CERTIFICATE OF LIABILITY INSURANCE
05/31/91
PAYMENT OF PREMIUM
COVERAGE AS SHOWN,
EXPIRES EFFECTIVE
OFFER TO RENEW
FLOOD INSURANCE
BY 05/31/91 CONTINUES
IF NOT, ALL COVERAGE
05/31/91.
FLD
1308769
FLD. 508'169 MEMORANDUM
. THE
SEIBELS BRUCE
INSURANCE
COMPANIES
POLICY NUMBER
FLD 1308769
**** GENERAL PROPERTY FORM ***
. COVERAGE IS PROVIDED IN THE AGENCY
CAROLINA INSURANCE CO
NAMEDINSUREDAIIJDADDRESS
CLEARWATER BEACH SEAFOOD &
RESTAURANT INC
37 CAUSEWAY BLVD
CLEARWATER FL
ALLEY REHBAUM & CAPES INC
POBOX 4620
CLEARWATER FLORIDA
34630
34618
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 DED
c.lS-$50GO , BUILlrING IS-NOT ELEV, SPEeIFI{;-(SUSI.1H F6R RATE h-3\,.iIclDlN~NSTROCTED.gN-OR- S\iBST ANTIALLY- ItlPRGYED :.r'fERFIRH
DATE OF 06/04/71, ELEVATION DIFF IS -06, NOT FLOOD PROOFED, POST-FIRM, UNIT 1, FREE OF OBSTRUCTION, LOWEST FLOOR ABOVE
GROUND LEVEL AND HIGHER FLOORS.
COVERAGE AT THE ABOVE DESCRIBED LOCATION IS PROVIDED ONLY WHERE A LIMIT OF LIABILITY IS SHOWN OR A PREMIUM
IS STATED
COVERAGES
BUILDING
SUBTOTAL
EXPENSE CONSTANT
TOTAL PREMIUM
LIMIT OF LIABILITY
$200,000
ONE-YEAR-PREMIUM
$7,575.00
$7,575.00
$45.00
$7,620.00
THREE-YEAR-PREMIUM
$22,725.00
$22,725.00
$45.00
$22,770.00
PAYOR IS INSURED.
TOTAL PREMIUM....... ... ...... . . . . .
$7,620.00
$7,620.00
04/10/91
DATE
**AT 12:01 AM STANDARD TIME AT THE MAILING ADDRESS SHOWN ABOVE.
FORMS AND ENDORSEMENTS: BJP428 10/88.
MORTGAGEE:
CITY OF CLEARWATER
C/O RISK MANAGEMENT
PO BOX 4748
CLEARWATER FL
34618
~ECEIVED
APlr-17 .1991----
'__. , ;, CLERK
------ S TAT E MENr 0 F A C C 0 U N T
I AMOUNT DUE 05/31/91 $7,620.00
~PLEASE MAKE CHECK OR MONEY ORDER
, PAYABLE TO AND MAIL TO - ***
SOUTH CAROLINA INSURANCE CO
POBOX 1
COLUMBIA SC 29202
: WRITE YOUR POLICY NUMBER ON YOUR
: CHECK AND RETURN WITH THIS STUB
THANKYOV FoR.LETNNGOS SERVE YOU