EVIDENCE OF PROPERTY INSURANCE
eVIDENCEOF.>PRQPERTY..INSI.JRANee',
qp....,P:I?l\.
DATE (MM/DDIYY)
08/25/03
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER P':.N::~, 727-456-1800<727-823-198 COMPANY
Brown & Brown Insurance
111 2nd Avenue N.E. Suite 610
St. I?etersburg FL 33701
David Pilkin ton
CODE: SUB CODE:
~USTOMER 10 #: COMMU - 6
INSURED
SAFE CO Insurance Company
2055 Sugarloaf Circle
Duluth GA 30097-4932
Community Service Foundation,
Inc
925 Lakeview Road
Clearwater FL 33756
EFFECTIVE DATE
CP 77768000B
EXPIRATION DATE
CONTINUED UNTIL
TERMINATED IF CHECKED
LOAN NUMBER
POLICY NUMBER
12/01/02 12/01/03
THIS REPLACES PRIOR EVIDENCE DATED:
PROPEF{'lYINFORftIlAfIQN ...
LOCATION/DESCRIPTION
001 Location: 029
Building: 001
1602 Fulton Ave
Clearwater FL 33755
COVI:~Q~'...ltJIfQRI\IlAf!QN..'.'.
COVERAGE/PERILS/FORMS
AMOUNT OF INSURANCE DEDUCTIBLE
240000 1000
4000 1000
27600
280000 1000
4000 1000
32400
240000 1000
4000 1000
27600
1602 FULTON AVE, CLEARWATER, FL
BUIDLING
CONTENTS
BI/EE
1604 FULTON AVE, CLEARWATER, FL
BUILDING
CONTENTS
BI/EE
1606 FULTON AVE, CLEARWATER, FL
BUILDING
CONTENTS
BI/EE
SEPARATE 5% WIND/HAIL DEDUCTIBLE APPLIES
TO ALL LOCATIONS
REIVlA~~~(I"~.\G~!rlQ,..~.pE!#i~I'.~91i,~iti.~.~li)."...'..'..
1608 FULTON AVE, CLEARWATER, FL
BUILDING > '-----,24ttOOO
CONTENTS 4000
BI/EE 27600
1620 GULTON AVE, CLEARWATER, FL
BUILDING 160000
CONTENTS 3000
BI/EE 17820
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
ADDI'T10NAL INTEREST
NAME AND ADDRESS
City of Clearwater
c/o Housing Division
POBox 4748
Clearwater FL 33758-4748
AUTHORIZED REPRESENTATIVE
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I:VIDENCeOFPROPERTY IN
PROPERTY..SCHEDULE
COMMU-6
DATE (MMlDD/Y'f)
08/25/03
PAGE 2
Community Service Foundation,
PROPERTY INFORMA rlON
LOCATION/DESCRIPTION 002
Location: 029
Building:
0.4m to w
1604 Fulton Ave
Clearwater FL 33755
PROflEf{l'Y...jN~~RMAtlg~'..{:'...;.'...' ..
LOCATION/DESCRIPTION 003'
0.4m to w
1606 Fulton Ave
Clearwater FL 33755
PROf'Ef{l'YI~~~RI\II>>'1JP~
LOCATION/DESCRIPTION 004
o . 4m to w
1608 Fulton Ave
Clearwater FL 33755
PROPERt'f.INF(>f{MATlONi
LOCATION/DESCRIPTION 005
Location: 029 Building:
0.4m to w
1620 Fulton Ave
Clearwater FL 33755
PROPE~IYJNF9RMAIIPN
LOCATION/DESCRIPTION
PROpER1)'INFPRMATION
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PROPERTY INFORMATION
LOCATION/DESCRIPTION
PROPERTY INFORMATION
LOCATION/DESCRIPTION