Policy Type Insurance Company Policy Number Policy Period Total Cost 8,422.00

Transcription

1 Policy Overview Prepared on : 01/13/2012 Page 1 of 17 Policy Type Insurance Company Policy Number Policy Period Total Cost Commercial Property Applebee Insurance /13/2012-1/13/2013 8,422.00

2 Applicant Information First Named Insured: Doing Business As: agency:, DBA: Toys Galore! Toys Galore! Applicant Information Prepared on : 01/13/2012 Page 2 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Applebee Insurance /13/2012-1/13/2013

3 Additional Interest Schedule Prepared on : 01/13/2012 Page 3 of 17 Additional Interest # 1 Bank of America Its Successors and/or assigns 112 SE Main St. addr2 Spokane, WA Name and Address Description of Risk Interest Type Veh # Honda Element Additional interest Additional Interest # 2 Loc # Dwight Electric Suite 300 Seattle, WA Additional Interest # 3 Loc # / Bldg #00001 Loc #1 on Property AOI PO Box 1101 Additional Interest # 4 Loc # Prop LOB Level aoi 125 Pike St. New London, CT Additional Named Insured Additional insured Certificate holder

4 Coverage agency: Summary of Insurance Prepared on : 01/13/2012 Page 4 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Commercial Property Applebee Insurance /13/2012-1/13/2013 Loc # Bldg # N. 4th Ave Building A Seattle, WA Building 900, ,000 Lim 500 Ded Business Personal Property 500, ,000 Lim 500 Ded Stock 100,000 Lim 4% Ded Spoilage

5 Coverage agency: Summary of Insurance Prepared on : 01/13/2012 Page 5 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Loc # Bldg # N. 4th Ave Building B Seattle, WA Building 400, ,000 Lim 500 Ded Business Personal Property 400, ,000 Lim 500 Ded Loc # Bldg # First Ave N. Suite 200 Seattle, WA Building 600, ,000 Lim 500 Ded Business Personal Property 600, ,000 Lim 500 Ded

6 Coverage agency: Summary of Insurance Prepared on : 01/13/2012 Page 6 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Loc # Bldg # Seattle, WA Building 500, ,000 Lim 500 Ded Business Personal Property 300, ,000 Lim 500 Ded Stained Glass 75,000 10,000 Lim 4% Ded BKTSP Air Conditioners Crime Applebee Insurance /13/2012-1/13/ A. Employee Dishonesty 300,000/500 Ded A. Employee Dishonesty 500,000 B. Forgery or Alteration 300,000 C. Theft, Disappearance & Destruction Sec 1-Inside the Premises Sec 2-Outside the Premises

7 Coverage agency: D. Robbery & Safe Burglary Sec 1-Inside:Robbery of Custodians Safe Burglary Sec 2-Outside the Premises E. Premises Burglary F. Computer Fraud G. Extortion Ins Loss Participation H. Premises Theft & Robbery Outside Sec 1 - Theft Sec 2 - Robbery Outside Q. Robbery & Safe Burglary Money & Securities Sec 1 - Inside the Premises Sec 2 - Outside the Premises U. Other Coverage Summary of Insurance Prepared on : 01/13/2012 Page 7 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Garage & Dealers Applebee Insurance /13/2012-1/13/2013 3, Bodily injury-single limit 500,000 Combined single limit 500,000 PIP-Additional 10,000 Medical Pay(GD) 5,000 Uninsured motorist property damage Underinsured motorist combined single limit Underinsured motorist BI split limit Underinsured motorist property damage Business Auto Applebee Insurance /13/2012-1/13/2013 Combined single limit 500,000 PIP-Basic 10,000 PIP-Additional 35,000

8 Coverage agency: Summary of Insurance Prepared on : 01/13/2012 Page 8 of 17 Amount/Limits Insurance Company Policy Number Policy Period Premium Medical payments 5,000 Uninsured motorist property damage 25,000 Uninsured motorist BI split limit 300,000 Towing and labor 250 Comprehensive Collision Workers Compensation Applebee Insurance /13/2012-1/13/2013 Part 1 - Workers Compensation States: WA Part 2 - Employers Liability: WC & Employer's liability Each Accident Limit: Disease Policy Limit: Disease Each Employee: Deductible: 1,000,000 1,000,000 50,000 5,000 Deductible Type: Dollars Applies To: Coins as percentage Part 3 - Other States Included: Part 3 - Other States Excluded:

9 Business Auto Vehicle Schedule Prepared on : 01/13/2012 Page 9 of 17 Veh# Cust# Year Make/Model VIN Garaged Class Cost New Liab PIP Med UM UIM Comp Coll SP Stated Amt Policy No: LOB: AUTOB Honda/Element 23,000

10 Business Auto Covered Auto Symbols Prepared on : 01/13/2012 Page 10 of 17 Business Auto (1) ANY AUTO (2) ALL OWNED AUTOS (3) OWNED PRIVATE PASSENGER AUTOS (4) OWNED AUTOS OTHER THAN PRIVATE PASSENGER (5) ALL OWNED AUTOS WHICH REQUIRE NO-FAULT COVERAGE (6) OWNED AUTOS SUBJECT TO COMPULSORY U.M. LAW (7) AUTOS SPECIFIED ON SCHEDULE (8) HIRED AUTOS (9) NON-OWNED AUTOS

11 Business Auto Driver Schedule Prepared on : 01/13/2012 Page 11 of 17 Driver Number Driver Name DOB License Number License State Policy No: LOB: AUTOB 0001 Jon Doe 12/10/1967 WA WA

12 Business Auto Garage Location Schedule Prepared on : 01/13/2012 Page 12 of 17 Garage Number Policy No: LOB: AUTOB N. 4th Ave Building A Seattle, WA Address

13 Garage & Dealers Vehicle Schedule Prepared on : 01/13/2012 Page 13 of 17 Veh# Cust# Year Make/Model VIN Garaged Class Cost New Liab PIP Med UM UIM Comp Coll SP Stated Amt Policy No: LOB: GARAG Ford/Taurus X X X X X

14 Garage & Dealers Covered Auto Symbols Prepared on : 01/13/2012 Page 14 of 17 Garage & Dealers (21) ANY AUTO (22) ALL OWNED AUTOS (23) OWNED PRIVATE PASSENGER AUTOS (24) OWNED AUTOS OTHER THAN PRIVATE PASSENGER (25) OWNED AUTOS SUBJECT NO-FAULT COVERAGE (26) OWNED AUTOS SUBJECT TO U.M. LAW (27) SPECIFICALLY DESCRIBED AUTOS (28) HIRED AUTOS ONLY (29) NON-OWNED AUTOS USED IN GARAGE BUS (30) AUTOS LEFT FOR YOUR SERVICE/REPAIR/STORAGE (31) AUTOS ON CONSIGNMENT AND DEALER AUTOS (32) COMPANY USE

15 Garage & Dealers Driver Schedule Prepared on : 01/13/2012 Page 15 of 17 Driver Number Driver Name DOB License Number License State Policy No: LOB: GARAG 0001 Bill 9/1/1967

16 Garage & Dealers Garage Location Schedule Prepared on : 01/13/2012 Page 16 of 17 Garage Number Policy No: LOB: GARAG N. 4th Ave Building A Seattle, WA Address

17 Commercial Property - Premise Schedule Prepared on : 01/13/2012 Page 17 of 17 Location # Building # Address Building Description Policy No: LOB: PROP N. 4th Ave Building A Seattle, WA Toy Store N. 4th Ave Building B Seattle, WA First Ave N. Suite 200 Seattle, WA Seattle, WA 98103