This Insurance is effected with certain Underwriters at Lloyd's,
This Certificate is issued in accordance with the limited
authorization granted to the Correspondent by certain Underwriters at
Lloyd's, London whose syndicate numbers and the proportions underwritten
by them can be ascertained from the office of the said Correspondent (such
Underwriters being hereinafter called "Underwriters") and in consideration of
the premium specified herein, Underwriters hereby bind themselves severally
and not jointly, each for his own part and not one for another, their
Executors and Administrators.
The Assured is requested to read this Certificate, and if it is not
correct, return it immediately to the Correspondent for appropriate
All inquiries regarding this Certificate should be addressed to the following
Southern Alabama Insurance Agency
PO Box 3768
Gulf Shores, AL 36547
Email: [email protected]
SLC-3 (USA) NMA2868 Amended (24/08/2000)
1. Signature Required. This Certificate shall not be valid unless signed by the Correspondent on the
attached Declaration Page.
2. Correspondent Not Insurer. The Correspondent is not an Insurer hereunder and neither is nor shall be
liable for any loss or claim whatsoever. The Insurers hereunder are those Underwriters at Lloyd's, London
whose syndicate numbers can be ascertained as hereinbefore set forth. As used in this Certificate
"Underwriters" shall be deemed to include incorporated as well as unincorporated persons or entities that
are Underwriters at Lloyd's, London.
3. Cancellation. If this Certificate provides for cancellation and this Certificate is cancelled after the
inception date, earned premium must be paid for the time the insurance has been in force.
4. Service of Suit. This Service of Suit Clause will not be read to conflict with or override the obligations of
the parties to arbitrate their disputes as provided for in any Arbitration provision within this Policy. This
Clause is intended as an aid to compelling arbitration or enforcing such arbitration or arbitral award, not
as an alternative to such Arbitration provision for resolving disputes arising out of this contract of
insurance (or reinsurance).
It is agreed that in the event of the failure of the Underwriters hereon to pay any amount claimed to be
due hereunder, the Underwriters hereon, at the request of the Insured (or Reinsured), will submit to the
jurisdiction of a Court of competent jurisdiction within the United States. Nothing in this Clause
constitutes or should be understood to constitute a waiver of Underwriters' rights to commence an action
in any Court of competent jurisdiction in the United States, to remove an action to a United States
District Court, or to seek a transfer of a case to another Court as permitted by the laws of the United
States or of any State in the United States.
It is further agreed that service of process in such suit may be made upon Messrs. Mendes and Mount,
750 Seventh Avenue, New York, New York 10019-6829, U.S.A., and that in any suit instituted against
any one of them upon this contract, Underwriters will abide by the final decision of such Court or of any
Appellate Court in the event of an appeal.
The above-named are authorized and directed to accept service of process on behalf of Underwriters in
any such suit and/or upon the request of the Insured (or Reinsured) to give a written undertaking to the
Insured (or Reinsured) that they will enter a general appearance upon Underwriters' behalf in the event
such a suit shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United States which makes
provision therefore, Underwriters hereon hereby designate the Superintendent, Commissioner or Director
of Insurance or other officer specified for that purpose in the statute, or his successor or successors in
office, as their true and lawful attorney upon whom may be served any lawful process in any action, suit
or proceeding instituted by or on behalf of the Insured (or Reinsured) or any beneficiary hereunder
arising out of this contract of insurance (or reinsurance), and hereby designate the above-named person
as the person to whom the said officer is authorized to mail such process or a true copy thereof.
5. Assignment. This Certificate shall not be assigned either in whole or in part without the written consent
of the Correspondent endorsed hereon.
6. Attached Conditions Incorporated. This Certificate is made and accepted subject to all the provisions,
conditions and warranties set forth herein, attached or endorsed, all of which are to be considered as
7. It is hereby understood and agreed that wherever this document is referred to by the word "Policy"
herein it shall be deemed to read "Certificate". It is further understood and agreed that wherever the
term "Company" or "we" appears herein it shall be deemed to mean "Underwriters". It is further
understood and agreed that wherever the term "Insured" appears herein it shall be deemed to mean
8. Short Rate Cancellation. If the attached provisions provide for cancellation, the table below will be used
to calculate the short rate proportion of the premium when applicable under the terms of cancellation.
Short Rate Cancellation Table For Term of One Year.
SHORT RATE CANCELLATION TABLE
For Term of One Year
Days Policy in Force
Per Cent of One Year Premium
0-182 (6 Months)
210-214 (7 Months)
242-246 (8 Months)
270-273 (9 Months)
302-305 (10 Months)
333-337 (11 Months)
361-365 (12 Months)
Rules applicable to insurance with terms less than or more than one year:
A. If insurance has been in force for one year or less, apply the short rate table for annual insurance to the full annual
premium determined as for insurance written for a term of one year.
B. If insurance has been in force for more than one year:
1. Determine full annual premium as for insurance written for a term of one year.
2. Deduct such premium from the full insurance premium, and on the remainder calculate the pro rata earned
premium on the basis of the ratio of the length of time beyond one year the insurance has been in force to the
length of time beyond one year for which the policy was originally written.
3. Add premium produced in accordance with items (1) and (2) to obtain earned premium during full period
insurance has been in force.
Producer: SOUTHERN ALABAMA INSURANCE AGENCY
Insurance is effective with certain Underwriters at Lloyd's, London 100%
COMMERCIAL PROPERTY DECLARATION PAGE
PREVIOUS POLICY NO: NEW
CURRENT POLICY NO: PLC-SA-002
AUTHORITY REF. NO:
Effective from 8/4/2012 TO 8/4/2013 both days at 12:01 am.
NAME AND MAILING ADDRESS OF INSURED:
AGENT NAME AND ADDRESS:
SOUTHERN ALABAMA INSURANCE
4912 MEREDITH COURT
O X 3768
MOBILE, NS 36618
Gulf Shores, AL 36547
ADDITIONAL NAMED INSURED:
INSURED PROPERTY LOCATION:
4912 MEREDITH COURT
MOBILE, NS 36618
B. OTHER STRUCTURES
C. PERSONAL PROPERTY
D. LOSS OF USE
LOSS ASSESSMENT COVERAGE
E. PERSONAL LIABILITY (THIS LOCATION ONLY)
F. MEDICAL PAYMENTS TO OTHERS (THIS LOCATION ONLY)
AL SURPLUS LINES TAX
A. MINIMUM EARNED PREMIUM 20.00 % ( $683.06 )
B. ALL OTHER PERILS DEDUCTIBLE
C. WIND/HAIL DEDUCTIBLE Wind Coverage Not Included
D. VALUATION BASIS OF COVERAGE A RCV
E. FLOOD DEDUCTIBLE Flood Coverage Not Included
COVERAGE FORMS: THIS INSURANCE IS SUBJECT TO THE TERMS, CONDITIONS, AND LIMITATIONS OF THE POLICY FORMS:
SEE ATTACHED FORMS SCHEDULE
SERVICE OF SUIT MAY BE MADE UPON: MENDES & MOUNT OF NEW YORK, NEW YORK
This contract is registered and delivered as surplus line coverage under Alabama Surplus Line Insurance Law (Acts 1963, No. 521, p. 112& 9;
Acts 1971 No. 407 & 197) License #A057864
William H. Sessions, Jr., Correspondent
CURRENT POLICY NO: PLC-SA-002
Schedule of Forms
COMMUNICABLE DISEASE EXCLUSION
Under "Section II - Exclusions", the following exclusion is added:
Coverage E - Personal Liability and Coverage F- Medical Payments to others do not apply to bodily injury
or property damage which arises out of the transmission of a communicable disease by an insured".
All other terms and conditions remain unchanged.
MICRO-ORGANISM EXCLUSION (MAP)
This Policy does not insure any loss, damage, claim, cost, expense or other sum directly or indirectly arising out of
or relating to:
Mold, mildew, fungus, spores or other microorganism of any type, nature, or description, including but
not limited to any substance whose presence poses an actual or potential threat to human health.
This Exclusion applies regardless whether there is (i) any physical loss or damage to insured property; (ii) any
insured peril or cause, whether or not contributing concurrently or in any sequence: (iii) any loss of use,
occupancy, or functionality; or (iv) any action required, including but not limited to repair, replacement, removal,
cleanup, abatement, disposal, relocation, or steps taken to address medical or legal concerns.
This Exclusion replaces and supersedes any provision in the Policy that provides insurance, in whole or in part, for
This insurance will not respond to any liability arising out of, either directly or indirectly, exposure to asbestos,
asbestos products, fibers or the manufacture, mining, use, sale, installation, distribution, removal, transportation,
storage, disposal, encapsulation, or to any obligation of the Insured to indemnify any party because of damages
arising out of such liability at any time as a result of the manufacture, mining, use, sale, installation, distribution,
removal, transportation, storage, disposal, encapsulation of or exposure to asbestos products, fibers or dust.
This insurance will not defend or respond to any suit or claim against the Insured alleging damages or injury
resulting from or contributed to by any and all manufacturing, mining, use, sale, installation, distribution, removal,
transportation, storage, disposal, encapsulation or exposure to asbestos fibers or dust.
ALL OTHER TERMS REMAIN UNCHANGED.