COMMERCIAL GENERAL LIABILITY COVERAGE PART - ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Endorsement effective Policy No.
01/09/2008 CLS1437095
12:01 A.M. standard time
Named Insured Countersigned by
BETHANY EDUCATIONAL PROGRAM, INC.
(Authorized Representallve)
SCHEDULE
1. Designation of Premises (Part Leased to You):
1250 HOLT AVENUE
CLEARWATER, FL 33755
2. Name of Person or Organization (Additional Insured):
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 33758
3. Additional Premium: $100.00
(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule
but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you
and shown in the Schedule and subject to the following additional exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you cease to be a tenant in that premises.
2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organiza-
tion shown in the Schedule.
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Copyright, Insurance Services Office, Inc., 1994
INSURED
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