LETTER AND CERTIFICATE OF INSURANCE
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March 29, 1978
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Mr. Tom A. Beisten
City Attorney
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33517
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Re: Clearwater Golf Park, Inc.
Attached please find Certificate of Insurance on the above captioned
for your records and file.
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this please give us a call.
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attachment
POE & ASSOCIATES, INC.
P. O. BOX 6906
ORLANDO, FLORIDA 32803
COMPANIES AFFORDING COVERAGES
COMPANY A
LETTER
B
AETNA INSURANCE COMPANY
COMPANY
LETTER
RICA INSURANCE
RECEIVED.
MAR 31
J,
CO.
NAME AND ADDRESS OF INSURED
CLEARWAT.ER GOLF PARK, INC.
1875 AIRPORT DRIVE
CLEARWATER, FLORIDA 33518
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
This is to certify that policies of Insurance listed below have been Issued to the insured named above and are in 0 at this time.
COMPANY POLICY limits of liability in Thousands (000)
LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY
A IX] COMPREHENSIVE FORM TO BE DETERMINED 4/1/79
A g PREMISES-OPERATIONS TO BE DETERMINED 4/1/79 PROPERTY DAMAGE
DEXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
A [Z] PRODUCTS~ TO BE DETERMINED 4/1/79
~I ~~ BODIL Y INJURY AND
o CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 300 $ 300
o BROAD FORM PROPERTY COMBINED
DAMAGE
o INDEPENDENT CONTRACTORS
A IX] PERSONAL INJURY TO BE DETERMINED 4/1/79 PERSONAL INJURY $ 300
AUTOMOBILE LIABILITY BODILY INJURY
o COMPREHENSIVE FORM (EACH PERSON)
BODILY INJURY
DOWNED (EACH OCCURRENCE)
o HIRED PROPERTY DAMAGE
o NON-OWNED BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
EXCESS LIABILITY
BODIL Y INJURY AND
B !Xl UMBRELLA FORM H 85966 1/1/79 PROPERTY DAMAGE
o OTHER THAN UMBRELLA COMBINED
FORM
WORKERS' COMPENSATION
A and TO BE DETERMINED 4/1/79
EMPLOYERS' LIABILITY
OTHER
A PROPERTY TO BE DETE&\1INED 4/1/79 SEE SCHEDULE BELOW
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
ADDITIONAL INSURED: CITY OF CLEARWATER
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.
NAME AND ADDRESS OF CERTIFICATE HOLDER'
TOM A. BEISTEN, CITY ATTORNEY
CITY OF CLEARWATER
P. O. BOX 4748
CLEARWATER, FLORIDA 33517
DATE ISSUED: