RENEWAL CERTIFICATE OF INSURANCE
COMPANIES AFFORDING COVERAGES
POE & ASSOCIATES, INC.
P. O. BOX 20195
ORLANDO, FLORIDA 32814
CLEARWATER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33515
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
NAME AND ADDRESS OF INSURED
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 (
oCCG~~~NCE AGGREGATE
GENERAL- LIABiLITY
BODILY INJURY
A [XI COMPREHENSIVE FORM
A [XI PREMISES~OPERATIONS
o EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
A ~ PRODUCTS/OBmCEXIX
~~Ij{~
o CONTRACTUAL INSURANCE
o BROAD FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
A @ PERSONAL INJURY
CPP 39-99-39
CPP 39-99-39
4/1/81
4/1/81
PROPERTY DAMAGE
$
CPP 39-99-39
4/1/81
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
$ 1, 000
$ 1,000
CPP 39-99-39
4/1/81
PERSONAL INJURY
AUTOMOBilE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON-OWNED
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
$
$
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
A
WORKERS'_CQMPEN5ATION
and
EMPLOYERS' LIABILITY
OTHER
WC 925216
4/1/81
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES
$125,000 On Club House & Pro Shop & $10,000 On Contents (80% Co-Insurance)
$2,260 on Garage & $1,000 on Contents (80% Co-Insurance)
$12,600 on Golf Cart Storage (80% Co-Insurance) COVERAGE: ALL RISK
Dr/,
!:...,
4
]980
Cancellation: Should any of the above described policies be cancelled before the expiration date therQr~E(J~)fiI>>1com-
pany will endeavor to mail -J.CL days written notice to the below named certificate holder, butTa~te to
mail such notice shall impose no obligation or liability of any kind upon the company.
~,
NAME AND ADDRESS OF CERTIFICATE HOLDER:
CITY OF CLEARWATER
P. O. BOX 4748
CLEARWATER, FLORIDA 33519
ATT: : LUCILLE WILLIAMS
CITY CLERK