CERTIFICATE OF INSURANCE (5)
POE & ASSOCIATES, INC.
P. O. BOX 1348
TAMPA, FLORIDA 33601-1348
it. /-:2. 3 1/
INSURED
CLEARWATER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33515
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAt'ON ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMENq.
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE!: I~,; ?
>,..... .\
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE
POLICY NUMBER
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAl
INDEPENDENT CO~TRACTORS
BROAD FORM PROPERTY DAMAGE
X PERSONAl INJURY
SVPD07811081
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS,)
AlL OWNED AUTOS (OTHER THAN)
PRIV, PASS.
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
NWCC28599699
OTHER
POLICY EFFECTIVE
DATE (MMlDDIYY)
4/1/87
4/1/87
PROPERTY SVPD07811081 4/1/87
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/SPECIAL ITEMS
ADDITIONAL INSURED: CITY OF CLEARWATER, FLORIDA
POLICY EXPIRATION
DATE IMMIDDIYYl
LIABILITY LIMITS IN THOUSANDS
EACH
OCCURRENCE
4/1/88
BODILY
INJURY
$
$
PROPERTY
DAMAGE
$
$
BI & PO
COMBINED
$1,000 $1,000
PERSONAL INJURY
800IL Y
INJURY $
(PER PERSON)
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PO
COMBINED $
BI & PO $
COMBINED
4/1/88
(EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
4/1/88 EE SCHEDULE
COl'f: {!,ry ({t_I::~t<-K.,
j) /le- rc/{S E .-f/'
-~
"
$150,700 - (80%
1875
$ 15,400 - (80%
$ 40,100 - (80%
1875
$ 24,700 - (80%
1875
,
I
PROPERTY
Co-Insurance) On Club House and Pro Shop located
Airport Drive, Clearwater, Florida.
Co-Insurance) On Contents contained in above building.
Co-Insurance) On Golf Cart Storage Building located
Airport Drive,Clearwater, Florida.
Co-Insurance) On Metal Clad Equipment Shed located
Airport Drive, Clearwater, Florida.
. j,