CERTIFICATE OF INSURANCE (3)
POE & ASSOCIATES, INC.
P.O. BOX 20195
ORLANDO, FLORIDA 32814
COMPANIES AFFORDING COVERAGES
COMPANY
LETTER
A AETNA
B
INSURANCE COMPANY
COMPANY
LETTER
CLEARWATER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33515
COMPANY C
LETTER
ltECEIVED
NAME AND ADDRESS OF INSURED
COMPANY 0
LETTER
MAY 12 1380
COMPANY E
LETTER
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 re n dition
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,
POLICY Limits of Liability in Thousan s (
TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY $
A [Xl COMPREHENSIVE FORM CPP 39-99-39 4/1/81
A ~ PREMISES-OPERATIONS CPP 39-99-39 4/1/81 PROPERTY DAMAGE $
EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
A ~ PRODUCTS/C~ CPP 39-99-39 4/1/81
~Dftt:KKH1K BODIL Y INJURY AND
o CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 300 300
o BROAD FORM PROPERTY COMBINED
DAMAGE
o INDEPENDENT CONTRACTORS
A !Xl PERSONAL INJURY CPP 39-99-39 4/1/81 PERSONAL INJURY $ 300
AUTOMOBILE LIABILITY BODILY INJURY
o COMPREHENSIVE FORM (EACH PERSON)
SODIL Y INJURY
DOWNED (EACH ACCIDENT)
o HIRED PROPERTY DAMAGE
o NON-OWNED BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
EXCESS LIABILITY
[Z] UMBRELLA FORM X-S116891 4/1/81 BODILY INJURY AND
B $3,000
o OTHER THAN UMBRELLA PROPERTY DAMAGE
COMBINED
FORM
WORKERS' COMPENSATION
A and WC925216 4/1/81
EMPLOYERS' LIABILITY (fACH ACCIDENT)
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
$125,000 On Club House & Pro
$2,260 on Garage & $1,000 on
$12,600 on Golf Cart Storage
Shop & $10,000 On Contents (80% Co-Insurance)
Contents (80% Co-Insurance)
(80% Co-Insurance) COVERAGE: ALL RISK
Cancellation: Should any of the above described policiesbe cancelled before the expiration date thereof. the issuing com-
pany will endeavor to mail ..lL 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.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
CITY OF CLEARWATER
P. O. BOX 4748
CLEARWATER, FLORIDA 33519
ATT: LUCILLE WILLIAMS
CITY CLERK
MAY 8
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CITY
OF
CLEARWATER
POST OFFICE BOX 4748
CLEARWATER. FLORIDA 33518
April 21, 1980
Ms. Ruth M. Wiese
Commercial Lines Assistant
Poe & Associates, Inc.
P.O. Box 20195
Orlando, Fla. 32814
Dear Ms. Wiese:
Thank you for the insurance binder you sent us on
April 15 for Clearwater Golf Park, Inc.
We will appreciate clarification concerning the
amount of liability coverage afforded. Policy
No. XS 96 13 75, which expired April 1, 1980,
carried 3 million dollars combined coverage as re-
quired by the lease. The binder you sent appears
to offer only $300,000.
May we hear from you concerning this matter.
Very truly yours,
Lucille Williams
City Clerk
LW/SL/dc
"E qual Employment and Affirmative Action Employer"
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RECEIVED
-
APR 24 1980
~ITY CLERK
April 22, 1980
Ms. Lucille Williams
City Clerk
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33419
Re: Clearwater Golf Park, Inc.
Dear Ms. Williams:
At the time we sent you the Insurance Binders on the above
captioned we evidentally failed to enclose the Binder on
the $3,000,000 Umbrella Policy.
Attached please find a copy of the Umbrella Binder.
If you have any further questions, please give me a call.
B~~:~gardS' . } _
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~~iese
Commercial Lines Assistant
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P.O, Box 20195 · Orlando, Florida 32814.305-671-2470
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CI.EARWATER GOLF -PARK, INC.
1875 AIRPORT DRIVE
CLEl'.R~iATER, FLORIDA 33518
COMPANY
HOUSTON GENERAL
Effective 12: 01Am 4/1 . 19 80
Expires 12:01 am 0 Noon 5 1.19 80
D This binder is issued to extend coverage in the above namedc",
company per expiring policy #S
(except as noted below)
Description of Operation/Vehicles/Property
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NAME Ar.D ADDRESS OF AGENCY
POE & ASSOCIATES, INC.
P. O. IDX 20195
JP~~jDO, FLORIDA 32814
NI-.ME AND MAILING ADDRESS Of INSURED
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Type and Location of Property
Coverage/Perils/Forms
Amt of Insurance
Oed.
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limits of liabili
Each Occurrence
Bodily Injury $
Property
Damage $ $
Bodily Injury &
Property Damage
Combined $
Personal Injury $
limits of Liability
Bodily Injury (Each Person) $
Bodily Injury (Each Accident) $
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I 0 Scheduled Form
A 0 Premises/Operations
B
I 0 Products/Completed Operations
L 0 Contractual
I 0 Other (specify below)
T 0 Med. Pay. $
Y
o Personal Injury
Type of Insurance
Coverage/Forms
o Comprehensive Form
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Per
Person
$
Per
ACCident
OA
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i A
~ U 0 Liability 0 Non-owned
:j T 0 Comprehensive-Deductible
~ ~ 0 Collision-Deductible
I 0 0 Medical Payments
B 0 Uninsured Motorist
I 0 No Fault (specify):
L 0 Other (specify):
E
o Hired
$
$
$
$
Property Damage
$
Bodily Injury & Property Damage
Combined $
o WORKERS' COMPENSATION - Statutory Limits (specify states below)
o EMPLOYERS' LIABILITY - Limit
$
SPECIAL CONDITIONS/OTHER COVERAGES
~ffiRELLA POLICY - $3,000,000 - Each Occurrence
$3,000,000 - Aggregate
ADDITIONAL INSURED AS RESPECTS CLEARWATER GOLF PARK, INC.: CITY OF CLEARWATER
P.O. BOX 4748, CLEARWATER, FL.
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NAM~ Af.D ADDRESS Of 0 MORTGAGEE
o LOSS PAYEE
o ADD'L INSURED
LOAN NUMBER
ACORD 75 (11-77)
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POE & ASSOCIATES. INC.
P. O. BOX 20195
ORLANDO. FLORIDA 32814
118. Sue La,mkin
Assistant City Clerk
City of Clearwater
P. O. Box 4748
Clearwater, Florida 33518
April 15,1980
RECEIVEQ
APR 17 1980
Re: Clearwater Eolf Park, Inc.
CiTy CLERK
Dear Ms. Lamkin:
Attached please find a copy of the Insurance Binder we sent to
Ms. Lucille Williams, City Cleark on March 26, 1980 with reference
to the above captioned.
Upon receipt of the renewal policy same will be forwarded to you.
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, NAME. AND ADDRESS Of AGENCY
POE , ASSOCIATES, INC.
P. O. BOX 20195
OP.LAUOO, FLORIDA 32814
COMPANY
AETNA INSURANCE COMPANY
Effective 1.2: OlA m 4/1 . 19 80
Expires 12:01 am 0 Noon 5 1 . 19 80
o This binder is issued to extend coverage in the above named
company per expiring policy #
(except as noted below)
Description of OperationlVehicles/Property
NAME AND MAILING ADDRESS Of INSURED
CLEARHluER GOLF Pl;.RK, INC.
1875 AlP-PORT DRIVE
CLEAID\TATER, FLORIDA 33518
f: '
"t'!'
Type and Location of Property
Coverage/Perils/Forms
Amt of Insurance
C<>ir-.
Oed. %
$100 80
$100
$100 80
ALL RISK
2,260
1,000
12.600
Limits of Liabili
Each Occurrence
P On Club Bonse , Pro Shop located
, R 1875 Airport Dr.. Clearwater, Fl.
; 0 On Contents contalnbd in above
: P uilding.
j E n Garage located 1.875 Airport Dr..
( R Clearwater, F1..
'T n Contents contained in Garage
Y n Golf Car Storage Building locate
rpO .1.ve, ..
Type of Insurance
ALL RISK
ALL RISK
ALL lUSK
ALL RISK
Coverage/Forms
L
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A
8
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~ I
i T
! Y
;
I A
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..0
!M
!O
;8
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J L
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f
o Scheduled Form
~Premises/Operations
[xProducts/Q6e~~~
o Contractual
o Other (specify below)
acMed, Pay. $ l,OO~r $ 10,000 Per
. Person AccIdent
CXPersonal Injury
(;Comprehensive Form
Bodily Injury
Property
Damage
$
$
$
~A
~B
~C
Bodily Injury &
Property Damage
Combined 300 000
Personal Injury
Limits of Liabili
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
Liability I%Non-owned
o Comprehensive-Deductible
o Collision. Deductible
o Medical Payments
o Uninsured Motorist
o No Fault (specify):
o Other (specify):
[1Q;ired
$
$
$
$
Property Damage
$
$
$
Bodily Injury & Property Damage
Combined $
[XWORKERS' COMPENSATION - Statutory Limits (specify states below)
I:x EMPLOYERS' L1ABILlTY- Limit
SPECIAL CONDITIONS/OTHER COVERAGES
ADDITIOUAL INSURED AS RESPECTS COMPREHENSIVE
CITY OF CLEARHM'Ell
P. O. BOX 4748
CLEARWATER, FLORIDA 33511
GENERAL LXABnarrY SECTION .-
PROPERrI' SECTION
NAME AND ADDRESS Of 0 MORTGAGEE 0 LOSS PAYEE
o ADD'L INSURED
LOAN NUMBER