CERTIFICATE OF LIABILITY INSURANCE (2)
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FLD 1308769 MEMORANDUM
liTHE
I SE'BELS BRUCE
INSURANCE
COMPANIES
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I\PR 20\994
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\ nl\om,:\;.\r, l 'OFFER TO RENEW
\~ FLOOD INSURANCE
PAYMENT OF PREMIUM BY 05/31/94 CONTINUES
COVERAGE AS SHOWN, IF NOT, ALL COVERAGE
EXPIRES EFFECTIVE 05/31/94.
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FLD
1308769
FROM TO
POlICY PERIOD
COVERAGE IS PROVIDED IN THE.
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POLICY NUMBER
P
FLD 1308769 05/31/94
NAMED INSURED AND ADDRESS
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05/31/95 CATAWBA INSURANCE COMPANY 0008287 0
AGENT
CLEARWATER BEACH SEAFOOD &
RESTAURANT INC
37 CAUSEWAY BLVD
CLEARWATER FL
ALLEY REHBAUM & CAPES INC
POBOX 4620
CLEARWATER FL
34630 34618
TEL NO 813-797-5193
LOCATION OF RESIDENCE PREMISES:
37 CAUSEWAY BLVD
CLEARWATER FL
34630
RATING INFORMATION: REGULAR PROGRAM, (SPECIFIC RATES), ZONE A12. SMALL BUSINESS, NO BASEMENT, TWO FLOORS, BUILDING OED
IS $5000, BUILDING IS NOT ELEV. SPECIFIC (SUBMIT FOR RATE), BUILDING CONSTRUCTED ON OR SUBSTANTIALLY IMPROVED AFTER FIRM
DATE OF 06/04/11, ~LEVATION DIFF IS -06, NOT FLOOD PROOrCD, POST-FIRM, UNIT " FREE OF OBSTRUCTION, LOWEST FLOOR ^BOVE
GROUND LEVEL AND HIGHER FLOORS, COMMUNITY RATING CREDIT OF 05% APPLIES.
COVERAGE AT THE ABOVE OESCRIBED LOCATION IS PROVIDED ONLY WHERE A LIMIT OF LIABILITY IS SHOWN OR A PREMIUM
IS STATED
COVERAGES
BU I LD I NG
SUBTOTAL
EXPENSE CONSTANT
FEDERAL SERVICE FEE
TOTAL PREMIUM
LIMIT OF LIABILITY
$200,000
DNE-YEAR-PREMIUM
$10,930.00
$10,930.00
$45.00
$25.00
$11,000.00
THREE-YEAR-PREMIUM
$32,790.00
$32,790.00
$45.00
$25.00
$32,860.00
PAYOR IS INSURED.
**AT 12:01 AM STANDARD TIME AT THE MAILING ADDRESS SHOWN ABOVE.
FORMS AND ENDORSEMENTS: BJP428 10/88, FLD162 10/92, FLD163 01/93. FLD166 04/93*. FLD154 04/91.
MORTGAGEE:
CITY OF CLEARWATER
C/O RISK MANAGEMENT
PO BOX 4748
CLEARWATER FL
34618
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APR 1 8 1994 tr...
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------ S TAT E MEN T 0 F A C C 0 U N T ------
AMOUNT DUE 05/31/94.......
$11,000.00
$11,000.00
FLD1308769 0531 DIRECT BILL INSR
CLEARWATER BEACH SEAFOOD &
AMOUNT DUE 05/31/94 $11,000.00
PLEASE MAKE CHECK OR MONEY ORDER
PAYABLE TO AND MAIL TO - ...
CATAWBA INSURANCE COMPANY
POBOX 1
COLUMBIA S.C. 29202
WRITE YOUR POLICY NUMBER ON YOUR
CHECK AND RETURN WITH THIS STUB
TOTAL PREMIUM..................
THANK YOU FOR LETTING US SERVE YOU