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COMPANY REPRESENTATIVE:
Ark-LA-Tex Underwriters, Inc. Countersigned By
1945 East 70th Street Authorized Representative
Suite C
Shreveport LA 71105 07/15/2008 VLW
IN WITNESS WHEREOF, this Company has executed and attested these presents; but this policy shall not be valid unless countersigned by the duly Authorized
Agent of this Company at the Agency hereinbefore mentioned.
Secretary President
CSCP 10 01 03 06 Page 1 of 1
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Policy Number: CCP 554011 CIL 15 00b 02 02
Forms and Endorsements applying to the Coverage Parts listed below and made a part of this policy at time of issue:
Form/ Edition
Endt. # Date Title Total # of Forms Selected: 21
7 Forms
14 Forms
EXCLUSION OF TERRORISM
This endorsement modifies insurance provided under the following:
SCHEDULE
The Exception Covering Certain Fire Losses (Paragraph D.) applies to property located in the
following state(s), if covered under the indicated Coverage Form, Coverage Part or Policy:
State(s) Coverage Form, Coverage Part Or Policy
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. The following definition is added and applies un- 2. When one or both of the following applies:
der this endorsement wherever the term terrorism a. The effect is to intimidate or coerce a govern-
is enclosed in quotation marks. ment or the civilian population or any seg-
"Terrorism" means activities against persons, or- ment thereof, or to disrupt any segment of the
ganizations or property of any nature: economy; or
1. That involve the following or preparation for the b. It appears that the intent is to intimidate or
following: coerce a government, or to further political,
a. Use or threat of force or violence; or ideological, religious, social or economic
objectives or to express (or express opposi-
b. Commission or threat of a dangerous act;
tion to) a philosophy or ideology.
or
c. Commission or threat of an act that inter-
feres with or disrupts an electronic, com-
munication, information, or mechanical sys-
tem; and
SCHEDULE
The Exception Covering Certain Fire Losses (Paragraph D.) applies to property located in the
following state(s), if covered under the indicated Coverage Form, Coverage Part or Policy:
State(s) Coverage Form, Coverage Part Or Policy
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Applicability Of The Provisions Of This En- a. The federal Terrorism Risk Insurance
dorsement Program ("Program"), established by the
1. The provisions of this endorsement be- come Terrorism Risk Insurance Act, has ter-
applicable commencing on the date minated with respect to the type of in-
when any one or more of the following first surance provided under this Coverage
occurs. But if your policy (meaning the pol- Form, Coverage Part or Policy; or
icy period in which this endorsement ap-
plies) begins after such date, then the pro-
visions of this endorsement become
applicable on the date your policy begins.
The term "act of terrorism" means any act that is certified by the Secretary of the Treasury, in
concurrence with the Secretary of State and the Attorney General of the United States, to be an act of
terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to
have resulted in damage within the United States, or outside the United States in the case of an air
carrier or vessel, or the premises of a United States mission; and to have been committed by an
individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to
coerce the civilian population of the United States, or to influence the policy or affect the conduct of the
United States Government by coercion.
Any losses caused by certified acts of terrorism would be partially reimbursed by the United States
under a formula established by federal law (TRIA). Under this formula, the United States pays 90% (85%
in 2007) of covered terrorism losses exceeding the statutorily established deductible paid by the
insurance company providing the coverage.
The portion of your annual premium that is attributable to coverage for acts of terrorism is:
Property $ 32
Inland Marine
Crime Excluded
General Liability
Garage Excluded
Total $ 32
This premium is not refundable in the event that Congress does not extend TRIA coverage beyond
12-31-07.
(Except in OH, IN, WI, WV and AZ)
DESCRIPTION OF PREMISES:
PREM BLDG LOCATION ADDRESS CITY ST ZIP CONST OCCUPANCY P/C
NO
1 1 301 ADLY DRIVE Abbeville LA 70510 Joisted Masonry VACANT RESTAURANT PC - 3
COVERAGES PROVIDED - Insurance at the described premises applies only for which a limit of insurance is shown
PREM BLDG OCC COVERAGE LIMIT INSURED VALUATION COVERED CAUSES OF LOSS COINS RATE
NO CODE
1 1 1180 Building $280,000 ACV Basic Form 80% 0.567
RC means Replacement Cost, ACV means Actual Cash Value; MP means Minimum Premium
OPTIONAL COVERAGES - Applicable only when entries are made in the schedule below
PREM BLDG CODE COVERAGE LIMIT INSURED COVERED CAUSES OF LOSS COINS RATE
NO
MORTGAGE HOLDERS
PREM BLDG MORTGAGE HOLDER NAME AND MAILING ADDRESS
NO
01 01 CHASE BANK PO BOX 9001020, LOUISVILLE KY 40290-1020
DEDUCTIBLE
See Attached Form CCF 1512
FORMS AND ENDORSEMENTS (other than applicable Forms and Endorsements shown elsewhere in the policy):
Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue:
PREMIUM
Subtotal for this Coverage Part $1,588 Minimum Premium for this Coverage Part: $750
TRIA Coverage $32
Premium for this Coverage Part $1,620
A. The following is added to the EXCLUSIONS section and is therefore not a Covered Cause of Loss:
WINDSTORM OR HAIL
We will not pay for loss or damage:
1. Caused directly or indirectly by Windstorm or Hail, regardless of any other cause or event that
contributes concurrently or in any sequence to the loss or damage; or
2. Caused by rain, water, snow, sand or dust, whether driven by wind or not, if that loss or damage would
not have occurred but for the Windstorm or Hail.
But if Windstorm or Hail results in a cause of loss other than rain, water, snow, sand or dust, and that
resulting cause of loss is a Covered Cause of Loss, we will pay for the loss or damage caused by such
Covered Cause of Loss. For example, if the Windstorm or Hail damages a heating system and fire results,
the loss or damage attributable to the fire is covered subject to any other applicable policy provisions
B. Under C. ADDITIONAL COVERAGE – COLLAPSE , in the Causes of Loss – Broad Form, windstorm or hail
is deleted from paragraph 2.a.
C. Under C. ADDITIONAL COVERAGE – COLLAPSE , in the Causes of Loss – Broad Form, item 2.e. Weight
of rain that collects on roof is deleted and under D. ADDITIONAL COVERAGE – COLLAPSE in the Causes
of Loss Special Form, item 2.e. Weight of rain that collects on roof is deleted.
D. In the Causes of Loss – Special Form, windstorm or hail is deleted from the definition of “specified causes
of loss” in G. Definitions.
If no premises is described above, this exclusion applies to all premises covered by this policy.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
CCF 1507 0506 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
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CCF 1512 0506
SCHEDULE
The Deductibles applicable to any one occurrence are shown below and the Deductibles apply as indicated by
checking one of the boxes below:
Each Building (regardless of the number of premises)
Each Premises (regardless of the number of buildings on the premises)
** For each deductible listed in this Schedule, enter the number corresponding to the Covered Cause(s) of Loss
to which that deductible applies (or enter the description):
(1) All Covered Causes of Loss
(2) All Covered Causes of Loss except Windstorm or Hail
(3) All Covered Causes of Loss except Theft
(4) All Covered Causes of Loss except Windstorm or Hail and Theft
(5) All Covered Causes of Loss except Water Damage
(6) Windstorm or Hail
(7) Theft
(8) Water Damage
Section D. Deductible is deleted in its entirety including the Examples and replaced with the following:
A. In any one occurrence of loss or damage (hereinafter referred to as loss), we will first reduce the amount of
loss if required by the Coinsurance Condition or the Agreed Value Optional Coverage. If the adjusted amount
of loss is less than or equal to the Deductible, we will not pay for that loss. If the adjusted amount of loss
exceeds the Deductible, we will then subtract the Deductible from the adjusted amount of loss, and will pay
the resulting amount or the Limit of Insurance, whichever is less.
B. In the event that loss or damage occurs to Covered Property at more than one building location as a result of
one occurrence, the schedule above will determine how the deductible will apply, either to each premises or
to each building.
C. When the occurrence involves loss to more than one item of Covered Property and separate Limits of
Insurance apply, the losses will not be combined in determining application of the Deductible. But the
Deductible will be applied only once per occurrence for that Covered Property.
D. The terms of this endorsement do not apply to any Earthquake Deductible or to any Windstorm or Hail
Percentage Deductible provided elsewhere in this policy.
VACANCY PERMIT
This endorsement modifies insurance provided under the following:
BUILDING AND PERSONAL PROPERTY COVERAGE FORM
CONDOMINIUM ASSOCIATION COVERAGE FORM
CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM
STANDARD PROPERTY POLICY
Schedule
A. The VACANCY Loss Condition does not apply to direct physical loss or damage:
1. At the locations; and
2. During the Permit Period; shown in the Schedule or in the Declarations.
B. This Vacancy Permit does not apply to the Excepted Causes of Loss indicated in the Declarations or by an "X" in the
Schedule.
PROTECTIVE SAFEGUARDS
This endorsement modifies insurance provided under the following:
COMMERCIAL PROPERTY COVERAGE PART
FARM COVERAGE PART
SCHEDULE
Protective Safeguards
Prem. No. Bldg. No.
Symbols Applicable
1 1 P-9
A. The following is added to the: (3) Tanks, their component parts and supports;
Commercial Property Conditions and
General Conditions in the (4) Pumps and private fire protection mains.
Farm Property – Other Farm
Provisions Form – Additional Coverages, b. When supplied from an automatic fire protective
Conditions, Definitions system:
General Conditions in the Mobile Agricultural
Machinery and Equipment Coverage Form (1) Non-automatic fire protective systems; and
General Conditions in the Livestock Coverage
(2) Hydrants, standpipes and outlets.
Form
PROTECTIVE SAFEGUARDS "P-2" Automatic Fire Alarm, protecting the
entire building, that is:
1. As a condition of this insurance, you are
required to maintain the protective devices a. Connected to a central station; or
or services listed in the Schedule above.
b. Reporting to a public or private fire
2. The protective safeguards to which this
endorsement applies are identified by the alarm station.
following symbols: "P-3" Security Service, with a recording
"P-1" Automatic Sprinkler System, including system or watch clock, making hourly rounds
related supervisory services. covering the entire building, when the premises
Automatic Sprinkler System means: are not in actual operation.
a. Any automatic fire protective or ex- "P-4" Service Contract with a privately
tinguishing system, including con- owned fire department providing fire protection
nected: service to the described premises.
(1) Sprinklers and discharge noz- "P-9" The protective system described in the
zles; Schedule.
(2) Ducts, pipes, valves and fittings;