CERTIFICATE OF INSURANCE (9)
.
Part 2: THIS DECLARATION PAGE, 11TH POLICY PROVISIONS - PART I AND ENDORSEMITTS, IF ANY ISSUED TO FORM
A PART THEREOF, COMPLETE nn.ELOW NUMBERED FLORIDA WINDSTORM UNDER JTING ASSOCIATION POLICY,
FLORIDA WINDSTORM UNDERWRITING ASSOCIATION
7077 Bonneval Road - Suite 500, Jacksonville, Florida 32216-6064
CLEARWATER BEACH SEAFOOD AND RESTAURANT
37 CAUSEWAY BLVD
CLEARWATER BEACH, FL 34630
THIS IS A
INSURED'S NAME AND ADDRESS
GENERAL BUSINESS
POLICY TERM 6/04/2001 TO 6/04/2002 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
$ $ 'Is $ $ $
1 251,000 90 7,530 T-42 680
169,000 90 5,070 T-42 458
TWO STORY MASONRY RESTAURANT LOC:
37 CAUSEWAY BLVD CI,.E..ARWATER. BEACH , PINEL LAS FL 33767 -.2003--
RECE:; ,j ~""~"
JUL 0 02001
CITY CLFRV
Oe-(6\ tJf'\L - Cc 'T'4. C C EiC I<
C'e: M{~1Z ( r.J E; a2.l5: i<....
TOTAL AMOUNT OF COVERAGE
ACTUAL PREMIUM
PREMIUM
Florida Hurricane Cat Fund
$ .00
P - I
TOTAL PREMIUM
00 NOT PAY
$
420,000
Subject to Form No(s):
CP2 07/00 FWUA 06 (07/00)
Mortgagee/Loss Payee
1,138.00
Rei nsurance
$
$
171.00
1,309.00
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
CLEARWATER, FL 34618
RECEIVED
Producer:
INSURED
"
- j ~ '001
STAHL & ASSOC INS INC 0483
8200 SEMINOLE BLVD
SEMINOLE, FL 33772
Payor:
F\:c-I\ lili\NAGEMENT
6/12/2001
FWUA 03 (08/98)
0483 Team 2
MORTGAGEE COpy
Date:
LV
R 26857
5143