IMPROVEMENTS LI/4 LOU! TAX CODE ROOF TYPE OTHER OCCUPANCIES • — GRADE 'AMONG. YR: PLUMBING. YR: -.-- ri tEXWING. YR: HEATING. YR: WINO CLASS ICATING BOXER ON PREMISES? . _ . YES i _. NO I SEM. .YI al R. RESISTIVE 0 mrsmuyE OTHER IF YES. TS INSURANCE PI ACE0 ELSEWHERE? YES NO TUC If EXPOSURE & DISTANCE LEFT EXPOSURE A DISTANCE REAR EXPOSURE S. DISTANCE i:issi:s tTisiaini . • - " CERTIFICATE N 1 EXPIRATION DATE .1 -EXTENT_fGRADE __ CENTRAL STATOR ADT WITH KEYS BIMCI.AR ALARM INSTALLED AND SERVICED BY a GUAROSAVATCHMEN CLOOC HOURLY "REUSES FIRE PROTECTION igilaklars, Standpipes. GOZ/ChomMal SWIRM) % SPRNK FIRE ALARM MANUFACTURER CENTRAL STATION LOCAL GONG ADDITIONAL INTERESTS RARE: NAME AND ADDRESS: REFERENCE M: I. [CERTIFICATEREWIRED INTEREST IN ITEM WMBER :NTEREST . LOCATION: I BUILDING: I II/SS PATTI SCHEDULED ITEM NUMBER: . . WWI GAO I' OTHER: ITEM DESCRIPTION: VALUE REPORTING INFORMATION t R4 R' INC FORM PROW* AVLRAGE VALUES FOR PAST 12 MONTHS ANY OTHER LOCA. ANY OTHER LOCA. PREMISES NOT OWNED . . . . _ _ ... _ _ . .__ ._ .. _ . .__ _._ _.._ _ _ _ _ ______ PREMISES( TION DECLARED BUILDING TION ACQUIRED OR ACQUIRED SUBJECT OF INSURANCE AT INCEPTION AFTER INCEPnON WAIT ATTACH TO APPLICANT INFORMATION SECTION © ACORD CORPORATION 1985 EFTA01221712  AlIDITIONAL PREMISES STREET ADDRESS: FINAN-1 ORE MISES INFORMATIONBUILDING I: BLDGDESCRIPTION: SUBJECT OFINSURANCE AMOUNT COINS% VALUATION OFLOSSWVLA CAUSES % DEDUCTIBLE GUARD COP FORMS ANDCONDITIONS TOAPPLY I euN VU'I ARMfIONALINFORMATION [ [ BUSINESS EXTRA INCOME/ EXPENSE BUSINESS INCOME EXPENSE EXTRA MOEXTRA 1 EXPENSE I I ORDINARY TYPIOFBUSINESS PAYROLL POWERMEAT TEXTPERIOD ._ TUITION FEES OFFPREMPOWER DEPEND PROP NONMICA Ex° I I wa. {_.____ I. ..___TIED DAYSS -[. . POWER STUDENTS 'AIG WAYS ELECMEDIA _] MOPERIOD IO ED WATER OTHER SERWINC ITTITCS AirLINO 180DAYS IMYS— COMM IN:LOW) MFGLOC (DESCR RE CTM C %COIN -1 . . %COINS .. S °FLOOR LAW MAX PERIOD LOC . .. _ ...... . _ .... -_ PROP-DAYS- - -*-- _--- LORLOCMESCBELOW) __. JAPAE ANDADOiEiSfeSIFOliPREMPOWERORDEPEND .. . Off E NU DAYSPERK/ORESI 1 LOSSPAY AlMiIIONAL OPTIONS, RESTRICTIONS. COVERAGES. ENDORSEMENTS INFORMATION ANDRATING -.% -.% - ii ')ONSTRUCTION TYPE HYDRANTFIRESTAT FIREDISTRICT/CODE 1 MSMIC9 NUMBER PROTCLr STORIESBASISTS ITIMLITOTALAREA td LIM FT MISURRADE I :HARINGIMPROVEMENTS GTCODETAXCODEROOF1YPE YR: .YEUNG. RPLUMUING. llYR WINDCLASS 4COFING. YR' PPLEATING YR BOILER HEATING ONPREMISES? YEST NO I .YINUR .. - RESISIWE IS L IFIISIIIST NE ri OTHER IFYES. IS INSURANCE PLACED ELSEVVIIERE? YES W) I _. IIIONTEXPOSURE &DISTAIICE TLEFT DISTANCE REAREXPOSURE DISTANCE 1 j EXPOSURE & 8 NURGLAR ALARMTYPE CERTIFICATE I EXPIRATION DATE GRADE CENTRAL STATION EXTENT IORGLAR ALARM INSTALLED ANDSERVICED BY WITIIXEYS IGUARDSAVATCHMEN CLOCKHOURLY aNEXISESFIREPROTECTION %SPRNKFIREALARM (Sprinklers. Standpipes, CONChonical Symms) MANUFACTURER CENTRAL STATION LOCALGONG ADDITIONAL INTERESTS NAMEANOADDRESS: I 5: REFERENCE . . CERTIFICATE REQUIRED INITEMNUMBER I I INTEREST INTEREST . IP/LYEI CXLS LOCATION: BUILDING: _ . I MAORI SCHEDULED ITEMNUMBER: CACI II ITEMDESCRIPTION: OTHER: REMARKS A•:MI NI Of- CLAW 'ASON VA TO KNOWNGLYA/0VMM ANY CONTAINING WENTTOM MATERIALLYBAUD FALSE ANYINSURANCE INFORMATION. OR COMPANY ORANOTHER CONCEALS FORTHE PERSON PURPOSE OF FRES MISTANAPPLICATION EAIXNG FORCONCERNING INFOR/AAT ION INSURANCE OR ANT ACT/MIT 3 JPIANHAL RIM.PENALTIES. ' CIVIITHERE TO.COMMITS INN AERAUDUI.ENI INSURANCE NE. ACT. (NI,OK,ORwVI:WHICH ISACOME applicabla in CO. HI. INANOVA. NOE. SUBJECTS TILEPERSON TOCRIMINAL ANDINY on DC. IA. and inswance DINIONS may also be denied) ACORD 140 (2002/09) EFTA01221713