CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY (2)
NSORED NAME AND ADDRESS
Part 2: THIS DECLARATION PAGE, WITH POllCY PROVISIONS - PART 1 AND BNDORSEMBNTS, IF ANY ISSUED TO FORM
A PART THEREOF, COMPLETE TIlE BELOW NUMBERED CITIZBNS PROPERTY INSURANCE CORPORATION POllCY.
CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY
6676 Corpamte CeIIter Padway, JlU:bonville, Florida 32216-0973
~CITIZENS
~...,...~f'tIII
THIS IS A
CLEARWATER BEACH SEAFOOD AND RESTAURANT
PO BOX 99
INDIAN ROCKS BEACH, FL 33785
GENERAL BUSINESS
'OLICY TERM 6/04/2008 TO 6/04/2009 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 150904
INCEPTION DATE EXPIRATION DATE This is your PoUcy Declantion Page - This is not a Bill - DO NOT PAY
$ $
1 357,000
,
$ $
10,710 T-42
$
209,000
90
90
6,270
T-42
1,160
622
TWO STORY MASONRY RESTAURANT LOC:
Non-Homestead Property
37 CAUSEWAY BLVD CLEARWATER BEACH, PINELLAS FL 33767-2003
RECEIVED
MAY 14 2008
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
RECEIVED
MAY 1 2 2008
RISK MANAGEMENT
....
o
....
o
1XI
o
C\I
..
~
To18l Coverat:e:
5566.000
Pavment Plan: FoB Pay
Total Premium:
52.188
PIemium Amount
Tax Exempt SU1'Charge
2005 Citizens Emergency Assessment
2005 Marlcet Equalization Surcharge
$1,782
$31
$25
$37
2005 Florida Huaicaue Catastrophe Fund Emergency Assessment $18
Catastrophe Reinsurauce SU1'eharge $267
2007 Florida InsuraIH:e Ouaranty Association Regular Assessment $ 2 8
Subject to Form No(s):
CIT CP2 CIT-W06
Mortgagee/Loss Payee:
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
_ 1-/7.4 t. C~EARWATER, FL 34618
.a ~ S/Il.JOl?
Agent: U,.6C-SrAH1~~OCIATE INS INC~3
11 0 CARILLON PARKWAY
ST. PETERSBURG, FL 33716
Payor:
INSURED
(727) 391-9791
CIT W03-CNR 01 08 04837 Team 2
Date: 5/02/2008
MORTGAGEE COPY -01
QSY R 40111
2236