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<br />;;;;;::;; <br />!!!!:!!! <br />= <br />!!!!:!!! <br />;;;;;::;; <br />- <br /> <br />;;;;;::;; <br />- <br />- <br />- <br />iiiiiii <br />;;;;;::;; <br /> <br />;;;;;::;; <br />!!!!:!!! <br /> <br />;;;;;::;; <br />!!!!:!!! <br />iiiiiii <br />'Ii <br />- <br />;;;;;::;; <br />- <br /> <br />;;;;;::;; <br />C <br />~ <br />- <br />iiiiiii <br />!!!!:!!! <br />- <br />!!!!:!!! <br />;;;;;::;; <br />- <br /> <br />- <br />- <br /> <br />;;;;;::;; <br />- <br /> <br />;;;;;::;; <br />- <br />;;;;;::;; <br />!!!!:!!! <br /> <br />. <br /> <br />-: <br /> <br />. NEW )~ SCOTTSDALE INSURANCE COMPANY- <br />8877 N. Gainey Center Drive, Scottsdale, Arizona 85258 <br />. 1-800-423-7675 (outside Arizona) . <br />COMMON POLICY DECLARATIONS A STOCK COMPANY <br />ITEM 1. Named Insured and Mailing Address <br /> <br />Polley Number <br />CPS0279401 <br /> <br />LA PORTE BAY AREA HERITAGE <br />P.o. BOX 847 <br />LA PORTE, TX 77 572 <br /> <br />ThIs Insur~nce contract Is with an Insurer not licensed to <br />tr~sact Insurance In this Slate and /s issued and <br />dellver~d as a surplus lines coverage pursuant to the <br />Texas Insura~ce'stalUles. The Stale Board of Insurance <br />does nOI.audlt the finances or review the solvency of the <br />surplus lines Insurer provIding this coverage and this <br />Insurer Is not a member of tne property and casualty <br />Insurance guaran~ assoc/atlon created under Article <br />21.28.C, Insurance Code. ArtIcle 1.14-2. Insurance Code <br />requlres payment of 4.85 percent tax on gross premium. . <br /> <br />Agent Name and Address <br /> <br />TEXAS SPECIALTY UNDERWRITERS, INC. <br />510 TURTLE COVE, STE 200 <br />ROCKWALL, TEXAS 75087 <br /> <br />ITEM 2. Policy Period <br /> <br />From: 05/09/1999 <br /> <br />Agent No. <br />To: 05/09/2000 <br /> <br />42002 <br /> <br />Term: 366 DAYS <br /> <br />12:01 A.M., Standard Tim. at your mailing addr.ss. <br /> <br />Business Description: <br /> <br />MUSEUM <br /> <br />... <br /> <br />In return for the payment of the premium, and subject to all the terms of this polley, we agree with you to provide the <br />Insurance as stated in this policy. This policy consists of the following coverage parts for which a premium Is Indicated. I <br />Where no premium Is shown, there is no coverage. This premium may be subject to adjustment. <br /> <br />Coverage Partes) Premium <br /> <br />Commercial General LIability Coverage Part $ 250 <br /> <br />Commercial Property Coverage Part $ 413 <br /> <br />Commercial Crime Coverage Part $ NOT COVERED <br /> <br />Commercial Inland Marine Coverage Part $ NOT COVERED <br /> <br />Commercial Auto (Business Auto or Truckers) Coverage Part $ NOT COVERED <br /> <br />Commercial Garage Coverage Part $ NOT COVERED <br /> <br />Profession~1 LIability Coverage Part $ NOT COVERED <br /> <br />$ <br /> <br />$ <br /> <br />Total Polley Premium: $ <br />POLICY FEE $ <br /> <br />STATE TAX $ <br /> <br />STAMPING FEE $ <br /> <br />TOTAL $ <br /> <br />$ <br /> <br />663.00 <br />75.00 <br />35.79 <br />loll <br />774.90 <br /> <br />Form(s) and Endorsement{s) made a part of this policy at time of issue: <br /> <br />See Schedule of Forms and Endorsements <br /> <br /> <br />Countersigned: 05/05/1999 8y <br />. ALZ (LS OATE AUTHORlZEDREPRESENTATlVE <br />fHIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION (S) , TOGETHER WITH THE COMMON POLICY CONDmONS. <br />COVERAGE PARTIS). COVERAGE FORM IS) AND FORMS AND ENDORSEMENTS. IF ANY. COMPLETE THE ABOVE NUMBERED POUCY. <br /> <br />OPS-D.11~ 111111I1/11111111 1111I11I11 11111111 INSURED 1111111111111I 1111111I11111 11111 111I11111I11111 1111111111111 <br />