HomeMy WebLinkAbout029-Tabernacle of Prayer For All People�U
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PAGE
001
SMP LIABILITY DECLARATIONS - SCHEDULED
INSURANCE COMPANY
LANSING, MICHIGAN 48909 RENEWAL
PREMIUM TERM 02 -17 -88 TO 02 -17 -89
AGENT BOYD- WALLACE INSURANCE AGENCY
12 -017 114 S PALMETTO AVE POLICY NUMBER
SANFORD FL 32771 814612 20192372
INSURED SANFORD TABERNACLE OF PR AYER INC POLICY PERIOD
FROM 12:01 A.M. 02 -17 -88
ADDRESS 950 W 13TH ST TO UNTIL CANCELLED
SANFORD FL 32771
POLICY CHANGE
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES. EFFECTIVE DATE OF CHANGE : MO - - -- DAY - - -- Y - - --
LIMITS OF LIABILITY
COMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE $300,000 EACH OCCURRENCE
$300,000 AGGREGATE
MEDICAL PAYMENTS $1,000 EACH PERSON $25,000 EACH ACCIDENT
CLASSIFICATION -CODE- LOCATION
PREMIUM
BASIS
RATES
BI PD
PREMIUM
BI PD
PREMISES - OPERATIONS
FLORIDA
ID 0020 CODE 65150 -1
FRONTAGE PER LINEAR
FOOT
VACANT LAND - EXCLUDING REAL ESTATE
50 .1310
INC
7
INC
DEVELOPMENT PROPERTY
MEDICAL PAYMENTS
.0170
1
ADDITIONAL INTEREST
1
INC
906 W 13TH ST
SANFORD FL
ID 0025 CODE 82115S -1
AREA PER
100 SQ
FT
DAY NURSERIES
540 23.5540
INC
127
INC
INCL COMPLETED OPERATIONS
1
I
ID 0010 CODE 86612 -1
AREA PER
I 100 SQ
FT
CHURCHES INCL COMPLETED OPERATIONS
4,004 6.8580
INC
275
INC
INCL PARSONAGE
950 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
2.1550
86
PRODUCTS- COMPLETED OPERATIONS EXCLUDED
EXCEPT AS PROVIDED UNDER PREMISES
OPERATIONS CLASSIFICATIONS
ISSUED 1 -19 -88
26666 (6 -80)
115 1
CASUALTY
650
Q
• T ,4''wq'•+hMi.".'. X71.. p". i' P^ �rP'X•'Rr^r^'�..^^'^,yt"YM�pwp` � A...,, .- ..�.,,,.. ^'.w+.'gw.r ^�.....y..�..
1
ADDITIONAL INTEREST ENDORSEMENT
Policy Number 201 92372
It is agreed that such insurance as is afforded by the policy for bodily injury or property damage lia-
bility shall also apply to each interest named herein as an insured, but only with respect to such
liability arising out of the specific interest indicated. The inclusion herein of such additional interest
or interests shall not operate to increase the limits of the Company's liability.
v
Name and P.O..Address Interest
Ci ',y Of Sanford
PO Box 177:;
Sanford, F L 32771
2684 (11
Le ysor
1
rz
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS PAGE PAGE 1
,4uto owners
INSURANCE COMPANY
LANSING MI 48909 -8160
INSURED: SANFORD TABERNACE OF PRAYER,
INC.
PO BOX 1822
SANFORD FL 32772 -1822
RENEWAL?mr.� }---�
POLICY NUMBER 814612 20192372 00 80A A 8 1989
AGENT :12017
BOYD - WALLACE INSURANCE AGENCY 0M Of SAMIF®Rp
114 S PALMETTO AVE
SANFORD FL 32771
POLICY PERIOD: FROM 02/17/89 TO 02/17/90 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING
ADDRESS SHOWN ABOVE.
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT S 300,000
(OTHER THAN PRODUCTS - COMPLETED OPERATIONS)
PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT $ 300,000.
PERSONAL AND ADVERTISING INJURY LIMIT $ 300,000
EACH OCCURRENCE LIMIT $ 300,000
FIRE DAMAGE LIMIT $ 50,000 ANY ONE FIRE
MEDICAL EXPENSE LIMIT $ 5,000 ANY ONE PERSON
LOCATION OF PREMISES YOU OWN, RENT OR OCCUPY
PREM NO BLDG NO 950 W 13TH ST.
00001 001 SANFORD FL 32771
PREMIUM
- CLASSIFICATION - CODE SUBLINE BASIS RATES PREMIUM
CODE 41650
CHURCHES OR OTHER HOUSES OF WORSHIP PREM/OP
INCLUDING PRODUCTS AND /OR COMPLETED
OPERATIONS ,
CODE 41714
DAY CARE CENTERS INCLUDING PRODUCTS PREM /OP
AND /OR COMPLETED OPERATIONS
AREA EACH 1000
4,004 102.985 $ 412.00
PERSONS EACH 1
29 7.737 $ 224.00
CODE 49950
ADDITIONAL INTERESTS
MANAGERS /LESSORS OF PREMISES
CITY OF SANFORD PREM /OP 4,004 4.953 20.00
TERR 006 COUNTY 059 LOCATION TOTAL PREMIUM 5 656.00
LOCATION OF PREMISES YOU OWN, RENT OR OCCUPY
PREM NO BLDG NO 221 E. 27TH ST.
00002 001 JACKSONVILLE FL 32206
PREMIUM
CLASSIFICATION - CODE SUBLINE BASIS RATES PREMIUM
CODE 41650 AREA EACH 1000
CHURCHES OR OTHER HOUSES OF WORSHIP PREM /OP 3,927 102.985 $ 404.00
INCLUDING PRODUCTS AND /OR COMPLETED
OPERATIONS
T ERR 006 COUNTY 016 LOCATION TOTAL PREM $ 4 04.0 0
55040 (11/87) ��' 3823 02/28/89
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS PAGE PAGE 2
,4ut0- Owners RENEWAL
INSURANCE COMPANY POLICY NUMBER 814612 20192372 00 89
LANSING MI 48909 -8160
INSURED: SANFORD TABERNACE OF PRAYER, AGENT:12017
INC. BOYD - WALLACE INSURANCE AGENCY
PO BOX 1822 114 S PALMETTO AVE
SANFORD FL 32772 -1822 SANFORD FL 32771
POLICY PERIOD: FROM 02/17/89 TO 02/17/90 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING
ADDRESS SHOWN ABOVE.
LOCATION OF PREMISES YOU OWN, RENT OR OCCUPY
PREM NO BLDG NO 906 W 13TH ST.
00003 001 SANFORD FL 32771
PREMIUM
CLASSIFICATION - CODE SUBL BASIS RATES PREMIUM
CODE 49450 ACRES EACH 1
VACANT LAND PREM /OP 1 .772 $ 1.00
INCLUDING PRODUCTS AND /OR COMPLETED
OPERATIONS
TERR 006 COUNTY 059 LOCATION TOTAL PREMIUM $ 1.00
AUDIT TYPE: ANNUAL AUDIT
TO PREMIUM $ 1,061.00
FORMS APPLICABLE: CG2144
11/85
CG2022
11/85
55030
07/87 CG2240
11/85
CG2146
01/87
IL0021
11/85
55081
08/88 CG0001
11/85
CGO041
05/86
CG0220
11/86
IL0017
11/85 55050
07/87
55064
07/87
CL175
02/86
55069
01/88 . CG2011
11/85
55040 (11/87) 3824 02/28/89
Tabernacle Of Prayer For All People
The Center of Hope
950 W. 13th Street MAILING ADDRESS: P. O. Box 1822, SANFORD, FLORIDA 32772 -1
ELDER CARRIE BUIE BRYANT, PASTOR
September 20, 1983
M W atten E . Knowtu
City Manage&
P.U. Cox 1118
San�otd, HoAi,da 32111
Dean Mt. Knowtes:
APOSTLE JOHNNIE WASHINGTON, OVERSEER
v�
GREETINGS IN THE WONDERFUL NAME OF JESUS!
I am in tece.ipt o4 your Eextet %egaAd.ing tea6e o4 City Ptopetty.
Thete4ote, pf -ease be adv.iaed that we would tike to renew out teaae
4ot another yeah.
Bncto.sed hetew.i.th i6 a check jot the amount agteeded upon.
Thank you, and may God continue to bte63 you, out City and out coun-
.tty .Zs my ptayet.
Si ncetety,
Etdet Catt,i,e Buie Bryant
Pa3 0
B e
/ Encto6uAe
L E A S E
THIS AGREEMENT, made and entered into this z4�'�► day
of August, A.D., 1982, by and between CITY OF SANFORD, FLORIDA,
a municipal corporation, hereinafter referred to as Lessor, and
TABERNACLE OF PRAYER FOR ALL PEOPLE, 950 W. 13th Street, Sanford,
Florida, hereinafter called Lessee;
WITNESSETH, for and in consideration of the premises
and the covenants and agreements hereinafter contained, Lessor
does hereby lease unto Lessee that property in the City of
Sanford, Florida, described as:
East 50 feet of Lot 8, Block G of A.D.
CHAPPELL'S SUBDIVISION, Plat Book 1,
Page 71, Seminole County, Florida;
to have and to hold the same for a period of one year beginning
the 24th day of August, A.D., 1982 and ending the 23rd day of
August, A.D., 1983, unless the said term shall be sooner termin-
ated as hereinafter set forth.
And Lessee in consideration for the aforesaid lease
does hereby covenant and agree as follows:
1. To pay Lessor rent for said premises at the rate
of ONE DOLLAR ($1.00) per year, in advance.
2. Lessee agrees to carry liability insurance in the
sum of $300,000.00 for each separate occurrence; that Lessee
agrees to furnish proof of said insurance to Lessor with Lessor
maintained as beneficiary of the said insurance. A copy of said
policy shall be filed with the City Clerk.
3. Lessee shall at all times refrain from engaging
in the sale of alcoholic beverages on the leased premises at any
time during the term of this Lease or any extension thereof.
4. Lessee agrees to maintain said premises during
the term hereof in good condition, free and clear of all weeds,
trash and rubbish, and to make such repairs as shall be necessary
from time to time in the opinion of the City Manager of the City
of Sanford, to keep said premises in a good state of repair and
safe for public use.
5. Lessee shall as a condition predecent to this lease
install at its own expense a chain link fence not less than five
feet in height around the perimeter of the premises.
6. Lessor may terminate this Lease at any time by giv-
ing Lessee notice in writing thirty (30) days in advance of the
termination date, and upon the giving of said notice, Lessee agreea
to deliver and give up said premises in at least as good condition
as the same is now, and to pay to Lessor any and all outstanding
costs and charges which may be owed, and to further pay Lessor
any sums necessary to restore said premises to its present con-
dition in the event Lessee fails so to do.
7. Lessee covenants and agrees to make no offensive
or illegal use of said premises or to do anything or allow any-
thing to be done thereon which could in any way constitute a
nuisance, or in any way disturb the peace and dignity of the
community and to use the premises as a children's playground and
for no other purpose.
8. Lessee agrees to pay promptly when due the costs of
all utilities, utility service, sewer, water and electrical
charges, or other charges lawfully assessed against said premises.
R
9. In the event it becomes necessary for either party
to this lease to retain any attorney and resort to the Courts
to enforce their rights, the prevailing party shall be entitled
to recover reasonable attorney's fees and allowable court costs
from the losing party.
In the event Lessor shall not have terminated this
Lease as is herein provided, Lessee shall be entitled to renewals
thereof for additional one -year periods upon giving notice in
writing to the City thirty (30) days in advance of the end of
such term.
The parties hereto warrant and agree that this Lease
shall not be recorded amongst the Public Records of Seminole
County.
IN WITNESS WHEREOF, this instrument has been executed
in the names of the parties hereto by their duly authorized
officers and their respective seals affixed.
CITY ZN ORD, FLORIDA
BY
MAYOR
ATTEST:
CIERK
TABERNACLE OF PRAYER FOR ALL
PEOPLE
BY:
ATTEST:
I
Signed and sealed in the presence
of:
,4uto
INSURAKE
DECLARATIONS s1'ECI( js "
PART TWO A`.' tt.cl rt5 Vod i
AGENCY 0 4AL.LACL: 12017
POLICY
NUMBER 814 612 2 U 1.i 2 3 7 2
INSURED SA TAL OF eRAYL:R
STREET
CITY& 950 W. 13TH 5T.
STATE
SANFORD FL
1 ❑ Individual [_f Partnership "Corporation
ENTITY: ❑ Fraternal Organization ❑ Other:
Location of Premises as follows, or "Same as above
Occupancy of Premises
1. 1. CHURCH
2. 2.
3. _
Insurance is provided with respect to those premises described above and with respect to those coverages and kinds of property for which a specific limit
liability is shown, subject to all of the terms of th policy includ forms and endorsements made a part hereof:
Coinsurance LIMIT OF LIABILITY
SECTION I — PROPERTY COVERAGE Percentage Loc. No. Bldg. No. Loc. No. Bldg. No. Loc. No. Bldg. No.
Appllaabk
Building(s) (Insurable Value $ _ 1 so - $ 100 0 000. $ $
Personal Property of the Insured 80 $ 50"000. $ $
Personal Property of Ot $ $ _ $
D - $ $ $
V 1 Add'I. Coy. (Specify)
S Deductible: $ SEE 14P0 each occurrence. $
aggregate each occurrence.
If no deductible stated above, the deductible shall be $100 each occurrenc $1,000 aggregate each occurrence.
0 Add'I. Coy. (Specify)
N
2.
$
$
$
SE:TluN 11- LIABILITY COVERAGE SCHEDULED COMPREHENSIVE []
LIMIT OF LIABILITY
Bodily Injury Liability $
each occurrence $
aggregate products liability
Property Damage Liability $
each occurrence $
aggregate
Single Limit Bodily Injury- Prope Damage Liability $ 10 0 00 0 .
each occurrence $ 1 U 0 . 00 0,
aggregate
Premises Medical Payments $ 1,00
e ach person $ 2
each accident
Add') Coy. (Specify)
$
SECTION III— CRIME COVE L J As state in th endorsement, m par of this Policy,
if indicated by x
Name STATE BA14K OF FOREST CITY
Mortgagee: Street P ' O t3 0 X 3117
"
( Ci ty & State_ FOREST CITY, F.L. _ 3275 -.1.
r` zi
- - - -
Code
p - - -- -- -- - -- -
Forms and Endorsements made part of this Policy: tinsert No. and Edition Date)
MP 0010(7 -77), MP0012(5 -81), MP0336(2 -82), 26072, 17310, 17321
Date of Issue— Countersigned by_.. ��,��� -- - - -__ - -- - - - - -- - - - - - -- -- -
Agent 20
In consideration of the premium and of the statements made in the above Declarations, insurance is provided the Named Insured subject to all the terms of this polio
including forms and endorsements made a part hereof
LAJ ALIT
❑ AUTO. OWNERS (MUTUAL) INSURANCE COMPAl'
❑ OWNERS INSURANCE.COMPAIt.,IY
11 PROPERTY- OWNERS INSURANCE. COMPANY
CITY S /`, F Q Li
_ PR EMIUM TE
2 17 822 J1 7 8
12:01 A.M. STANDARD TIME AT
LOCATION OF INSURED PROPERTY
Provisional Premium: $ 639.
❑ Audited N Non - Audited
Z Code 32 7_1 1 _ - -- _ 114S_ T_I_ T_ U_T_I
[_] Municipality [] Institution
17112(1 -79)
CIW OF SANFORD, FLORIDA No. 820
Dat Au, 2 5, 1 9_g 12
Received of Tgberr_acle of Pia er for
,� All People $ IoC0
One and no/7 00------------------------------- - - - - -- Dollars -
For Leese of Vacant Property at 906 sal. 1'th
• for priwte park.
l.uF;ust 24, 1 82 thin , august 23, 1 83.
1- 01- 6!- -"0 -5
J -, 1
III IT. T arim, Jr. j
1 E CITY TAX COLLECTOR
Celery City Printins Co., Sanford, . 9 7 1 14584 l E
t ry .
-
F
•
l
E ®YD- WALLACE MSMANCE AGENCY
114 S. FALM%r_ I` .O iWENUE
SANFORD, FLORIDA 32771
TO: F DATE: 3-25-92
Auto - owners Insurance SUBJECT: Sanford Tabernacle of Prayer
Policy #814612 20192372
Lakeland, FL Ekps 2-17-93
L
Effective today, please add the following location under Section 11: 906 W. 13th
Street, Sanford, Florida - vacant lot 50' frontage - 95' depth and show City of
Sanford, P. 0. Box 1774, Sanford, FL 32771 as additional insured.
Also, increase S/L Bodily Injury - Property Damage liability to $300,000/300,000.
Many thanks for your assistance.
cc: City of Sanf ord
Robert James Co., Inc. P.O Box 2726, Birmingham, AL 35202 Reorder No. RJF072ML DUPLICATE
AFljf0 terS PAGE 001 SMP LIABILITY DECLARATIONS - SCHEDULED
INSURANCE COMPANY
LANSING, MICHIGAN 48909
AGENT BOYD - WALLACE INSURANCE AGENCY
12017 114 S PALMETTO AVE
SANFORD FL 32771
INSURED SANFORD TABERNACLE OF PRAYER INC
ADDRESS 950 W 13TH ST
SANFORD FL 32771
POLICY CHANGE
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES.
RENEWAL
PREMIUM TERM 02 -17 -84 TO 02 -17 -85
POLICY NUMBER
814612 20192372
POLICY PERIOD
FROM 12 =01 A.M. 02 -17 -84
TO UNTIL CANCELLED
EFFECTIVE DATE OF CHANGE : MO - - -- DAY - - -- YR - - --
LIMITS OF LIABILITY
COMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE
MEDICAL PAYM
EACH PERSON --
PREMIUM
CLASSIFICATION -CODE- LOCATION BASIS
PREMISES - OPERATIONS
FLORIDA
ID 0020 CODE 65150 -1
VACANT LAND- EXCLUDING REAL ESTATE
DEVELOPMENT PROPERTY
MEDICAL PAYMENTS
ADDITIONAL INTEREST
906 W 13TH ST
SANFORD FL
ID 0025 CODE 82115S -1
DAY NURSERIES
INCL COMPLETED OPERATIONS
ID 0010 CODE 86612 -1
CHURCHES INCL COMPLETED OPERATIONS
INCL PARSONAGE
950 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
PRODUCTS - COMPLETED OPERATIONS EXCLUDED
EXCEPT AS PROVIDED UNDER PREMISES
OPERATIONS CLASSIFICATIONS
ISSUED 1 -12 -84
26666 (6 -80)
$1,000
RATES PREMIUM
BI PD BI PD
FRONTAGE PER LINEAR FOOT
50 .1230 -NC 6 INC
.0150 1
1 INC
AREA PER 100 SQ FT
540 17.8690 NC 96 INC
APEA PER 100 SQ FT
4,004 4.8550 :NC 194 INC
1.4010 56
7�
CASUALTY
$300,000 EACH OCCURRENCE
$300,000 AGGREGATE
$25,000 EACH ACCIDENT
ADDITIONAL INTEREST ENDORSEMENT
Policy Number 20192372
It is agreed that such insurance as is afforded by the policy for bodily injury or property damage lia-
bility shall also apply to each interest named herein as an insured, but only with respect to such
liability arising out of the specific interest indicated. The inclusion herein of such additional interest
or interests shall not operate to increase the limits of the Company's liability.
Name and P.O. Address Interest
City Of Sanford
PO ?fox 1778
Sanford, FL. 32771 Lessor
Form 2684 (11-74)
,4iuto- fawners
PAGE 002 SMP LIABILITY DECLARATIONS — SCHEDULED
INSURANCE COMPANY
LANSING, MICHIGAN 48909 RENEWAL
PREMIUM TE 02 - -84 TO 02 -17 -85
AGENT BOYD— WALLACE INSURANCE AGENCY
12017 114 S PALMETTO AVE POLICY NUMBER
SANFORD FL 32771 814612 20192372
INSURED SANFORD TABERNACLE OF PRAYER INC POLICY PERIOD
FROM 12:01 A.M. 02 -17 -84
ADDRESS 950 W 13TH ST TO UNTIL CANCELLED
SANFORD FL 32771
POLICY CHANGE a
CROSS OUT OLD INFORMATION AND WRITE IN THE CH AN GE S. EFFECTIVE DATE OF CHANGE : MO - - -- DAY - - -- YR - - --
CONTRACTUAL AS DEFINED IN THE
POLICY — ALL OTHERS EXCLUDED
PROTECTIVE
IF ANY SUBJECT TO AUDIT
OLT TERR 06 COUNTY 59
INSURED IS — CORPORATION
ENDORSEMENTS: 2684 26153
ISSUED 1 -12 -84
2000000354
COVERAGE PREMIUM
TOTAL LIABILITY PREMIUM
354 INC
354
26666 (6 -80) — CASUALTY
C47N
auto- Owners
INSURANCE COMPANY
LANSING, MICHIGAN 48909
AGENT BOYD - WALLACE INSURANCE AGENCY
12017 114 S PALMETTO AVE
SANFORD FL 32771
INSURED SANFORD TABERNACLE OF PRAYER INC
ADDRESS 950 W 13TH ST
SANFORD FL 32771
POLICY CHANGE
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES.
ATTACHED TO AND FORMING PART OF
POLICY NUMBER
814612 20192372
POLICY PERIOD
FROM 12:01 A.M. 02 -17 -84
TO UNTIL CANCELLED
EFFECTIVE DATE OF CHANGE : MO - - -- DAY - - -- YR - - --
IN CONSIDERATION OF THE PREMIUM CHARGED
FOR THIS POLICY, IT IS UNDERSTOOD AND
AGREED THAT THE MEDICAL PAYMENTS
COVCRAG' SHALL N` APPLY TO FUFILS WHILE
ATTENDING A SCHOOL, DAY NURSERY AND /OR
KINDERGARTEN NOT CONDUCTED PRIMARILY FOR
RELIGIOUS EDUCATION AND /OR RELIGIOUS
INSTRUCTION.
ISSUED 1 -12 -84
26153 (7 -77) - CASUALTY
DECLARATIONS
PART TWO
)i- Owners
INSURANCE
AGENCY BOYD- WALLACE 12 017
POLICY
NUMBER 814612 20192372
INSURED SANFORD TABERNACLE OF PRAYER, INC.
STREET
CITY & 950 W. 13TH ST.
STATE
S FL.- - _ - -- --- - -- ---
Individual (] Partnership ® Corporation
ENTITY: E Fraternal Organization ❑ Other:
Location of Premises as follows, or FX 1 Same as above
77
N
F]
[
AUTO.OWNERS (MUTUAL) INSURANCE CnMAANY
OWNERS INSURANCE COMPANY
PROPERTY-OWNERS INSURANCE COMPANY
CITY SANFORD
PREMIUM TERM
_�. 2 17 8 2 17 84
12:01 A.M. STANDARD TIME AT
L LOCA OF INSURED PROPERTY
Provisional Premium: $ 705
[l Audited Non- Audited
INSTITUTIONAL.
Zip Code 32771 - - -- - - - - - -- - - -- - -.
1_�] Municipality FJ Institution
Occupancy of Premises
t.
► . 0 MCI
2.
12.
13 �3
O nsurance is provided with respect to those premises described above and with respect to those coverages and kinds of property for which a specific limit of
l iability is shown, subject t,, all of the t erms of this policy including forms and endor sements m ade a part hereof: —
Cefgwrsnos —. - - - -_ - - - - - -- - LIMIT OF LIABILLTY
SECTION t- .^ROPERTY COVERAGE P�Wft" -W- M .. -- eN-Man -'�� ila� ' a .-
Applicable 1 1 -.
Buildinp(s) (Insurable Value $ ) sa $ hx) $ $
Personal Pr operty of the Insured
Personal Property o Others $ — $ _ $
V 1 iAdd'I. Cov. (Specify)
S Deductible: $ MP0336 each occurrence. $ aggregate each occurrence.
I If no deductible stated above the deduc s hall be $100 each occurrence, $1,000 aggregat each o ccurrence.
O Add'I. Cov. (Specify)
�NI
S ECTI $ 1$ ,I $
I ! , ON I I- LIA BILITY COVE SCH EDULED ( COMPREHENSIVE LIMIT OF LIABILITY SEE SCHEDULE
Bodily Injury L $ each occurr g aggregate products liability
' Property Damage Liability $ _- -- each occurr $ — — aggregate -- —
Single Limit Bod ily Injury - Property Damage Liability $ each occurrence e, aggregate
Premises M edical Payments $ - ea ch per $ each acci dent
iAdd'I Cov (Specify)
$ $ $
SECTION III - CRIME COVERAGE �- J As stated in the endorsement, made part of this Policy, it indicated by x -
- - - -- -- ncC'r rr 't'y _
`Name �t _8 � r�� -vr��- 5 �. eA i
Mortgagee: Street P.Q. _BQX 3 /G W . (� a ' e� Iry
city & State FOREST CITY FL . 32751
- _ - -- .- - - - ,,5 4) v [&,/)/ I f
Forms and Endorsements made part of this Policy: onsert No. and Edition Date
4VO010(1 -83), VIP00120 -33), MP0)3 3i (1 -83), 2GE;G6(6-30) �
/
Date of Issue _ _2 V4 &3 Countersigned by �. 2 % Agent 200
In consideration of the premium and of the statements made to the above Declarations, insurance is provided the Named Insured subject to all the terms of this policy
including forms and endorsements made a part hereof.
11112(1 -79)
a
�i4'rsto- �zvners
PAGE 001
SMP LIABILITY DECLARATIONS - SCHEDULED
INSURANCE COMPANY
LANSING, MICHIGAN 48909
AGENT BOYD - WALLACE INSURANCE AGENCY
12017 114 S PALMETTO AVE
0 SANFORD FL 32771
INSURED SANFORD TABERNACLE OF PRAYER INC
ADDRESS 950 W 13TH ST
SANFORD FL 32771
POLICY CHANGE s
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES.
RENEWAL
PREMIUM TERM 02 -17 - 83 TO 02-17-84
POLICY NUMBER
814612 20192372
POLICY PERIOD
FEB. 1 7 9903 FROM 12:01 A.M. 02 -17 -83
TO UNTIL CANCELLED
EFFECTIVE DATE OF CHANGE c MO - - -- DAY - - -- YR - - --
LIMITS OF LIABILITY
300,000
COMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE Li- 6-t3;-Q 0-0- EACH OCCURRE E
0 AGGREGATE
600 p,04
MEDICAL PAYMENTS $1,000 EACH PERSON $25,000 6 CH ACCIDENT
PREMIUM RATES PREMIUM 1
CLASSIFICATION -CODE- LOCATION BASIS BI PD BI PD
PREMISES - OPERATIONS
FLORIDA
ID 0020 CODE 65150 -1
VACANT LAND - EXCLUDING REAL ESTATE
DEVELOPMENT PROPERTY
906 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
ADDITIONAL INTEREST
ID 0010 CODE 86612 -1
CHURCHES INCL COMPLETED OPERATIONS
INCL PARSONAGE
950 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
PRODUCTS- COMPLETED OPERATIONS EXCLUDED
EXCEPT AS PROVIDED UNDER PREMISES
OPERATIONS CLASSIFICATIONS
CON1 'RACTUAL AS DEFINED IN THE
POLICY - ALL OTHERS EXCLUDED
FRONTAGE PER 50 LINEAR FOOT
50 ' .0680 'NC 3 INC
.0120 1
1 INC
APEA PER 100 SQ FT
4,004 2.9280 :,NC
1.2230
ADDITIONAL INTEREST ENDORSEMENT
Policy Number '' " I . ' ' _"''
It is agreed that such insurance as is afforded by the policy for bodily injury or property damage lia-
bility shall also apply to each interest named herein as an insured, but only with respect to such
liability arising out of the specific interest indicated. The inclusion herein of such additional interest
or interests shall not operate to increase the limits of the Company's liability.
Name and P.O. Address
C r c F
P'.
1;aniUT V1. i?7/1
Interest
f
Form 2684 (11-74)
117 INC
49
t. Uf0- WljerS PAGE 001
INSURANCE COMPANY
LANSING, MICHIGAN 48909
AGENT BOYD - WALLACE INSURANCE AGENCY
12017 114 S PALMETTO AVE
0 SANFORD FL 32771
INSURED SANFORD TABERNACLE OF PRAYER INC
ADDRESS 950 W 13TH ST
SANFORD FL 32771
POLICY CHANGE s
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES
61ZIM4934111FA a61 *41F31_��[�l:b�I�Lta111147
ENDORSEMENT EFF. 02 -17 -83
PREMIUM T 02 -17 -83 T 0 -1 7 -
POLICY NUMBER
814612 20192372
POLICY PERIOD
FROM 12:01 A.M. 02 -17 -83
TO UNTIL CANCELLED
EFFECTIVE DATE OF CHANGE : MO - - -- DAY - - -- YR - - --
LIMITS OF LIABILITY
XCOMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE $300,000 EACH OCCURRENCE
$300,000 AGGREGATE
MEDICAL PAYMENTS $1,000 EACH PERSON $25,000 EACH ACCIDENT
PREMIUM RATES PREMIUM
CLASSIFICATION -CODE- LOCATION BASIS BI PD BI PD
PREMISES-OPERATIONS
FLORIDA
ID 0020 CODE 65150 -1
VACANT LAND - EXCLUDING REAL ESTATE
DEVELOPMENT PROPERTY
906 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
ADDITIONAL INTEREST
ID 0010 CODE 86612 -1
CHURCHES INCL COMPLETED OPERATIONS
INCL PARSONAGE
950 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
PRODUCTS - COMPLETED OPERATIONS EXCLUDED
EXCEPT AS PROVIDED UNDER PREMISES
OPERATIONS CLASSIFICATIONS
CONTRACTUAL AS DEFINED IN THE
POLICY - ALL OTHERS EXCLUDED
FRONTAGE PER 50 LINEAR FOOT
50 .0810 :NC 4 INC
.0120 1
1 INC
AREA PER 100 SQ FT
4,004 3.4480 NC 138 INC
1.2230
49
* DENOTES CHANGES
ISSUED 3 -08 -83
26666 (6 -80)
SMP POLICY CHANGE ENDORSEMENT
AGENCY BOYD WALLACE
Code No. Sol. No.
City SANFORD 12017
Date of Change PREMIUM TERM
Attached to and forming
part of POLICY NUMBER 814612 20192377 8 25 82 2 17 82 2 17 83
INSURED SANFORD TABERNACLE OF PRAYER
STREET 950 W. 13TH ST.
CITY & STATE SANFORD FL. 32771
It is agreed that this policy is amended as follows:
❑Name of Insured changed. ❑ Coverage is added. ❑ Rates are changed.
❑Address of Insured changed. ❑ Limits of Liability changed. Coverage is changed as described:
SECT. II — LIABILITY LIMITS ARE ANENMD TO 300,000/300,,000 SINGLE LIMITS
COVERAGE IS ADDED FOR VACANT LAND 65150 -1
ADDITIONAL INTEREST IS ADDED PER ATTACHED 2684
REVISED 26072 IS ATTACHED
Section I — Property Coverage Premium Difference
Loc. Bldg. New Amount
Coverage Description Additional Return
No. No. of Insurance
$ 1 $
Section II — Liability Coverage Premium Difference
Coverage Description Limits of Liability Additional Return
SCHEDULED ❑
COMPREHENSIVE ❑
Bodily Injury Liability
$
each occurrence
$ aggregate products liability
$ $
Property Damage Liability
$
each occurrence
$ aggregate
$ T $
Single Limit Bodily Injury- Property Damage Liability
$
each occurrence
$ aggregate
$ $
Premises Medical Payments
$
each person
$ each accident
$ $
Add'I. Cov. (Specify)
PREMIUM SUMMARY Additional
I � Return
Premium Due At Endorsement Effective Date: 8T; 82 $ 11.
New Revised Annual Premium: $ 669
8 Z 82 26�i
COMPANY:
C� AUTO- OWNERS
�] HOME- OWNERS Agent
Ll OWNERS
❑ PROPERTY OWNERS
17992 (1 -78)
MEMORANDUM COPY
d va9'
we k: 9/8/32
Per the attached ins. coverage
On Sanford Tabernacle of Prayer f/
Vacant city owned lot leased to them for a children's
playground on W. 13th St.
Orig. should go to Henry for "safe" keeping.
I have made a copy for our file........
Okay ? ??
mary Is coverage sufficient /correct ? ? ??
$300,000. for ea. L_
separate occurrence.
ADDITIONAL INTEREST ENDORSEMENT
Policy Number 814612 20192372
It is agreed that such insurance as is afforded by the policy for bodily iniury or property damage lia-
bility shall also apply to each interest n a
liability arising out of the specific interest
or interests shall not operate to increase the
Name and P.O. Address
CITY OF SANFORD
P. 0. PDX 1778
SANFORD.. FL. 32771
med herein as an insured, but only with respect to such
indicated. The inclusion herein of such additional interest
limits of the Company's liability.
Interest
LESSOR
Form 2684 (11-74)
LIABILITY SCHEDULE
Page of Pages
CHURCHES —INCL. COMPLETED
OPERATIONS INCL. PARSONAGE
950 W. 13TH ST.
SANFORD, FL. 86612 -1 A 4004
VACANT LAND —EXCL. REAL ESTATE
DEVELOPMENT PROPERTY —INCL.
ADDT'L. INTEREST
906 W. 13TH ST.
SANFORD.. FL. 65150 -1 B 50
MEDICAL PAYMENTS 86612 -1
PRODUCTS — COMPLETED OPERATIONS
INCLUDED
A 3.016 .018 121. INCL.
B .073 .008 4. INCL.
44.
TOTAL 169. INCL.
1 26072 (6 -77)
Attached to and forming
part of POLICY NUMBER
814612 20192372
Rates
Premiums
CLASSIFICATIONS & LOCATIONS
CODE Premium Bases
B. 1.
P. D.
Bodily Injury Property Damage
Premises — Operations — Products —
(a)
Area (Sq. Ft.)
(a) Per 100 Sq Ft.
Completed operations — Contractual
(b)
Frontage
(b) Per Linear Foot
Independent Contractor
(c)
Remuneration
(c) Per $100
(d)
Number Insured
(d) Per Unit
(e)
Cost
(e) Per $1 0
PREMISES — OPERATIONS
(f)
Receipts
(f) Per $ 1, ,000
(g)
Sales
(g) Per $1,000
CHURCHES —INCL. COMPLETED
OPERATIONS INCL. PARSONAGE
950 W. 13TH ST.
SANFORD, FL. 86612 -1 A 4004
VACANT LAND —EXCL. REAL ESTATE
DEVELOPMENT PROPERTY —INCL.
ADDT'L. INTEREST
906 W. 13TH ST.
SANFORD.. FL. 65150 -1 B 50
MEDICAL PAYMENTS 86612 -1
PRODUCTS — COMPLETED OPERATIONS
INCLUDED
A 3.016 .018 121. INCL.
B .073 .008 4. INCL.
44.
TOTAL 169. INCL.
1 26072 (6 -77)
ttt`OmOlVnerS PAGE 001
INSURANCE COMPANY
LANSING, MICHIGAN 48909
AGENT BOYD - WALLACE INSURANCE AGENCY
12 -017 114 S PALMETTO AVE
SANFORD FL 32771
INSURED SANFORD TABERNACLE OF PRAYER INC
ADDRESS 950 W 13TH ST
SANFORD FL 32771
POLICY CHANGE :
CROSS OUT OLD INFORMATION AND WRITE IN THE CHANGES.
SMF LIABILITY DECLARATIONS - SCHEDULED
RENEWAL
PREMIUM TERM 02 -17 -86 TO 02 -17 -87
POLICY NUMBER
BOYD- WALLACE 814612 20192372
INSURANCE AGENCY POLICY PERIOD
114 S. Palmetto Ave. FROM 12:01 A.M. 02 -17 -86
Sanford, FL 32771 TO UNTIL CANCELLED
EFFECTIVE DATE OF CHANGE = MO - - -- DAY - - -- YR - - --
LIMITS OF LIABILITY
COMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE $300,000 EACH OCCURRENCE
$300,000 AGGREGATE
MEDICAL PAYMENTS $1,000 EACH PERSON $25,000 EACH ACCIDENT
PREMIUM RATES PREMIUM
CLASSIFICATION -CODE- LOCATION BASIS BI PD BI PD
PREMISES - OPERATIONS
FLORIDA
ID 0020 CODE 65150 -1
VACANT LAND - EXCLUDING REAL ESTATE
DEVELOPMENT PROPERTY
MEDICAL PAYMENTS
ADDITIONAL INTEREST
906 W 13TH ST
SANFORD FL
ID 0025 CODE 82115S -1
DAY NURSERIES
INCL COMPLETED OPERATIONS
ID 0010 CODE 86612 -1
CHURCHES INCL COMPLETED OPERATIONS
INCL PARSONAGE
950 W 13TH ST
SANFORD FL
MEDICAL PAYMENTS
PRODUCTS - COMPLETED OPERATIONS EXCLUDED
EXCEPT AS PROVIDED UNDER PREMISES
OPERATIONS CLASSIFICATIONS
FRONTkGE PER LINEAR FOOT
50 .0990 '.NC 5 INC
.0130 1
1 INC
AREA PER 100 SQ FT
540 19.4010 :.NC 105 INC
AREA PER 100 SQ FT
4,004 5.7110 NC 229 INC
1.7960 72
ISSUED 2 -07-86
26666 (6 -80)
let
CASUALTY
RZA
ADDITIONAL WEREST ENDORSEMENT
Policy Number 20102372
It is agreed that such insurance as is afforded by the policy for bodily injury or property damage lia-
bility shall also apply to each interest named herein as an insured, but only with respect to such
liability arising out of the specific interest indicated. The inclusion herein of such additional interest
or interests shall not operate to increase the limits of the Company's liability.
Name and P.O. Address
City
PO :�o :
Sanford, I'L 32771
Interest
Lessor
Form 2684 (11 -74)