EVIDENCE OF PROPERTY INSURANCE
DATE (MM/DDIYY)
06113/00
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER COMPANY
AUEY REHBAUM & CAPES
ASSURANCE, INC.
P. O. BOX 4620
CLEARWATER A. 33758
Catawba Insurance Company
CODE:
CUSTOMER ID #:
INSURED
SUB CODE:
Clearwater Beach Seafoods
Restaurant, Inc.
37 Causeway Blvd.
Clearwater
EFFECTIVE DATE
05/31/00
POLICY NUMBER
FLD1308769
EXPIRATION DATE
05/31/01
CONTINUED UNTil
TERMINATED IF CHECKED
lOAN NUMBER
FL 33767
THIS REPLACES PRIOR EVIDENCE DATED:
L.ocalion: 37 Causeway Blvd., Clearwater, FL
COVERAGE/PERilS/FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
Building - Flood
220000
5000
REcr'VED
JUN f +- 2J)OO
HISK MANf..:_3AENT
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THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD, SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW,
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NAME AND ADDRESS
City of CleaJWater
c/o Risk Management
P. O. Box 4748
Clearwater
A. 33758
AUTHORIZED REPRESENTATIVE
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