INSURANCE BINDERS INCLUDING PREVIOUS YEAR
or
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,~ INSURANC~ BINDER n _
THIS BINDER IS A TEMPORARY INSURAN9E" CONTRACT, SUBJECT TO THE CONDITIONS SHO;"'N ON THE REVERSE SIDE OF THIS FORM.
PRODUCER
Rodgers & Cimmings Insurance, Inc.
P.O. Box 5148
Clearwater, FL 34618
COMPANY BINDER NO.
The Travelers 88C01l6
EFFECTIVE EXPIRATION
DATE DATE TIME
AM 12:01 AM
3/1/88 PM 4/1/88 NOON
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED
COMPANY PER EXPIRING POLICY NO.:
CODE
SUB-CODE
DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY (lNCLUOING LOCATION)
CHI CHI RODRGUEZ YOUTH FOUNDATION, INC.
1345 Court Street
Clearwater, FL 34618
1. Clubhouse
2. Clubhouse
3. Office
4. Greenhouse
INSURED
TYPE OF INSURANCE
PROPERTY
COVERAGESIFORMS
ALL VEHICLES
SCHEDULED VEHICLES
AMOUNT DEDUCTIBLE COINSURANCE
See Below* $100 80%
GENERAL AGGREGATE
PRODUCTS-COMP/OPS AGGREGATE
PERSONAL & ADVERTISING INJURY
EACH OCCURRENCE
FIRE DAMAGE (ANY ONE FIRE)
MEDICAL EXPENSE (ANY ONE PERSON)
CSL $
81 PERSlACCID $
PO $
MED. PAY $
PIP $
UM $
ACV
STATED AMOUNT $
OTHER
EACH AGGREGATE SELF-INSURED
OCCURRENCE RETENTION
CAUSES OF LOSS
BASIC D BROAD [i]SPECIAL
Building
Contents
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE W OCCURRENCE
OWNER'S & CONTRACTORS
PROTECTIVE
AUTOMOBILE
LIABILITY
NON/OWNEO
HIREO
GARAGE
RETRO DATE FOR CLAIMS MADE:
ALL VEHICLES SCHEDULED VEHICLES
COLLISION OED: ? 50
OTC OEO:
EXCESS LIABILITY
UMllRELLA F.O.RM_
OTHER THAN UMBRELLA FORM
RETRO DATE FOR CLAIMS ,MADE:
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
(DISEASE-EACH EMPLOYEE)
SPECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES
*Amountsl 1. Building $110,000
Contents $ 25,000
2. Building $ 25,000
Contents $ 2,500
3. Building $8,000
4. Building $2,000
City of Clearwater
P.o. Box 4748
Clearwater, FL 33518
2. Dana Commercial Credit-Location 1 & 2
P.O. Box 7011
Troy, HI 38007-7011
I
,
CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side, This insurance is
subject to the terms, conditions and limitations of the policy(ies) in current use by the Company,
This binder may be cancelled by the Insured by surrender of this binder or by written notice to
the Company stating when cancellation will be effective, This binder may be cancelled by the
Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled
when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled
to charge a premium for the binder according to the Rules and Rates in use by the Company.
APPLICABLE IN NEVADA
Any person who refuses to accept a binder which provides coverage of less than
$1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B)
is liable to the party presenting the binder as proof of insurance for actual damages sus-
tained therefrom.
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CITY OF CLEARWATER
Interdepartmental Memorandum
SUBJECT: Chi Chi Rodriguez (Glen Oaks)
T9: ~ Don Petersen, Risk Manager
FR9H:> El i zabeth S. Haeseker, Ass i stant
COPIES: Ream Wilson, Parks & Recreation Director
DATE:
December 21, 1987
The above-referenced insurance policy is due to expire February 1, 1988.
Please forward a copy of the current Certificate of Insurance to me when you have
determined the pOlicy meets the lease requirements.
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FROM: Stephanie DiNatale
TO:
Mr. Donald J. Petersen
Risk Manager
City of Clearwater
POBox 4748
Clearwater, Fl 34618-4748
Rodgers & Cummings Insurance, Inc.
,
1499 Gulf-to.Bay Boulevard
P.O. Box 5148
Clearwater, Florida 33518
Insurers Since 1926
(813) 461-6111/Tampa (813) 229-2083
DATEt/28/88 .
SUBJECT: Chi Chi Rodriguez Youth Foundation
_. Dear Mr. Petersen:
Enclosed please find an insurance binder for the renewal of the captioned policy,
effective 2/1/88. The policy has been ordered and certificate will be forthcoming.
Sincerely, _
-dup/l LL-(LL~~ '/lcd-cLLc
eornrercial AccOunt Representative
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P 0 J:IW4Im 5148
C1.eanI!lt.er, Fla. 33518
COMPANY
'J!Je '.rraWlers Ins\IraI:le CO.
Effective 12: 0 8m .
Expires g 12:01 am 0 Noon 3/1/,19
o This binder is issued to extend coverage in the above named
company per expiring policy #
(except as noted below)
NAME ANO MAILING ADDRESS OF INSURED
Description of Operation/Vehicles/Property
CHI an lOlRIQUEZ mmI ~,nc.
Ul5 Q:Jurt street
Cl..eaxwIter, Fla. 33516
Type and location of Property
Coverage/Perils/ Forms
Amt of Insurance Oed.
110,000 100
25,000 " .
25,000 100
2,500 n ..
8,000
1345 CCIurt St
Clwr Fla.
lMndhY;J 11
(bitMIts
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AIL RISK
Type of Insurance
Coverage/ Forms
limits of liability
Each Occurrence
Bodily Injury $
Aggregate
$
o Scheduled Form [J Comprehensive Form
[j Premises/Operations
o Products/Completed Operations
rJ Contractual
ex Other (specify below)
ex Med. Pay. $
o Personal Injury
Per
Person
JI!m[,
$
Per
Accident
o ft. L J B [J C
Property Damage $
Bodily Injury &
Property Damage $1,000,000
Combined
Personal Injury
limits of liability
Bodily Injury (Each Person) $
IBOdily Injury (Each Accident) $
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$
$
o Liability ex Non-owned 0 Hired
o Comprehensive-Deductible $
o Collision-Deductible $
n Medica! Payments $
o Uninsured Motorist $
o No Fault (specify):
o Other (specify):
o WORKERS' COMPENSATION - Statutory Limits (specify states below)
Property Damage $
Bodily Injury & Property Damage
Combined $
o EMPLOYERS' LIABILITY -- Limit $
SPECIAL CONDITIONS/OTHER COVERAGES
0-
NAME AND ADDRESS OF MORTGAGEE
o LOSS PAYEE
IJ ADD.L INSURED
LOAN NUMBER
cr.rr C6 a.DlWllER
P. o. BaIt 4748
C18nater, Fla. 33518
Signature of Authorized Representative
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FROM: Stephanie DiNatale
1
AfL/Rodgers & Cal;nmings Insurance, Inc.
A company 01 Merrill Lynch Realty, Inc ~~
Rutland Bank Building ~ Merrill Lynch
1499 Gulf-to-Bay Boulevard
P.O. Box 5148
Clearwater. Florida 33518
To':~ity of Clearwater
POBox 4748
Cleqrwater, Fla. 33518
(813) 461-6111/Tampa (813) 229-2083
DATE:
4/14/86
SUBJECT:
CHI CHI RODRIQUEZ YOUTH FOUNDATION
PLOLICY #650 607G576-7-cof-86
The attached endorsement amends your policy as described, with
no change in the premium.
Please attach to your
feel free to call.
policy and if you have any questions
RECEIVEn
_d rrECEI~IED
please
Sincerely,
Stephanie DiNatale
Customer Service Representative
APR 16 19B6
APR 16 1986
CITY CLERtl'ty C-
. . LEID;
I. The Travelers
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CHAN~E EN~ORSEMENT I
GEN 10
POLICY NO: 650-607G576-7-COF-86
ISSUE DATE: 04-10-86JS
EFFECTIVE DATE: 02-01-86
(MO.. DAY. YR.)
POLICY EXPIRES:
02-01-87
(MO., DAY. YR.)
NAMED .INSURED: CHI CHI RODRIQUEZ YOUTH FOUNDATION, INC
PROVISIONAL PREMIUM due under these declarations: $
NIL
_additional
_return
CHANGES:-It is agreed that the policy is amended as described below.
SECTION II TO ADD OPN #10 - CITY OF CLEARWATER, AS ADDITIONAL INSURED AS PER
G III ATTACHED.
SECTION II, DECLARATIONS SCHEDULE GL 3-2 IS AMENDED PER GL 4-1 ATTACHED.
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Authorized Agent and Countersignature Date
GEN 10
(See Reverse Side)
Page 1 of 2
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DECLARATIONS SCHEDULE SUPPLEMENT
(General Liability jSection II)
GL 4-1
POLICY NO: 650-607G576-7-COF-86
ISSUE DATE: 04-10-86
NO.
EFFECTIVE DATE-8ame as policy unless otherwise specified:
Opn, Loc. Subline- Premium Rates Advance Premium
No, No, Description of Hazards Code No. Bases
B,I. P,D, B.1. P,D,
10 ADDITIONAL INSURED 106 INCL INCL
FOlU1 G I I I
ADD
GL 4-1
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" Tp.is endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
STOREKEEPER'S INSURANCE
ADDITIONAL INSURED
(State or Political Subdivisions - Permits Relating 10 Premises)
It is agreed that the "Persons Insured" provision includes as an insured any state or political subdivision designated in the
schedule below, subject to the following additional provisions:
1. The insurance for any such insured applies only with respect to such of the following hazards for which the state or
political subd~ision has issued a permit in connection with premises owned by, rented to or controlled by the named
insured and to which the Bodily Injury Liability Coverage applies:
(a) the existence. maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies,
cellar entrances, coal holes, driveways. manholes. marquees. hoistway openings, sidewalk vaults, street banners
or decorations and similar exposures;
(b) the construction, erection or removal of elevators;
(c) the ownership, maintenance or use of any elevators covered by the policy,
2. If Property Damage Liability Coverage is not otherwise afforded, such insurance shall nevertheless apply with respect
to operations performed by or on behalf of the named insured in connection with the hazard for which the permit has
been issued subject to the limits of liability stated herein.
SCHEDULE
Designation of State or Political Subdivision,
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL. 335le f POL b I
,mits 0 roperty amoge io i Ity
$ 1,000,000
each occurren ce
$ 1,000,000
aggregate
Premium
$
INCL
Amending Policy No.
C-11261 7-66 Printed in U,S,A, N,S. (779)
GIll