First Insurance: Port of Sale

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 OP ID SH DATE (MWOO(YYTY) AGEtICY COMMERCIAL INSURANCE APPLICATION APPLICANT INFORMATION SECTION CARRIER NAM CODE: UNDERWRITER Certain Underwriters I Lloyd's ri fdAIRigR'gr, First Insurance: Port of Sale P.O. Box 306359 St. Thomas VI 00803-6359 lARMIEFOWFROZIO:R1LEZWEgTEr 14404-0374 for First Insurance Agency INDICATE SECTIONS ATTACHED EQUIPMENT FLOATER GARAGE AND DEALERS moot ow, tio,,Exit 340-779-1799 PROPERTY INSTALLATION/BUILDERS RISK VEHICLE SCHEDULE na inc Nog 340-779-1926 GLASS AND SIGN ELECTRONIC DATA PROC BOILERS MACHINERY 1.444:' - ADDRESS: COUNTS RECEIVABLE/ VALUABLE PAPERS AL GENERA COMMER L L CIIABILITY WORKERS COMPENSATION COOS: SUB CODE: CRIMERAISCEUANEOUS CRIME BUSINESS AUTO UMBRELLA AGENCY CUSTOMER 10: FINAN-1 TRANSPORTATION? MOTOR TRUCK CARGO TRUCKERS/MOTOR CARRIER STATUS OF TRANSACTION PACKAGE POLICY INFORMATION ENTER THIS *FORMATION WHEN COMMON DA ES AND TERMS APPLY TO SEVERAL LINES. OR FOR MONOUNE POLICIES. PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN AUDIT DIRECT BILL 11/10/10 11/10/11 X AGENCY BK.I. 0J011 I j ISSUE POLK* J RENEW BOUND (Ova Dale *Foci Allach Copyh DATE I TIME APPLICANT INFORMATION VAMI: (rks! Named Insured & Other Named Insureds) Financial Trust Co. CI IMRE CANCEL 12: 00 IX IPM PA4 E-MAIL AIRNIESSLESL INUiviDUAL I I CORPORMX)N rem UN hub ael., I (or First Named Insuied): OVE— letcsys,pn9: 340-775-2528 PAM NEILEMV L JOINT vanuft •- INSPECTION CONTACT 'PHONE - (NC, No, ERIK PREMISES INFORMATION St/SOUPIER CORPORATION NOT FOR PROFIT ORG i LLC lattfir i —arBIIREAU NAME 55 INCL ZIP /4 of Firs! Named Insured) 6100 Red Hook Plaza Ste 83 St. Thomas VI 00802 wEeasR. ADDRESSIES)e ID NUMBER ACCOUNTING RECORDS CONTACT STARTED 7- 011E1AIS ADDRESS: INC. No, Er* ADDRESS: LOCI SLOE STREET, CRY, COUNTY, STATE,21144 CITY LUSTS INTEREST YR BUILT 9 EMPLOYEES ANNUAL REVENUES PART OCCUPIED American Yatch Harbor STE B-3 St. Thomas VI -- X INSIDE ansmc OWNER TENANT — X -- /SIDE OUTSIDE OWNER TENANT — — NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S) FINANCIAL SERVICES OFFICE GENERAL INFORMATION EXPLAIN ALL 'YES' RESPONSES - '11 IS VII APPI *CAM A SUILSIDIARY OF ANOTHER ERTEN ? ' h IXTI i DIEWIN-JCANI cl/b/E.AEW SMBSIOLARIES? - ? IS A FORMAL RNA TY PROGRAM 94 OPERA DON? 3 MIT E XPOSURE TO I LAMMABLES. EXPLOSIVES CHEMICALS? YES NO " X-. x X X EXPLAIN AU."YES" RESPONSES IN0 TO StXuAL AIIVSt 00 -7 - -ASOLACTIII&PAELtEGACIONS (tRImiWOIONOR NITA ICENT HIRING? S. DURING THE LAST FIVEYEA/th (LENIN RI). HAS Na APPLICANT BEEN DONVICTED OF ANY DEGREE OE M+ CRIME OF ARSON? Failure to d,sclo, on quesoon must be answcted by a On ny applcon is a am lOr properly insurance. punishable by 8 sews " of up to one year of kno ionmenou _ YES; IX o NO X -I AW CALM I ROPI IE EXPOSURE? x 9. ANY UNCORRECTED FIRE CODE VIOLATIONS? X S AW OTHER INSURANCE MN DRS COMPANY OR BEING sustarrEm -toti X firAFIYIlallikUPTCTE3W, CM CREOMLIENS-A0rw(STTRCAPPECANT-- --- IN THE PAST5YEARS? _ " " X A POLICY ORCOVERAMSECURFD OR N . Er DIMING ME PRIOR] YEARS? (Rol_eppkallo in MO It. HAS ISUSINL5blibtfi PLACED IN Al RUS i? 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 f ION. OR CONCEALS FOR THE PURPOSE OF MISI EADING. INFORMATION P.OFAI ItNING ANY FACI MATE/UM IIIERE l(). COMB IS A FRAUDUL EN I 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 RSIGNE I) 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 Le c t 0 A R M m i L L R I c A 8 i I L S I 7 Y 1 CATEGORY CARRIER I 'IX ICY la.IMIIIR I - 1 I KR ICY I YPT ! 'Il.litOlIAll. . . . . . . . , I If I Xif DAI I' GI NI RN nooRredar midxfc rS dooms ols ACCIWCAI I PI ItSONM. B AMIN/ [ ucwrm 1 FL"..D4L ... _. . . . . .. . .. .. . .. ._ .. _.___ _ ........___ _. . . .. . . ic= I 1.--- . ..._ _. _.. _.. . ... .. . . 1.°=.. L I--- . _ _ [ c.141 [ F.— . . _ _ .___. _. __. . . . . —.1-t:'; 1 1— - F.ADI OCCURRENCE i i ENE DAMAGE M MEDICAL EXPENSE i nookr OCCURRENCE INJURY AGGREGATE piton mThOCCURRENCE DAMAGE AGGREGATE COMIWRI)SINGIF LIMIT MOILIFICAIION I AC1OR POI AL PHI MIUM ---- L I I: A u8 a LI ._. 1 v L E Y 'AMBER POI ICY NUMIN It ; LILY I YPE V A flE1 XV DATE - . _ _ (ANNUM I) SING If L IMF! noon r I A PERSON INJURY ACCIDENT PROPFJUY DAMAGE MOINFIC.AlION I ACTOR . . _ . . _ . . .. TOTAL MB .MIUM ... . . _ _... . _. . .. .... -- — . .. ._ . ._. . ... _ . . . .. . P R 0 p E R Tv CARRIER "MCI KIMBER IIXICY I YPE I IF I XV DATE I W ILIVIG ... _ AMT I PI RSPROP AMT - _ W3IXFICAIION FACTOR I OIAL PRI MIUM GAMER POLICY NUMBER POLICY TYPE II+ I Xlf DATE F ISM MOILIFICAI ION F AC IOR 101AL IfItIMIUM LOSS HISTORY 4 AI t. UN I Obbtb pil•UNIULtbb • 0! 'IN !MDR S YE ARS(JY8AFIS.N IN I-Alt I ANU VYtit IIIFJIVHNUI iNbURI:Lpant DI.IUIINF.l1ptS INA, MAY OlVt It bt It/ LLAMAS XS IS NY). I I tAilk Mitt Mt AI XIF NON I kOM IAVItD OMMAItY 'LATE OF OCCURRENCE UNE TYPEMESCRIPTION OF OCCURRENCE OR CLAIM DATE DE CLMM AMOUNT PAID AMOUNT RESERVED CLAIM STATUS _ • ^ • . -1 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 Int ORAIATION PRACTICES (PRIVACY) HAS LW EN GIVEN TO THE APPLICANT. (NS **able in talLattS. Consult )•eAt agent pc broker for yoix slate's requiem., 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 AGEN IS MAY IN CFR INN CIRCUMSTANCES BE DISCLOSED TO MIRO PATTI IES WITHOUT YOUR AJI I Old/A IION. YOU HAVE DIE 10011T (0 REVIEW YOUR PERSONAL. IM-011MA T ION 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. 1 AGGRO 125 (2004103) EFTA01221711 ACORD PROPERTY SECTION FINAN-1 OP ID SHI DATE (MWDONYYTI 09/28/10 AGE‘CY PlIcirp.;!„): . . 340.77797.1799 . . (LTA. Net . ..._1.40-_779-1926 .._______ First Insurance: Port of Sale P.O. Box 306359 St. Thomas VI 00803-6359 for First Insurance Agency _ COOL.: I SUB CODE: AGENCY CtaJOAFR ID' FINAN-1 APPLICANT IFIrt_ , rue° Financial Trust Co. _ _ ..... .._ ___ .________ _._ ___._____ _ EFFECTIVE DATE EXPIRATION DATE 1 I DIRECT BEL PAnatirt PTAH - --- -- 11/10/10 11/10/11 X AGENCY mu FOR COMPAIff USE ONLY -Mioll PREMISES INFORMATION PREMISES I: BUILDING i: STREET ADDRESS: BLDG bileriiiiiiiii SUBJECT OF INSURANCE AMOUNT COINS % VALUADO CAUSES OF LOSS INHA RUN GUARD % DEDUCTIBLE MA i 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 SERVAL AIRING I . ISO DAYS DAYS LMT — COMA NEC LOC _ . % CODA I. - _________ $ ORO OR LAW DAYS _I MAX PERIOD -- (DESCR BELOW) — MFG LOC LIM LOC WESC UELOVO NAM: AND ADDRESS ES) FOR OFF PREM POWER OR American YatCh Harbor DEPENDPROP .. _ EXPENSE Y PERT REST DA OD S ••rs B - 3 it. Thomas VI ADD. TONAL COVERAGES. OPTIONS. RESTRICTIONS. ENDORSEMENTS AND RATING INFORMATION -INSTANCE mar LOSS PAY CONSTRUCTOR TYPE STEEL/CON. TO HYDRANT FIRE STA1 F ,,1 d FIRE DISTRICT/CODE NUMBER PROT CL TCT-ORIES]: BASMITSI 3 I 1992 YR BUILT TOTAL AREA 2800 BOLDING • IMPROVEMENTS 'AMONG. YR: — -.-- PLUMBING. YR: 3 LI/4 LOU! GRADE TAX CODE ROOF TYPE OTHER OCCUPANCIES tEXWING. YR: .YI al R. . _ HEATING. YR: WINO CLASS I SEM. RESISTIVE 0 mrsmuyE ri OTHER ICATING BOXER ON PREMISES? IF YES. TS INSURANCE PI ACE0 ELSEWHERE? . YES YES _. i NO NO TUC If EXPOSURE & DISTANCE . • - " LEFT EXPOSURE A DISTANCE REAR EXPOSURE S. DISTANCE i:issi:s tTisiaini ADT CERTIFICATE N 1 EXPIRATION DATE __ CENTRAL STATOR WITH KEYS .1 -EXTENT_fGRADE 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: :NTEREST . I II/SS PATTI WWI GAO I' NAME AND ADDRESS: REFERENCE M: I. [CERTIFICATE REWIRED INTEREST IN ITEM WMBER LOCATION: I BUILDING: SCHEDULED ITEM NUMBER: . . OTHER: ITEM DESCRIPTION: VALUE REPORTING INFORMATION t R4 R' INC FORM PROW* AVLRAGE VALUES FOR PAST 12 MONTHS . . . . _ _ ... _ _ . .__ ._ .. _ . .__ _._ _.._ _ _ _ _ ______ SUBJECT OF INSURANCE PREMISES( BUILDING ANY OTHER LOCA. TION DECLARED AT INCEPTION ANY OTHER LOCA. TION ACQUIRED AFTER INCEPnON PREMISES NOT OWNED OR ACQUIRED WAIT ATTACH TO APPLICANT INFORMATION SECTION © ACORD CORPORATION 1985 EFTA01221712 AlIDITIONAL ORE MISES INFORMATION PREMISES BUILDING I: STREET ADDRESS: FINAN-1 BLDG DESCRIPTION: SUBJECT OF INSURANCE AMOUNT COINS % VALUATION CAUSES OF LOSS WVLA I euN GUARD % DEDUCTIBLE VU'I COP FORMS AND CONDITIONS TO APPLY ARM f IONAL INFORMATION [ [ BUSINESS INCOME/ EXTRA EXPENSE 1 I BUSINESS INCOME MO EXTRA EXPENSE EXTRA EXPENSE TYPI OF BUSINESS I ORDINARY PAYROLL POWERMEAT TEXT PERIOD TUITION FEES OFF PREM POWER ._ DEPEND PROP NON MICA AirLINO . . % COINS .. S WAYS ELEC MEDIA MO PERIOD S OTHER ED WATER 180 DAYS -_ °FLOOR LAW . .. _ ...... . _ IMYS — _] IO MAX PERIOD MFG LOC STUDENTS -[. . SERWINC COMM (DESCR IN:LOW) -1 RE CTM C ITTITC LOC% COIN 'AI G __. .... I. Ex° I I wa. {_.____..___TIED DAYS S POWER DAYS LOR LOC MESC BELOW) . JAPAE AND ADOiEiSfeSIFOli Off PREM POWER OR DEPEND PROP - - - - *-- _- - - .. 1 E NU DAYSPERK/ORESI LOSS PAY ii -.% -.% - AlMiIIONAL COVERAGES. OPTIONS, RESTRICTIONS. ENDORSEMENTS AND RATING INFORMATION ')ONSTRUCTION TYPE 1 MSMIC9 HYDRANT FIRE STAT F T I MI :HARING IMPROVEMENTS 4COFING. YR' P ll RPLUMUING. YR PLEATING YR .YEUNG. YR: .. - .YI NUR RESISIWE 1 ISLIFIISIIIST NE II ION T EXPOSURE & DISTAIICE TLEFT EXPOSURE & DISTANCE FIRE DISTRICT/CODE NUMBER ROOF 1 YPE SUR RADE TCODE TAX CODE G WIND CLASS NURGLAR ALARM TYPE CERTIFICATE I IORGLAR ALARM INSTALLED AND SERVICED BY aNEXISES FIRE PROTECTION (Sprinklers. Standpipes, CONChonical Symms) ri OTHER EXPIRATION DATE PROT CL r STORIES td BASISTS LIM ITIMLITOTAL AREA IF YES. IS INSURANCE PLACED ELSEVVIIERE? YES W) I _. YEST I NO HEATING BOILER ON PREMISES? j REAR EXPOSURE 8 DISTANCE % SPRNK FIRE ALARM MANUFACTURER EXTENT GRADE IGUARDSAVATCHMEN CENTRAL STATION WITIIXEYS CLOCK HOURLY CENTRAL STATION LOCAL GONG ADDITIONAL INTERESTS INTEREST . I CXLS P/LYEI MAORI CACI II NAME ANO ADDRESS: ITEM DESCRIPTION: I REFERENCE 5: . . I I CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER _ . LOCATION: I BUILDING: SCHEDULED ITEM NUMBER: OTHER: REMARKS 'ASON VA TO KNOWNGLY A/0VMM WENT TOM BAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FRES AN APPLICATION FOR INSURANCE OR A • :MI NI Of-CLAW CONTAINING ANY MATERIALLY FALSE INFORMATION. OR CONCEALS FOR THE PURPOSE OF MIST EAIXNG INFOR/AAT ION CONCERNING ANT ACT /MIT RIM. THERE TO. COMMITS A ERAUDUI.ENI INSURANCE ACT. WHICH IS A COME ANO SUBJECTS TILE PERSON TO CRIMINAL AND INY 3 JP IANHAL' CIVII PENALTIES. INN applicabla in CO. HI. NE. (NI, OK, ORw VI: on DC. IA. NOE. IN and VA. inswance DINIONS may also be denied) ACORD 140 (2002/09) EFTA01221713