LETTER RE-RENEWAL BINDER FOR POLICY # WC018496 & CPP399939
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Ms. Lucille Williams
City Clerk
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33519
Dear Ms. Williams:
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April 27, 1983
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Re: Clearwater Golf Park, Inc.
As of this date we have not received the renewal policy on the above
captioned and are herewith attaching a renewal Insurance Binder to
act as your evidence of coverage until the renewal policy is received.
/rmw
attachment
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Best r~ds,
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R M. Wiese (Mrs.)
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Commercial Lines Assistant
P.O, Box 20195 · Orlando, Florida 32814.305-671-2470
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(INSURANCE BINDER)
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT
TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM,
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Binder No
Ef:a
POW Ii .A8~tA'PU, DIC.
P.O. BOX 20195
ODT~ImO. rr.n~IDA 32814
Effective12.01 A m 5/1. , 19 83
Expire 12:01 am a-Noon , 19
.. This binder is issued to extend coverage in the above named
company per expiring policy #IrOl8496 a (!ItP399939
-rexcept as noted DeloW! '
Description of Operation/Vehicles/Property ':)
RECEIVED "
NAME AND MAILING ADDRESS DF INSURED
t'"UZ~1UIM.'_ QOloI' p~ DC.
1875 ~ DRIVB
Cl~~ I'LQRJDIk 33515
APR 28 1983
Type of Insurance
Coverage/Forms
Limits of Liabilit
Each Occurrence
Aggregate
Type and Location of Property
Coverage/Perils/Forms
D Scheduled Form
o Premises/Operations
o Products/Completed Operations
o Contractual
o Other (specify below)
o Med, Pay, $
o Personal Injury
o Comprehensive Form
A
U 0 Liability 0 Non-owned
T 0 Comprehensive-Deductible
o 0 Collision-Deductible
M 0 Medical Payments
o
B 0 Uninsured Motorist
I 0 No Fault (specify):
L 0 Other (specify):
E
oA
DB
DC
Bodily InjUry $ $
Property
Damage $ $
Bodily InjUry &
Property Damage
Combined
Personal Injury
Limits of liabilit
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
Per
Person
$
Per
ACCident
o Hired
$
$
$
$
Property Damage $
o WORKERS' COMPENSATION - Statutory limits (specify states below)
Bodily Injury & Property Damage
Combined $
SPECIAL CONDITIONS/OTHER COVERAGES
o EMPLOYERS' LIABILITY - Limit
$
NAME AND ADDRESS OF 0 MORTGAGEE
o LOSS PAYEE
o ADD'L INSURED
LOAN NUMBER
ACORD 75 01.77)
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CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side This insurance is subject
to the terms, conditions and limitations of the policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Com-
pany stating when cancellation will be effective, This binder may be cancelled by the Company by notice
to the Insured in accordance with the policy conditions. This tii:der is cancelled when replaced by a pol-
icy If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder
according to the Ru!es and Rates in use by the Company,
.