ADDITIONAL INSURED ENDORSEMENT
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RECEIVED
JUL 28 1983
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CITY CLEHK
July 27, 1983
Ms. Lucille Williams
City Clerk
City of Clearwater
P. O. Box 4748
Clearwater, Florida 33519
Dear Ms. Williams:
Re: Clearwater Golf Park, Inc.
In follow-up to our letter of May 27, 1983, attached
please find endorsement on INA Policy # SVPD0796689l
on the above captioned adding the City of Clearwater,
Florida as Additional Insured.
Please place this endorsement with your pOlicy.
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attachment
Best regards,
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R th M. Wiese (Mrs.)
ornrnercial Lines Assistant
P,O, Box 20195 · Orlando. Florida 32814 · 305.671.2470
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ADDITIONAL INSURED
ENDORSEMENT (Liability-Leased Premises)
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Name of person or organization insured CLEARWATER GOLF PARK, TNC_
Date this endorsement takes effect
ApriJ 1,1983
Policy number
SVP DO 79 66 89 1
Name of company issuing this endorsement INSURANCE COMPANY OF NORTH AMERICA
(We will not fill in the above unless we issue this endorsement after we issue your policy.)
Any person or organization shown as an "Additional Insured" in the Declarations is added to the WHO IS COVERED section of
YOUR LIABILITY COVERAGE. However, that person or organization is covered only against liability that arises out of the
ownership, maintenance or use of premises that are leased to the named insured and listed and described in the Declarations.
And we won't cover that person or organization against liability:
. that arises out of an occurrence that takes place when the named insured is no longer a tenant of the described
premises;
. that arises out of construction, structural alteration or demolition activities performed by, or on behalf of, the person or
organization; or
. that is assumed under a contract or agreement.
ADDITIONAL INSURED - CITY OF CLEARWATER, FLORIDA
KK-5L31 (6/82)
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