CERTIFICATE OF INSURANCE (8)
Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART I AND ENDORSEMENTS, IF ANY ISSUED TO FORM
A PART THEREOF, COMPLETE THE IELOW NUMBERED FLORIDA WINDSTORM UNDERVIuTING ASSOCIATION POLICY,
FLORIDA 'wINDSTORM UNDERWRITING ASSf>CIA TION
7077 Bonneval Road - Suite 500, Jacksonville, Florida 32216-6064
INSURED'S NAME AND ADDRESS
CLEARWATER BEACH SEAFOOD AND RESTAURANT
37 CAUSEWAY BLVD
CLEARWATER BEACH, FL 34630
THIS IS A
GENERAL BUSINESS
POLICY TERM 6/04/2000 TO 6/04/2001 AT 12:01 A.M. (EST) POLICY NO. 150904
INCEP~'ION DATE EXPIRATION DATE THIS IS YOUR POLICY DECLARATION PAGE - This is not a Bill
PAGE 1
::'~~~:: :::::::::::,::,:':,:::::~~:~'i~'~:~#:::::::::::::::::::::':::::::::'i':::':':::::::::::::'~~#.~%##~:'::",:::::::::':::,,:::~. . .'. ' ::'. ~::::::::::::'.::,:::.:::'::::::::::::::::::::::::::::::::::::::::::::::::::,i::,'::::.::::::::::i:::i:.::::::::#:~fH:wm,:::.:::::,':':':'::':':::::':'::':'::::::::::::::,:J1Mw*~::i:,:i!,::::,.:::::.:i:i:.:":,:'::::::!::,':.::'i:,
$ $
1 244,000
%
$ $
7,320 T-42
$
164,000
90
90
4,920
T-42
661
444
TWO STORY ~~SONRY RESTAU~~ LOC:
37 CAUSEWAY BLVD CLEARWATER BEACH, PINELLAS FL 33767-2003
RECEIVED
JUN 1 3 2000
RISK MANAGEMENT
P - I
408,000
SubJect to Form No s :
CP2 08/98 FWUA 06 (08/98) FWUA 1791
Mortgagee/Loss Payee
1,105.00
Florida Hurricane Cat Fund
$ .00
Reinsurance
$ 166.00
DO NOT PAY
$
$
1,271.00
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
CLEARWATER, FL 34618
Pro ucer:
ALLEY REHBAUM & CAPES 3212
ASSURANCE INC
2433 GULF TO BAY BLVD
tLE:.ARWATER,JFL 33765
Payor:
INSURED
6/01/2000
FWUA 03 (08/98)
3212 MEJ
MORTGAGEE COPY
Date:
R 40111
77