CERTIFICATE OF INSURANCE (4)
POE & ASSOCIATES, INC.
P. O. BOX 20195
ORLANDO, FLORIDA 32814
COMPANIES AFFORDING COVERAGES
CLEARWATER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33515
COMP~NY A
LEITER
COMP~NY B
LEITER
COMP~NY C
LEITER
COMP~NY D
LEITER
COMPANY E
LETTER
AETNA INSURANCE COMPANY
NAME AND ADDRESS OF INSURED
l
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time, 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 conditions of such policies.
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits of Liability in Thousands (
OCC~~~~NCE AGGREGATE
GENERAL LIABILITY
A [Xl COMPREHENSIVE FORM
A [Xl PREMISES~OPERATIONS
o EXPLOSION AND COLL~PSE
HAZARD
DUNDERGROUND H~ZARD
A [K] PR~~
o CONTRACTUAL INSURANCE
o BROAD FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
A [Xl PERSONAL INJURY
CPP 39 99 39
CPP 39 99 39
BODILY INJURY $
4/1/82
4/1/82
PROPERTY DAMAGE
CPP 39 99 39
4/1/82
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$ 1,000
$ 1,000
CPP 39 99 39
4/1/82
PERSONAL INJURY
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON,OWNED
EXCESS LIABILITY
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
WORKERS' COMPENSATION
A
and
EMPLOYERS' LIABILITY
OTHER
WC 574392
4/1/82
DESCRIPTION OF OPERATlONSiLOCATIONSNEHICLES
$125,000 On Club House & Pro Shop & $10,000 On Contents (80% Co-Insurance)
$ 12,600 On Golf Cart Storage (80% Co-Insurance)
COVERAGE: ALL RISK
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
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NAME AND ADDRESS OF CERTIFICATE HOLDER
CITY OF CLEARWATER
P. O. BOX 4748
CLEARWATER, FLORIDA 33519
ATTN: LUCILLE WILLIAMS, CITY
CLERK
ACORD 25 (1-79)
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