TWO STORY MASONRY RESTAURANT
INSURED NAME AND ADDRESS
Part 2: THIS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM
A PART THEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY.
CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY
6676 Corporate Center Parkway, Jacksonville, Florida 32216-0973
~Clll~~M~
THIS IS A
CLEARWATER BEACH SEAFOOD AND RESTAURANT
PO BOX 99
INDIAN ROCKS BEACH, FL 33785
GENERAL BUSINESS
POLICY TERM 6/04/2005 TO 6/04/2006 AT 12:01 A.M. (EST) CITIZENS POLICY NO. 150904
INCEPTION DATE EXPIRATION DATE THIS IS YOUR POI.,ICY DECLARATION PAGE - This is not a Bill
PAGE 1
$ $
1 292,000
%
$ $
8,760 T-42
$
196,000
90
90
5,880
T-42
791
531
TWO STORY MASONRY RESTAURANT LOC:
37 CAUSEWAY BLVD CLEARWATER BEACH, PINELLAS FL 33767-2003
~~
'(Y\~
.~
RECEIVED
MAY 1 7 2005
OFFICIAL RECORDS AND
LEGISLATIVE SR\lCS DEPT
P - I
$
1,322.00
Florida Hurricane Cat Fund
$ .00
Reins/Cat Financing
$ 198.00
DO NOT PAY
$
488,000
Subject to Form No(s):
Tax-Exempt Sur 23.00
1,543.00
RETAINED
CIT CP2
Mortgagee/Loss Payee:
CIT-W06
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
CLEARWATER, FL 34618
RECEIVED
INSURED
Agent:
STAHL & ASSOCIATES 0483
INSURANCE, INC
8200 SEMINOLE BLVD
SEMINOLE, FL 33772
(727) 391-9791
CIT-W03 (7/02) 04837 Team 2
Payor:
RISK MANAGEMENT
Date: 5/05/2005
MORTGAGEE COpy
R 40111
693