LETTER AND INSURANCE BINDER
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April 2, 1981
RECEIVED
POE & ASSOCIATES. INC.
P. O. BOX 20195
ORLANDO. FLORIDA 32814
APR 2~ 1981
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CITY CLERK.
Ms. Lucille Williams
City Clerk
City of Clearwater
P. O. Box 4748
Clearwater, Florida 33419
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Re: ,~learwaterGolf Pa:r~, Ioc.
Dear Ms. Williams:
The insurance policies we have for the above captioned expired April 1, 1981.
The attached Insurance Binder will act asyour evidence of coverage until renewal
policies are received.
r;;. ~
th M. Wiese (Mrs.)
Commercial Lines Assistant
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attachment
POI It ASSOCIATEs. DC.
P. o. BGIt 2019'
mn.AlDO. I'IJ1RT1)A 32814
AE'.l'1IA IllS
. . Effective 12:0lA m 4/1 , 19 81
Expires [j: 12:01 am 0 Noon .5 1 ,19 81
lJtThis binder is issued to extend coverage in the above named
company per expiring policy # ~~"J~P2S216
Description of Operation/Vehicles/Property
NAME AND MAILING ADDRESS OF INSURED
CU~.&'RWATD. GOU PAIX. IRe.
1875 Airport Drive
Clurvat.r. nor1da 33515
Type and location of Property
Oa Club .... , Pro Shop 1.ocate4 187.5
Airport Dri.... Cleanratar. n.
OIl Cea~_ta COIIui.... 1a .... . ' ,
Oa Garage located 1875 Airport Dri....
Cleanater. ftorfAla
OIl Coateab-.ataf--j 1a Mow .
OIl Golf CRt Stor... ....ld-l.. .1.Gca,w,
19875 Airport Bri..... ClMrvac.x-. ,n.
Coverage/ Perils/Forms
AU. nIX.
AmI of Insurance Oed.
ALl. .JlISX , ,
4LL RIft
,.AU.,UR. .
AU. .UR , .
$125.000.
$ 10.000.
$ 2,260.
$ 1,000.
$ 12.600.
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I 0 Scheduled Form Iji COOlprehensive Form
~ IX Premises/Operations .
I IX Products/Completed Operations
l 0 Contractual
I 0 Other (specify below)
~ Ii' Med. Pay, $ l.~:~~~-$ 1O,00Q Ac~"::ent
Iil Personal Injury
Type of Insurance
Coverage/Forms
IiA
IiiB
Bodily Injury $
Property
Damage $ $
Bodily Injury &
Property Damage
Combined
Iii C Personal Injury
limits of liabilit
Bodily Injury (Each Person) $
Bodily Injury (Each Accident) $
A
U ai Liability Iii 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
IX Hired
$
$
$
$
Property Damage $
Bodily Injury & Property Damage
Combined $
III WORKERS' COMPENSATION - Statutory Limits (specify states below)
Xi EMPLOYERS' LIABILITY -: Limit
$
SPECIAL CONDITIONS/OTHER COVERAGES,
$24.100.00 - . CCU COB
$38.610.90 - (If ... ~.. 1QIfIIJIIIr. ,
$10,000.00 - IMPLODI: DJ....:xx <CCIUUB. .,.
$ 1,000.00 - LOSS ODt'SIDB It LQa >>-W.- ,JI(IIft , ,~,
NAME AND ADDRESS OF 0 MORTGAGEE
o LOSS PAYEE
aJ ADD'L INSURED
CIft OP f!l..'R.&w.ua.
P. O. BGI 4748
Cf.RDrfAftll, ~IN. 33517
LOAN NUMBER
ACORD 75 (11-77)
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