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CERTIFICATE OF INSURANCE (6) r fiI J @ November 24, 1998 Attn: Debbie Richter City of Clearwater P. O. Box 4748 Clearwater, FL 34618-4748 Insured: Location: Policy Description: Insurance Company: Effective Date: Expiration Date: Dear Debbie: -,/ L L (" . /' (' I ;I' - rj, I . J '.~1 (L-C.-''> Ic.~.. y ILl ::">lL-/v , /'-' '--1 Poe &: Brown, lnc.@ Post Office Box 1229 · Tampa, Florida 33601-1229 813/226-1300 · FAX 813/226-1313 Fax #727-562-4825 5 Pages Mail Originals Clearwater Golf Park, Inc. 1875 Airport Drive, Clearwater, FL Package Policy #CK00903267 St. Paul Fire & Marine Ins Co 04/01/98 04/01/99 Per our phone conversation, enclosed is a certificate of insurance for the above policy term and 4/1/96-97, 4/1/97-98 per your lease requirement. Sincerely, Please advise if you have any questions or need further verification. qdiL- Julie Cockey Account Manager jc/encl. CC: Ms Louise Chouinard Clearwater Golf-Park, Inc. 1875 Airport Drive Clearwater, FL 33515 ''f'" ~'4! \ ".' l.~ T '!!.Y,..:' '\f.'~ . ~" '." ) _~~'~J, ~ : < \, '" , ')" '\098- nEe [ifo;' ,~ -'''1' I;~)' ~ ~ D\&.pT """"""""""""""""" ,:",:,:,:~:,:". .;.;.;.;.:.;.;.:.;.;.;.;.;.;.;.;.: PRODUCER :... "'i6~Dq"':~~::A::::r.~rlrn:';"~D . TXTm:.ii.::::Mimrm:"', .:: :'::'::.: .'.:. '.::::.:.':.' :'. :::.:;..', . :'. .::: :. .' .::...1ik;C;:JXi:J/:J:ItJ::1iJi.~:::1\ .: 1tl:1V' Il~::~:;t~4i.~~:1$:Iti< ..': .:"::" ":.:: .: ':;. ::..:.... :::"::: ..... .= ."'. :..... . .. ....... ...... ...,.... ....... ..... .' ..... 226-1300 THIS CERTIFICATE IS ISSUED AS A MATTER~F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, DATE (MMIDDIYYl ;.;.:.;.;.;.:.-:;:.;........ 11/24/98 Poe & Brown, Inc. P.O. Box 1229 Tampa, FL 33601-1 229 COMPANIES AFFORDING COVERAGE INSURED COMPANY A St. Paul Fire & Marine Ins Co COMPANY Clearwater Golf Park, Inc. 1875 Airport Drive Clearwater FL 33515 B COMPANY c COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOClF.lfENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFTORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI~fS, CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFT, DATE (MMIDDIYY) POLICY EXP. DATE IMMIDDIYY) LIMITS A GENERAL LIABILITY COMM, GENERAL LIABILITY CLAIMS MADE 0 OCCUR OWNER'S & CONTRACT'S PROT CK00903267 4/01/98 4/01/99 GENERAL AGGREGATE PROD-COMP/OP AGG, PERS. & ADV.INJURY EACH OCCURRENCE 1000000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCIIEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS FIRE DAMAGE(One Fire) MED EXP(Any one person) 5000 COMBINED SINGLE LIMIT BODILY INJURY (per person) BODILY INJURY (per accident) PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY EACH OCCURRENCE AGGREGATE STATUTORY LIMITS THE PROPRIETOR! PARTNERSIEXECL'TIVE OFFICERS ARE: INCL EXCL EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPL OTHER A CK00903267 4/01/98 4/01/99 Building Special Perils DESCRIPTION OF OPERA TIONSILOCA TlONSIVEHICLESISPECIAL ITEMS Certificate Holder is Additional Interest (42105) as respects Lease Agreement for 1875 Airport Road, Clearwater, FL 34625 CITY OF CLEARWATER ATTN: LEO SCHRADER, RISK MGR. P. O. BOX 4748 CLEARWATER, FL 34618-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO;ll DA TE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DA YS WRlTIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHO RESENT A TIVE / i,~' o...--rv}UL ~ , l.. A.D.tlll.~ POE & ASSOCIATES INC POBOX 1348 TAMPA FL 33601-1348 ISSUE DATE (MM/DD/YY) 05/07/91 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW QOVERAGE$ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COMPANIES AFFORDING COVERAGE COMPANY A LETTER AMERICAN MOTORISTS I NS.C O. COMPANY B LETTER COMPANY C RECEIVED LETTER COMPANY D MAY 0 9 1991 LETTER E CITY CLERK INSURED CLEARWATER GOLF PARK INC 1875 AIRPORT DRIVE CLEARWATER FL 33625 CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYY) ALL LIMITS IN THOUSANDS * il-GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 3MG 320 821 02 04/01/91 04/01/92 GENERAL AGGREGATE PRODUCTS-COMP lOPS AGGREGATE PERSONAL & ADVERTISING INJURY EACH OCCURRENCE $ 2,,000 $.LOOO $ 1,,000 $J J DDO $ 50 $ 5 FIRE DAMAGE (Anyone lire) MEDICAL EXPENSE (Anyone person) EACH OCCURRENCE $ $ COMBINED SINGLE $ LIMIT BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) $ OTHER THAN UMBRELLA FORM WQRKER'S COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY A 3CE59348S02 $ $ 04/01/91 04[01/92 $ 100 500 100 (DISEASE-POLICY LIMIT) (DISEASE-EACH EMPLOYEE) OTHER A PROPERTY 3MG 320 821 02 04/01/91 04/01[92 SEE. AITACHED lIST DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS **ADDITIONAL INSURED: CITY OF CLEARWATERJ FLORIDA CERTIFICATE..HOLDER cA;~cl;w,.__;I"" MR. LEO SCHRADERJ RISK MANAGER CITY OF CLEARWATER POBOX 4748 CLEARWATER FL 34618-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL --1.D..- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ~c: M:~t ACORD 25-81J189 .... ..... .... ~QRD CORPORATION 1989 If-otJ7~tJ() -L/~ ... ~;~. Ju.' .......... ~. . . PROPERTY SCHEDULE $150J700 - ON CLUB HOUSE & PRO SHOP LOCATED 1875 AIRPORT DR.J CLEARWATERJ F $ 15J400 - ON CONTENTS CONTAINED IN ABOVE BUILDING. $ 40J100 - ON GOLF CART STORAGE BUILDING LOCATED 1875 AIRPORT DR.J ClEARWATERJ FL $ 24J700 - ON MET~l CLAD EQUIPMENT SHED lOCATED 1875 AIRPORT DR.J CLEARWATERJ FL ADDITIONAL INTEHEir .iLENT copy '~t ".lIIul ! '-' This endorsement changes your: ~ Multlcover Property Protection Comp~~t Proper,ty Protection ' Condominium Property Protection The following person or organization Is also protected under your Property Protection Person or orga.,lzatlon Agreement to the extent 01 their flnanclElI Interest In the described property. Description of Property 187S Airport .oad Cl..rwat.~.'L 34625 City of Clearwater Attn: Leo' Schrader, Risk Mgr. P. O. Box 4748 Clearwater, FL 34618-4748 .----- Olher Terms All other terms of your policy remain the same. -- Policy Nllnlle, CK00903267 Ifflctlv. D.II 04/01/98 PrDC81111g Dill 04/13/98 14: 14 001 Nlme of Insured CLEARWATER GOLF PARK, n~c. 42106 Ed.3"80 Printed In U.S_A. lISt.Paul Fire and Marine Insurance Co.1980 Endorsement Page 1 of 1 _w_'~~= PRODUCER 226-1 300 TInS CERTIFICATE IS ISSUED AS A MATTER F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIUS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Poe & Brown, Inc. P.O. Box 1229 Tampa, FL 33601-1229 COMPANIES AFFORDING COVERAGE INSURED COMPANY A St. Paul Fire & Marine Ins Co COMPANY Clearwater Golf Park, Inc. 1875 Airport Drive Clearwater FL 3351 5 B COMPANY c COMPANY D TIDS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIDCH TIDS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP, LTR DATE (MMIDDNY) DATE (MMIDDNY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE A COMM. GENERAL LIABILITY CK00903267 4/01/97 4/01/98 PROD-{;OMP/OP AGG. CLAIMS MADE ~OCCUR PERS, & ADV. INJURY OWNER'S & CONTRACT'S PROT EACH OCCURRENCE 100 0 FIRE DAMAGE(One Frre) MED EXP(Any one person) 5000 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (per person) lURED AUTOS BODILY INJURY NON-OWNED AUTOS (per attldent) PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATI1TORY LIMITS EMPLOYERS' LIABILITY EACH ACCIDENT THE PROPRIETOR! INCL PARTNERSIEXECUTIVE DISEASE-POLICY LIMIT OFFICERS ARE: EXCL DISEASE-EACH EMPL. OTHER A CK00903267 4/01/97 4/01198 Building Special Perils DESCRIPTION OF OPERATIONSILOCA TlONSNEIDCLESISPECIAL ITEMS Certificate Holder is Additional Interest (42105) as respects Lease Agreement for 1875 Airport Road, Clearwater, FL 34625 ~:~bitiMi6.ttm"\i}\?\ . . .... ........................... ........................... ........................... ........................... ........................... ........................... . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... . ........................... ........... ... .......... :e~ri6N}: ~:~~~~~:~~:~:::::::::::::::~~:~:~:~:::~:~:~:~~~:~:f~~~:~:~:~:~:~:~f(t~:~f:fr: ........ ..... ................. .... CITY OF CLEARWATER ATTN: LEO SCHRADER. RISK MGR. P. O. BOX 4748 CLEARWATER, FL 34618-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DA YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEn", BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE :::At:OiUfts.;;S: 3m3:::::::::::::: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................ . . . . . . .. ...................... .::::::::::::/::...::::::~jf...:::::::.:.:........ :.:-:.;.;.:.:.;.;.:.:.:-: :.:.;.>:::~;:::.:.:. .................. ................... .:::::::::::::::::<P::.:.:....... :::::~...::::::: ....:.111111111:: ~;~;;;;t~~~~:~i~:~~~~;:;::i~i;:;~;:::;::~::;:;;~:::::::;;;i::::::;:;:;::;~i;::~:;:;:~:~;~~~~i\f:~~r:~rt 226-1300 THIS CERTIFICATE IS ISSUED AS A MATIER F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ::::::;;;;;:;::::::::::::: PRODUCER Poe & Brown, Inc. P.O. Box 1229 Tampa, FL 33601-1229 COMPANIES AFFORDING COVERAGE INSURED COMPANY A St. Paul Fire & Marine Ins Co COMPANY Clearwater Golf Park, Inc. 1875 Airport Drive Clearwater FL 33515 B COMPANY c COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO wmCH TlDS CERTIFICATE MA Y BE ISSUED OR MA Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF. DATE (MMIDDIYY) POLICY EXP. DATE (MMIDDIYY) LIMITS A GENERAL LIABILITY COMM. GENERAL LIABILITY CLAIMS MADE m OCCUR OWNER'S & CONTRACT'S PROT CK00903267 4/01/96 4/01/97 GENERAL AGGREGATE PROD-COMP/OP AGG. PERS." ADV. INJURY EACH OCCURRENCE FIRE DAMAGE(On. F"u-e) MED EXP(Any on. person) COMBINED SINGLE LIMIT 5000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS illRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per aa:ldent) PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT OTIIER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY EACH OCCURRENCE AGGREGATE STATUTORY LIMITS THE PROPRIETORI PARTNERSIEXECUTIVE OFFICERS ARE: INCL EXCL EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPL. OTHER A CK00903267 4/01/96 4/01/97 Building Special Perils DESCRIPTION OF OPERA TIONSILOCA TIONSIVEillCLESISPECIAL ITEMS Certificate Holder is Additional Interest (42105) as respects Lease Agreement for 1875 Airport Road, Clearwater, FL 34625 CITY OF CLEARWATER ATTN: LEO SCHRADER, RISK MGR. P, O. BOX 4748 CLEARWATER, FL 34618-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 0 DAYS WRlTIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ... ~ l\' CLEARWATER GOLF-PARK, INC '" '~~T":' ("rn. 1._,.. .. . . . " _..""~""""':r;;;::::'!;".!-,'t'"'",Ef",,,,,;,,~';I;m".,r.,,..,u. 1875 AI R PO RT DRIVE .:....fff1i:"':\;.. ..... -'. .,... I 1 m ~D--=- ~ · CLEARWATER, FLORIDA 33515 September 29, 1997 City of Oearwater P.O. Box 4748 OealWater, Florida 34618 ATTENTION: FINANCE DEPARTMENT Enclosed is our Check No. 9567 bi the amount of 51,000.00 covering the annual lease payment for Oearwater Golf P8Ik, Inc. , located at 1875 Airport Drive in Oearwater. Please acknowledge receipt or this payment. Sincerely, Oearwater Golf Pam, Inc. ~(~~~ Miriam Fnmk President MFllc F.nl"ln!l1..... CLEARWATER GOLF PARK INC. PHONE (813) 447-5272 1875 AIRPORT DRIVE CLEARWATER. FL 34625 9567 PAY TO THE ORDER OF o~ ie.~7:.~, ", "". 1'''I'i(' , /~' i" '. j I ,-" r i j: I' : II :' ~., ,I ;., ;' "~' ,,.;: .. J I '... 'j,,; I.,.' ..1111 JfUY IIUlI ~!I"I "." I" ",1,4 1;1,1 'UJ1.,:/ ......'.. 9-c;2 9 19:tJ I $/ 000.00 63-612/631 3 DOL L A R S mE::::-":." II_ 028.003 . . E..t Clearwater OfficI I . 2150 Clewelend Street CI..rwate" Florid. 34821 FOR g...u* 11100 g 5 b 7111 I: 0 b 3 ~ 0 b ~ 2 g I: 1~~~cL___~ ~ 2 b 30 25 g 7 2111 @CLARKE AMERICAN