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CERTIFICATE OF LIABILITY INSURANCE (3) A4~4'lrlt@ CERTIFICA TejoF LIABILI .-- t:. ..~ - ".. . . :'3'~.'. .IlS DATE (IoIWDIYY) , . ,: -:. . ~'.- '.' 05f&t8 . .- '~'..,~:. ". PRODUCER THIS CER11FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONfERS NO RIGHTS UPON THE CERT1FICATE Northeast Underwriters, Inc. HOLDER. THIS CERT1FICATE DOES NOT AMEND, EXTEND OR POBox 7506 ALTER THE COVERAGE AFFORDED BY THE POLICIES BelOW. 4790 1 at Street North COMPANIES AFFORDING COVERAGE / ~73H506CITV I"\C:: '" C^O\^,^TEr COMPANY ..... -- A Underwrll8rs at LJoyd'a RECE4VJ:D ~ ~ ,",UI1-U ~ COMPANY JUN 0 1 1998 ( C1e8lWater Beach Seafoods HARBuiiMA::i I trt\:l Ul-rlG B Restaurant loc nl~" h"I"\''JAut:MENT 37-Causeway Boulevard COMPANY Cle8lWater 34630 C COMPANY D COVERAGES THIS IS TO CEi'iTlFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NO"'VITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE :.:;Y BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POI..IClES DESCRIBED HERBN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co TYPE OF INSURANCE POlICY NUUBER POlICY EfFECTIVE POUCY EXPIRATlON WIlTS Lm DATE (MMlDDIYY) DATE (MMlDDIYY) A GENERAL LIABIlITY GL15380 97 05/31/98 05/31/99 GENERAL AGGREGATE $ 1,000,000 ...,..,.... X COMMERCiAL GENERAL LIABILITY PRODUCTS. COMPiOP AGG $ 1,000,000 I C..~iMS MADE o OCCUR PERSONAL & ADV INJURY $ 1 ,000,000 OWNERS & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 X 5250 DEDUCTIBLE APPLIES FIRE DAMAGE (Any one finl) S 50,000 MED EXP (Any one p&lSOl1) S 5,000 ~OMOBILL c:ABILlTY COMBINED SINGLE LIMIT S ANY AUT( ""- ~ ALL OW,'.LD AUTOS BOOIl Y INJURY (Pfl( peqan) S SCHEDULED AUTOS . ""- HIRED AUTOS BOOI. Y INJURY ""- (Pfl( ICtidenl) S NON-OWNED AUTOS ~ PROPERTY DAMAGE S GARAGE LlA81clTY AUTO ONly. EA ACCIDENT S - ANY Aun OTHER THAN AUTO ONLY: - EACH ACCIDENT S AGGREGATE S EXCESS LlAc'L: ry EACH OCOJRRENCE S q UMBRELL,\ FORM AGGREGATE S OTHER ,-c.AN UMBRELLA FORM S WORKERS COMPENSATION AND I T8t\'l~~'rYs I I~l,r- EMPLOYERS. LIABILITY El EACH ACCIDENT S THE PROPRIE, GR! R1INCL EL DISEASE . POUCY LIMIT S PARTNERS.HE':UTIVE OFFICERS AiiE: EXCL EL DISEASE . EA EMPlOYEE S OTHER A Liquor Liability LL25097.97 05/31/98 05/31/99 Each Common Cause 1,000,000 Per Aggregate Limit 1,000,000 DESCRIPTION OF OPEQ,\TIONSLOCATIONSNEHICLESlSPECIAL ITEMS 5.29-98ce This certilirate holder is listed as an Additional Insured. CERTIACA TE HOLDER CANCEUATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL clo Risk Management -.1Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO Box 4748 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Clearwater FL 34618 OF ANY KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE '----... C 7f 1~ '-1Y)~ h -' r~ ACORD 25-S (1/95) - '-" A&'R~ CORPORATi 1988 C (,6'2. I::.' . M ~ I \JUo) I -rt. cc. Cl A-el c- G FLOOD POLICY DEClARATIONS I OS/28/1998 I c...~TA WBA INSURANCE COMPANY- Columbia SC 29202 NO~'~0130876900~~ '- , '- 58 ISSUE DATE 5/28/1998 REC~VED JUN 0 1 1998 AI\:>r\ MANAGEMENT RENEWAL FIRST MORTGAGEE NAME AND ADDRESS CITY OF CLEARWATER C/O RISK MANAGEMENT PO BOX 4748 CLEARWATER FL 34618 NAMED INSURED AND MAILING ADDRESS CLEARWATER BEACH SEAFOOD &: RESTAURANT INC 37 CAUSEWAY BLVD CLEARWATER FL 34630 POLICY TERM: 1 YEAR(S) INCEPTION: 5/31/1998 EXPIRATION: 5/31/1999 THESE DECLARATIONS ARE EFFECTIVE 5/31/1998 12:01 AM. LOCAL TIME AT THE DESCRIBED LOCATION COVEREO BY THIS POLICY LOCATED AT THE ABOVE MAILING ADDRESS, UNLESS OTHERWISE STATED BELOW, ". :'Am'i:#$':}W~;;;'<~~""_8').i$Yi"Y~~h':::""'<!::;''iliW'''':;$@.~\:~::v.:<. ><:;l'/ {Ai' '.',... ", ,. o'.... :... " ,,"',v'T.': . :..... 'V';:'^".<<t",y~:Wi:('liW::::::4&~~ ~~"\,~'.~. ';'-'i'? :::':"f:"1%,:,:;;f''''"=':;<T:: {",?'::<':;" ",,1 TING'INFORr\11\Tf()N ....' , ....".. i'. . x.....,.:.:".!.;""..<*\'':::xi\':TW:''''-::::\::&. ," '-'. ',>.~ '-~'~N. .' '. . .. .~..q; :'f;;; :?~ ;:', ~~..;"~/."':-.'''::''~~'' .';., I:<.:"~""': . ~.. ~ ... ... . ... .. .. "::" ~.. :~:: ~'Y:;;:>'''': ^"';~~'{1,r"ffl CONSTRUCTION DATE: 01/01/84 BUILDING DESCRIPTION: NON-RES IDENTIAL NO. OF FLOORS: TWO BASEMENT DESCRIPTION: NONE CONTENTS LOCATION: N/A COMMUNITY NAME: CLEARWATER, COMMUNITY NO.: 1250960000C PROGRAM STATUS: REGULAR CONDO TYPE: NOT A CONDO CITY OF COMMUNITY RATING: 08 RISK ZONE: A12 NO. OF UNITS: N/A ELEVATED BUILDING: NO LOWEST FLOOR ELEVATION: 5.5 BASE FLOOD ELEVATION: 12.0 RATING ELEVATION: -6 LIMITS OF LIABILITY BUILDING CONTENTS $220,000 NONE DEDUCTIBLE AMOUNTS BUILDING CONTENTS $5,000 N/A TYPE OF COVERAGE BUILDING BASIC AMT. OF INS. RATE PREMIUM ADDITIONAL j DEDUCTIBLE I TOTAL AMT. OF INS. RATE PREMIUM !BUYBACK/DlSCI PREMIUM 135,000 x 5.15 = $6,953 85,000 x 3.35 , 1 .. $2,848 1- $1,862.001 $7,939.00 J I I N/AI ! CONTENTS AGENT'S NAME AND ADDRESS ALLEY REHBAUM &: CAPES INC 2433 GULF TO BAY BLVD POBOX 4620 CLEARWATER FL 33765 PREMIUM SUBTOTAL COVERAGE D (lCC) CRS DISCOUNT EXPENSE CONSTANT FEDERAL POUCY FEE TOTAL PREMIUM 7,939.00 35.00 -797.00 50.00 30.00 $7,257.00 ENDORSEMENTS: END1:ICC END2 :DED AGENCY NO. I PRODUCER NO. 0008287 I C c ~ C.... { 'iL'\ AGENT PHONE NO. PAYOR (813) 797-5193, INSURED CL8Z.il::: i M/+1ltfJE COUNTERSIGNATURE ,A4:4tlllt*EVI9ENQli QfJRlltll1&BiY INSWaANSE ..' D~n) c .. '" .- ,..~ .' '..~, " 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 ALLEY REHBAUM & CAPES ASSURANCE, INC. P. O. BOX 4820 ClEARWATER COMPANY FLORIDA WINDSTORM t:")e", TilliE J VIr () f't'\oe. \ '. 4 1998 ~VA6J.:.. "ME. FL 33758 COOE: cu OMER 10 I: INSURED SUB CODE: Clearwater Beach Seafoods Restaurant, Inc. 37 Causeway Blvd. Clearwater EFFECTIVE DATE 06J04I98 POLICY NUMBER 150904 EXPIRATION DATE 06AW99 CONTINUED UNTIL TERMINATED IF CHECKED LOAN NUMBER FL 34630 THIS REPLACES PRIOR EVIDENCE DATED: PROPEflTY.lNFORMATION LOCATIOf<<)ESCRIPTlON 37 Causeway Blvd., Clearwater, FlorIda COVERAGE INFORMATION COVERAGEIPERILSIFORMS AMOUNT OF INSURANCE DEDUCTIBLE BuIldIng . Windstorm & Hall coverage ContenIs . WIndstorm & Hall coverage 233000 150000 6990 4680 REMARKS (Including Special Condillons) CANCELtATION 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 12 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. ADDmoNAlINTEREST NAME AND ADDRESS X MORTGAGEE LOSS PAYEE City of Clearwater clo Risk Management P. O. Box 4748 Clearwater FL 34618 AllTHORIZED REPRESENTATIVE I ACORD 27 (3193) @ ACORD COR~RATION 1993 . A.~.tltl.4P EVIDENGE0FI RIl6)PER~~INSlrJ~..1 D~OOYl1 THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS A~.JHE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. . I"' PRODUCE COMPANY ~D ALLEY REHBAUM & CAPES '')''-'' 0 ~ ASSURANCE, INC. Catawba Insurance Company I ''''~/V/. 1.9.90 P. o. BOX 4620 ", ~J... CLEARWATER Fl 33758 '-#.....11? ~Iv SUB CODE: Clearwater Beach Seafoods Restaurant, Inc. 37 Causeway Blvd. Clearwater EFFECTIVE DATE 05/31/98 POLICY NUMBER FlD1308769 EXPIRATION DATE 05/31199 CONTINUED UNTIL TERMINATED IF CHECKED LOAN NUMBER Fl 34630 THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATIONIOESCRIPTION Location: 37 Causeway Blvd., Clearwater, Fl COVERAGE . INFORMATION COVERAGEIPERILSlFORMS AMOUNT OF INSURANCE DEDUCTIBLE Building . Flood 220000 5000 REMARKS (including Special CondIIIons) CANCEUATION 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. ADDrnONAL INTEREST NAME AND ADDRESS X MORTGAGEE LOSS PAYEE City of Clearwater c/o Risk Management P. O. Box 4748 Clearwater Fl 34618 CJ ACORD CORPORATION 1993 I ACORD 27 (3/93)