INSURANCE RENEWAL CERTIFICATE
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Poe & Associates, Inc.
P.O, Box 1348/Tampa. Florida 33601-1348
(813) 222-4100
Telex 52-629
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April 16, 1987
Mr. G. B. Weimer
Assistant City Manager
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33518
Re: Clearwater Golf Park, Inc.
Insurance Company of North America
Policy # SVPD07811081
Dear Mr. Weimer:
We are herewith attaching endorsements on the above captioned
policy extending coverage for the period April 1, 1987-88.
Please place these endorsements with the policy and should
you have any questions give us a call.
Best regards,
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,;>'" ~~; M. Wiese (Mrs.)
Commercial Lines Assistant
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attachments
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PACKAGE peLLey
COMPANY OF NCRTH
D~CLARATIQNS - SCKV!CC
t,MED INSURED
CLEARWATER GOLF PARK? INC.
1875 AIRPORT ED AD
, ClEARWATEH, -
CRENa,AL CERTIFICATE
GENERAL SERVICES
THE NAMED INSURED IS: CORPORATION
POLICY PERIOD
PREMIUM
WHEN COVERAGE BEGINS : 04/01/87
WHEN COVE~AGE ENDS : 04/01/88
PAYMENT PLAN : MONTHLY
* PREMIUM
TOTAL
,13,786
$13,786
CO-INSURANCE CONTRACT
JHE RATE CHARGED IN THiS POLlCY IS EASED
UPON USE CF ACO.INSURANCE CLAUSE
-ATTACHED HER~TO, WJTH THE CONSENT
'OF THE ASSURED.
PAYABLE MONTHLY
IN 11 PAYMENTS DF
AND 1 FINAL P,~YMENT OF
TOTAL PREMIUM DUE WHEN
COVERAGE BEGINS
$1,149
1,147
$1,149
PP.EMIUMSOUE WITH REPORTS OR RESULTING
FROM AUDITS ARE NOT INCLUDED IN THE
ABOVE PRHHUM
COVERAGES AND COVERAGE lIMITS
SECT 1 ON 1 : PROP ERN
SECTION 11 : LIABILITY
INFORMATION ABOUT YOUR PROPERTY
COVERAGE IS SHGWN BELOW AND ON
THE FOLLOWING PAGES.
BODILY INJURY, PERSONAL INJURY AND
PfWP ERTY DAMAGE
$1,000,000 EACH OCCURRENCE
$1,000,000 ,4GGREGATE
MEDICAL COVERAGE
$1,000 EACH PERSON
$1,000,000 EACH ACCIDENT
LIST GF COVERED LOCATIONS
COVERED LOCATION
NW18ER
DESCRIPTION OR ADDRESS
1-1
2-1
1875 AIRPORT ROAD, CL~ARWA7ER, FL
SAME lGCAT I ON- STORAGE Bur LDING #1
KK-7204 (CONTINUED ON NEXT PAGE)
:.'OPIES OF THIS DOCUMENT HAVE BEEN SENT TO:
,. ,F;SU REd 8228 ADVANTAGE J: GSV
PAGE 1
870319 TAS
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IL'J5l!R;INr.r- CJMP,~NY OF NORTH AMEKlt;\
- SERVICE INDUSTRIES P~CKAG2 peLley
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,Y~CL.4. R.!\TI ON S
.,.\\I:D INSURED
.CL.:M~WATl=.::;;' GOLF PARK,
1875 AIRPORT ROAD
:U:ARWATER
INC.
FL33515
3-1
SAME lOCATION- STORAGE BUILDING #2
YOUR PROPERTY COVERAGES AND COVERAGE LIMITS
COVERED
LOCATION
NU~8ER A.REAl PROPERTY B.PERSONAL PROPERTY C.LOSS OF INCOME D.EXTRA EXPENSE
---------
1-1
2-1
3-1
. $150,700
$40,100
$24,700
$15,400
NOT COVEREO
NOT COVERED
NOT COVERED
NOT COVERED
NOT CDVERED
$5,000
$5,000
$5,000
E. PERSONAL PROPERTY OFF YOUR PREMISES
--------
COVERAGE LIMIT
$10,000
SPECIAL DEDUCTIBLE $100
OPTIONAL PROPERTY CaVERAGES
OPTION 1 - SUPPLEMENTARY VALUABLE PAPERS AND RECORDS
ALL LOCATIONS ARE COVERED UNDER EXTENSION 4 ONLY
OPTION 2 - SUPPLEMENTARY ACCOUNTS RECEIVABLE
ALL LOCATIONS ARE COVERED UNDER EXTENSION 6 ONLY
, CPTIDN 3 - MONEY AND SECURITI ES
: COV. LOC. NUMBER COVERAGE lIMIT
SPECIAL DEDUCTIBLE
1-1
1-1
$lyOOO ON PREMISES
$1,000 OFF PREMISES
$0
$0
TH! S CPT! fiNAL COVERAGE ODES NOT APPLY TO ANY CTHER LOCATION
OPTION 4 - PERSCNAL PROPERTY - CRIME
COV. LOC. NUMBER COVERAGE LIMIT
lEVEL CF PROTECTION
SPECIAL DEDUCTIBLE
1-1
THEFT IS INCLUDED UNDER COMPREHENSIVE PROTECTION
THI S OPT IONAl Cmt ER;\GE ODES NOT APPLY TO ANY CTH~R LOCAT! eN
, LEVELS OF PROPE:(TY PROTECTION
CDVERED LOCATION
NUt.,BER
COVE'RAGE
LEVEL CF PROTECTION
K;{-7204
OP1ES OF THIS DOCUMENT HAVE BEEN SENT TO:
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(C~NTINUEO eN NEXT PAG~)
PAGE 2
8223 ADVANTAGE
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870319
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INSURINCF. CgMP,~NY OF NDRTH AMERIIA
SE~VICc INDUSTRIES PACKAGE PGlley
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DECLARATIONS -
:",'IED INSURED
'CLE.\RWATER GOLF PARK,
-1375 AIRPORT ROAD
'CLEARWATER
INC.
fl.33515
COINSURANCE AGREEMENT
COVERED lOCATION
NUMBER
COVERAGE
COINSURANCE PERCENTAGE
--------
ALL
A,S
80
DEDUCTIBLE
COVERED LOCATION
NUMBER
AMOUNT
Al1.
$250
REP lACEMENT COST
P=RSONAL PROPERTY WILL. BE VALUED USING THE REPLACEMENT COST METHOD AT THE
FDLLOWING LOCATIONS:
COV. lOC.
NUMBER
ALL
· COMPREHENSIVE CRIME ENDORSEMENT
COVERAGE
COVERAGE LIMIT
SPECIAL DEDUCTIBL
COMMERCIAL BLANKET
BLANKET HONESTY
t=ORGERY
COUNTERfEIT CURRENCY AND MONEY ORDERS
PRIOnaONO NUMBER: NEW
, $10,000
NOT CDVERED
$1,000
$1,000
$0
$0
$0
-
I SPECiAL PROPERTY FLOATER ENOORSEl"iENT
COVER.I\GE lIMIT
SPECIAL DEDUCTIBLE
$110,850
AS PER SCHEDULE ON FILE WITH COMPANY.
$250
! ADDITIONAL INSURED ENDCRSEMENT (LIAS)
: CCV. LaC.
NUMBER ADDITIONAL INSURED
1 CITY OF CLEARWATER, FLDRIDA
KK-7704 (C~'JNTINUED eN NEXT Pl~G;=)
.( )PTS OF THIS DOCUMENT HAVE BEEN SENT TO:
~_f,~,j'3UREd 8228 ADVAN1AGE E GSV
PAG;': 3
870319 TA:
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lNSURINCF C8MP4NY CF NGRTH AMERIIA
-'~LECLI\RATIONS - SERVICE INDUSHi..h::S PACKAGE PCLley
"~,\feD INSURED
'~l:::AiiWATER GOlf PARK, INC.
1. 875 AI ftPORT ROAD
-LE^RWAT~
'~".'fOllCY-ID
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LIQUOR lIABILITY ENDORSEMENT
COV. LOC.
NUMBER COVERAGE lIMITS
---- -----------
1 $100,000. EACH COMMON CAUSE
$100,000 AGGREGATE
~IABILITY ,CnVERAGE DEDL~TI6LE ENOT
COVERAGE
AMOUNT AND BASIS OF DEDUCTIBLE
--------
B I/PllIABllITY .
PO LIABILITY
EACH OCCUR
$100 EACH OCCUR
. NON-OWNED & RENTED AUTOMOBILE LIAB ENOT
COV. LOC.
NUMBER COVERAGE COVERAGE LIMIT
---- ----- -------
ALL BODILY INJURY/PROPERTY DAMAGE $1,000,000 EACH OCCURRENCE
KK-5L18B
.: KK-5l21
. KK-5L31
KK-5L68
~ KK-5L 55
. KK-5L 73
KK- 5L 98
,< KK- 6l 00
KK-6L12
ENDORSEMENTS
SVP POLICY BDOKLET
GENERAL SERVICES SPECIAL CONDITIONS
ADDITIONAL INSURED ENDORSEMENT (LIAB)
lIABILITY COVERAGE DEDUCTIBLE ENDT
LIQUOR LIABILITY ENDORSEMENT
NON-DwNED & RENTeD ,\\JTO;"1C3IL2 LIAS ;:~1DT
COMPREHENSIVE CRIME ENDDRSEMENT
MOR TG AGE E
SP'CCL4L PROPERTY FUJA TER ENDDRSEMENT
COUNTERSIGNED AT: ~~ 4~'
DArE: ~~
AUTHORIzED
AGENT~..4..~.', '.. .
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( LAS T PAG!~)
P,i\GE4
KK-7204
_OPIFS OF THIS DOCUMENT HAVE BEEN SENT TO:
!\ISURF~
8228 ADVANTAGE E GSV
870319 TAS