INFORMATONAL NOTICE OF PREMIUM TO BE PAYED BY INSURED
['A') STATE FARM INSURANCE COMPANIES
.. POLICY NUMBER
10-BL-4180-2
BUSINESS MISCELLANEOUS PROG~AM
NOTE: DO NOT PAY. THE PREMIUM IS
BEING PAl BY THE INSURED.
DATE DUE,
PLEASE PAY THIS AMOUNT
THIS IS FOR INFORMATION ONLY
12 INS U RED :
CARTER COMMUNICATIONS INC
IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT
"
10
1214/00
C
CITY OF CLEARWATER
25 CAUSEWAY BLVD
CLEARWATER FL 34630-2064
RECEIVED
J U N 1 4 1994
1..11..1..1.11....11.11"1..1.111....11...1..1..1.1.1.1..1.1.1
CITY CLERK DEPT. '
Regional Office Use Only
0901
710 100424400039339 4906122241802025 >
rA') S TAT E FAR M FIR E AND CAS U A L T Y COM PAN Y R ENE W A L C E R T I FICA T E
" P.O. BOX 45061, JACKSONVILLE FL 32232-5061 PREPARED JUN 09 94
POLICY NUMBER DATE DUE PLEASE PAY THIS AMOUNT BUSINESS MISCELLANEOUS PROGRAM
90-BL-4180-2 TO BE PAID BY INSURED INSURED:
CARTER COMMUNICATIONS INC
POLICY NUMBER 90-BL-4180-2 REPLACES 90-78-8132-1
FULL PAYMENT BY DATE DUE RENEWS THE POLICY
FROM AUG 02 94 TO AUG 02 95.
SECTION I
LOCATION
1> 25 CAUSEWAY BLVD RM 31,32
CLEARWATER BCH FL
COVERAGES/LIMITS
BUILDINGS- BUSINESS PERSONAL
COVERAGE A PROPERTY-COVERAGE B
EXCLUDED 21,800 $
PREMIUMS
255.00
LOSS OF INCOME-COVERAGE C
- -'--
DEDUCTIBLES-BASIC $250
OTHER DEDUCTIBLES
SECTION II
BUSINESS LIABILITY-COVERAGE L
MEDICAL PAYMENTS-COVERAGE M
PRODUCTS-COMPLETED OPERATIONS
GENERAL AGGREGATE (OTHER THAN
ACTUAL LOSS
MAY APPLY-REFER TO POLICY
300,000
5,000
(PCO> AGGREGATE 600,000
PCO> 600,000
AUDIT PERIOD:
ANNUAL
$ 48.00
COVERAGE A -
INFLATION COVERAGE
INDEX:N/A
COVERAGE B -
CONSUMER PRICE
INDEX: 147.4
FORMS, OPTIONS, AND
SPECIAL FORM 3
AMENDATORY ENDORSEMENT
TREE DEBRIS REMOVAL END
POLICY ENDORSEMENT-BUSINESS
ADVERTISING INJURY EXCL
ADDITIONAL INSURED
PERSONAL INJURY EXCLUSION
ENDORSEMENTS
FP-6103
FE-6210.2
FE-6451
FE-6464
FE-6345
FE-6320
FE-6346
$
86.00
See reverse side for important information affecting your insurance.
Please keep this part for your record.
lIruiJ in &1tiHf td J.ett'g r. . .
AgentRUGGfE, BILL
Telephone 813-443-0493
o
ESTIMATED PREMIUM
FL EMPA FUND SURCHG
FL TRUST FUND SURCHG
$
$
$
389.00
4.00
.39
IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. IF THIS IS NOT
CONVENIENT, PLEASE COMPLETE THE FOLLOWING.
.A
Note: If this is a change in insured property, please sCJtour State Farm Agent.
D Mailing address change only D LocatioJichange I expect to be here
D permanent change D temporary change months.
List below all other State Farm policies (Auto, Life, Fire or Health)
on l!!'hich premium notices should be sent to the new. address.
(PL - E PRINT)
Pol. No.
Insured's Name
Street or Rural Route Address
Pol. No.
Insured's Name
City
St./Prov.
Zip/Postal
Township
D Inside City Limits
County
D Outside City Limits
Pol. No.
Insured's Name
Pol. No.
Insured's Name
Pol. No.
Insured's Name
New Residence Phone No. (_)
New Business Phone No. (_)
NOTICE TO POLICYHOLDER
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of
this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms
attached to this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement
to your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have
any questions about your insurance coverage, contact your State Farm agent.
Please keep this with your policy.
538-141.6 Rev. 1-90 Printed in U.S.A.