CERTIFICATE OF INSURANCE
POE & ASSOCIATES, INC.
P. O.BOX 20195
ORLANDO, FLORIDA 32814
COMPANIES AFFORDING COVERAGES
COMPANY
LE ITER
A
B
HOLLAND-AMERICA INSURANCE CO.
COMPANY
LEITER
NAME AND ADDRESS OF INSURED
COMPANY C
LETTER
CLEARWAT-ER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33518
COMPANY D
LETTER
COMPANY E
LETTER
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and Jj;IT6'rl~ER~is time,
Limits of Liability in Thousands ( 00)
EACH
OCCURRENCE
POLICY
EXPIRATION DATE
TYPE OF INSURANCE
POLICY NUMBER
A
GENERAL LIABILITY
IXI COMPREHENSIVE FORM BODIL YINJURY_
CPP 39":9-9 - 39 4/1/79 \)
IXI PREMISES~OPERATIONS CPP 39-99-39 4/1/79 PROPERTY DAMAGE $
o EXPLOSION AND COLLAPSE -..,
<1
H AZA RD '.
o UNDERGROUND HAZARD
[X] P~~ CPP 39-99-39 4/1/79
BODILY INJURY AND
o CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 300 $ 300
o BROAD FORM PROPERTY COMBINED
DAMAGE
o INDEPENDENT CONTRACTORS
IXI PERSONAL INJURY CPP 39-99-39 4/1/79 PERSONAL INJURY $300
AUTOMOBILE LIABILITY BODILY INJURY
o COMPREHENSIVE FORM (EAC H PERSON)
BODILY INJURY
DOWNED (EACH ACCIDENT)
o HIRED PROPERTY DAMAGE
o NON.OWNED BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
EXCESS L1ABIUTY
IXI UMBRELLA FORM 4/1/79 BODILY INJURY AND
H 85966 PROPERTY DAMAGE $3,000
o OTHER THAN UMBRELLA COMBINED
FORM
WORKERS' COMPENSATION
and WC 67 80 58 4/1/79
EMPLOYERS' LIABILITY
OTHER
PROPERTY CPP 39-99-39 4/1/79 SEE SCHEDULE BELOW
A
B
A
A
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
$95,000 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 Car Storage (80% Co-Insurance) COVERAGE: ALL RISK
RATER
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail -1..0- 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 335lg
ATT:
LUCILLE WILLIAMS, CITY