CERTIFICATE OF INSURANCE (10)
lA.uto Club South Insurance company,.
P.O. Box 33011
St. Petersburg, FL 33733-80113.
1-800-884-4982
BFL 99.001 0201
0303055
5/18/02
FWOD DECLARATIONS PAGE
~
535 08701 FLD RGLR Renewal
General Property Form
Date of Issue
5/18/02
Insured
CRABBY BILLS
CLEARWATER BEACH RESTAURANT
1901 ULMER TON RD STE 750
CLEARWATER FL 33762-2326
Loan Number
CITY OF CLEARWATER
C/O RISH MANAGEMENT
PO BOX 4748
CLEARWATER FL 33758-4748
RECEIVED
MAY 2 2 t002
RISK MANAGEMENT
Insured Location (if other than above)
37 CAUSEWAY BLVD, CLEARWATER FL 33767
Building Description Non-Residential
# of Floors Two Floors
Basement/Enclosure None
Community Name CLEARWATER,
Community # 125096
Community Rating 07 / 15%
Program Status Regular
Risk Zone A12
CITY OF
Condo Type N/ A
# of Units 0
Adjacent Grade 0
Elevation Difference 6-
Contents Location
BUILDING
CONTENTS
$220,000
$0
$5000
$0
$23,515.00
$.00
$23,515.00
$4,468.00
$35.00
$2,862.00
$50.00
DEAR MORTGAGEE
The Reform Act of 1994 requires you to notify
the WYO company for this policy within 60 days
of any changes in the servicer of this loan.
The above message applies only when there is
a mortgagee on the insured location.
ANNUAL SUBTOTAL:
DEDUCTIBLE CREDIT:
ICC PREMIUM:
COMMUNITY DISCOUNT:
EXPENSE CONSTANT:
TOTAL WRITTEN PREMIUM:
FEDERAL POLICY SERVICE FEE:
$16,270.00
$30.00
TOTAL PREMIUM:
Premium paid by:
$16,300.00
Insured
Submit For Rate
This policy covers only one building. If you have more than one building on your property, please make sure they are all covered. See
III. Property Covered within your Flood policy for the NFIP definition of "building" or contact your agent. broker, or insurance company.
V(2l6INAC I c.( ~ CLtGf2(('
This policy is issued by
AAA et ~ )'Y\/1\12-l rJ (5
Copy Sent To: As indicated on back or additional pages, if anY.f<..\SI'-
Lender
00020000941011142310213800008
Part 2: THIS DECLARATION PAGE filTH POLICY PROVISIONS - PART I AND ENDORSEl'1IHS, IF ANY ISSUED TO FORM
A PART THEREOF, COMPLETE n:IBELOW NUMBERED FLORIDA WINDSTORM UNDERII. tlTING ASSOCIATION POLICY.
FLORIDA WINDSTORM UNDERWRITING ASSOCIATION
7077 Bonneval Road - Suite 500, Jacksonville, Florida 32216-6064
CLEARWATER BEACH SEAFOOD AND RESTAURANT
1901 ULMERTON RD #750
CLEARWATER, FL 33762
THIS IS A
INSURED'S NAME AND ADDRESS
GENERAL BUSINESS
POLICY'EERM 6/04/2002 TO 6/04/2003 AT 12:01 A.M. (EST) POLICY NO_ 150904
INCEPTION DATE EXPIRATION DATE THIS IS YOUR POLICY DECLARATION PAGE - This is not a Bill
PAGE 1
$ $
1 253,000
'Is
$ $
7,590 T-42
$
170,000
90
90
5,100
T-42
685
460
TWO STORY MASONRY RESTAURANT LOC:
37 CAUSEWAY BLVD CLEARWATER BEACH, PINELLAS FL 33767-2003
Qr&~" ~l~ c.tu-uk
t..t~ ~
\~~
- -----_._-'_...---:_-----~'----:--- "--,--.--.,: --,---.--. -- -----~.-----.
TOTAL AMOUNT OF COVERAGE
ACTUAL PREMIUM
PREMIUM
Florida Hurricane Cat Fund
$ .00
P - I
TOTAL PREMIUM
DO NOT PAY
$
423,000
Subject to Form No{s):
1,145.00
Rei nsu ranee
$
$
172.00
1,317.00
CP2 07/00 FWUA 06 (07/00)
Mortgagee/Loss Payee
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
CLEARWATER, FL 34618
R ir...."""'"-" ~......"'p
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L:,
P. Rot (, /.
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Producer:
STAHL & ASSOC INS INC 0483
8200 SEMINOLE BLVD
SEMINOLE, FL 33772
Payor:
INSURED
RiSK iV1ANAGEMENT
4/17/2002
I l
/ (r: .' (J/
FWUA 03 (08/98)
0483 Team 2
MORTGAGEE ~fY
Date:
R 40111
229