INSURANCE BINDER AND NOTICE OF CANCELLATION
r
'NSURANCE BINDEr~
~-<---"'-
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT
TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
COMPANyS"r f'AlJL !:":I:1:~!:~
C:: tl F: C ("i <\ .m L (:-;
Binder No.
C L E (': F~ :.....! {:l T E~ F~ F L. ::~:: '"3 ~.> 1. (
I:~' i"l ,.~, '';'
Effective :I. ? .; ~.;.,. .;1 m "i j .' e" 19 "
Expires 12:01 am iI.,?' , 19
o This binder is issued to extend co,y.?{~.~e, LI),J\1:~.;a,t:>ove named
company per expiring policy #.......... '..iI".'....,.....,'
exce t as noted below
Description of Operation/Vehicles/Property
c: ~::! r.~ ::> C' ;.....: ? i r:= [ 1< J t--.: c
., ....
.L ..:...1..L
CUUF:T
CT
"n't
NAME AND MAILING ADDRESS OF INSURED
_ ~r: {i C ::c L :r 'r 'yO
. '...' .:,. 'in;',!
(:Ar~I_.(}lJI:::l.. l"!()M~~=(JWt~r:RS AS~:~OC
E'U:<
'-Of /' c" ....
'.,) ", Y.:..
c: L.. ;.) L: :::: :..:: :--1
"..
,
I I...
:] J ~.~; :I. ~:j
Type and Location of Property
Cove ra~e!P(!ri Is/Fo r ms
Amt of Insurance Ded.
COINS.
%
:-, \')
, .".f_",~
APR.
.l -1 l&8'{
c: ",
.... '
C'/'LI]:- (,: k,r
Type of Insurance
o Scheduled Form 0 Comprehensive Form
8 Premises/Operations
products/com.. pleted Operations
8. Contractual...
. Other (specify belowT
Med. Pay. $ $.
Per Person Per ACCident
Personal Injury
Coverage/Forms
Limits of liability
Each Occurrence
Aggregate
DA
DB
Dc
Bodily Injury
Property
Damage
Bodily Injury &
Property Damage
Combined
Personal Injury
limits 0
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
;',
Liabil ity D Non-owned
Comprehensive-Deducti bl e
Coil ision.Deducti ble
Medical Payments
Uninsllfpd Motorj<t
No Fault (specify):
Other (specify):
D Hired
S
S
S
S
Property Damage
Bodily Injury & Property Damage
Combined
D WORKERS' COMPENSATION - Statutory Limits (specify states below)
o EMPLOYERS' L1ABI L1TY - Limit
SPECIAL CONDITIONS/OTHER COVERAGES
;X j.! ::::':'1- '. '. 1::.1 CD n d :i. t:i. G n :;;
NAME AI\JD ADDRESS OF 0 ~j10RTGAGEED LOSS PAYEE
o ADD'L INSURED
r' T' -f' '. . CJ r' L ;... ;::: t1 F: !., ~ (~r --:" ::~ ~':
i~\ -,' -r ;.1:; E~... ::C ::. i' I i._'
.. I' '; (, E '::; f; ,. r"
LOAN NUMBER
,---.., I
i ' .. . , / . .
i ~ /.J.. ~ Iq
l,r ~r'lli1il",r(!I.qf Jt.~!t~~ii'eJflllprpsentative
~ ~j " " .. ..
,i. ij
! r.. '..J -~..
"', ".' ,"', ~..- .-:'\"" ..:1 ,>
i..'..... I..
. :. I:: t. F: I.) ('I T E F: ::
. '-':r"
Date
(8-84) 75
....
POll CY NO.
509JM8558
INSURANCE
COMPANY
NAME AND
ADDRESS
OF INSURED
N~. ICE OF CANCELLATION OR NONRENEYlA. L
, (Florida) I
LIABILITY POLICY
ISSUED THROUGH AGENCY OR OFfiCE AT:
KIND Of POLICY
CANCELLATION OR TERMINATION WILL TAKE EFFECT AT:
(HOUR-STANDARD TIME)
12:01AM 4/tO/87
CLEARWATER, FL
ST. PAUL FIRE & MARINE INS.
C/O CONDON - MEEK, INC.
1211 COURT STREET
CLEARWATER, FL 33516
CARLOUEL HOMEOWNERS ASSOC.
BOX3442
CLEARWATER, FL 33515
(DATE)
5/9/87
CO.
{"-~;:'-r: _
".<'..~~
(Specific information concerning the cancellation
or nonrenewal has been given to the Insured.)
DATE Of MAILING
F~
f" ".
...,,-,-'.1 b~),../""
~-.~ ....-..1.;.. ),J\.