MORTGAGE CLAUSE (2)
The ~liCLOSURE
~ i; for: your records
,
,
Date: 6-6-8S
The enclosed contains a Mortgage Clause, or Loss Payable Clause
in your favor.
Owner:
CLearwater Beach Seafood, I nc.
Company WCW400-04-92
Thank yOU, Pam zeyok
~O~
INSURANCE AGENCY INC.
620 BYPASS DRIVE
P. O. BOX 5025 P z
CLEARWATER, FLORIDA 335~8-4985
Phone: (8131 797-4499
Tampa: 229,8208
Company and Policy No. .
West AmerLcan Insurance
,
CLty of CLearwater
TO P.O. BoX 4748
CLearwater, FL. 33518
L
09-00-1301
'(Q5' ENDORSEMENT
t
ATTACHED TO AND ORMING PART OF EFFECTIVE DATE
POLICY NUMBER ..
wl.W (86) 40'0-04-92 05/31/85
POLICY ATTACHING DATE POLICY EXPIRATION DATE
"
O~/31/85
05/31/86
NAME OF COMPANY
WEST AMERICAN INSURANCE COMPANY
INSURED'S NAME & ADDRESS
ENDORSEMENT NUMBER AGENT NUMBER
PRODUCER'S NAME & ADDRESS
lEARWATER 8EACH SEAFOOO IN(;
37 CAUSEWAY 8LVO
'lEARWAIER fl
AIM INSURANCE AGENCY INe
POBOX 5025
33515 CLEARWATER Fl 33518
IN CONSIDERATION Qf AOOITIDNAL PRiHIUM DUE NOM $2.914.00
IT IS AGREEO THAl IhE POLICY IS AMENDED AS FOLLOWS:
lLA SS 8031 (02) (5CH. NO. 010900) IS AMf:NOEO TO READ:
5.70 30.000 $1.710.00
CLASS 9019 (05) (5CH. NO. 010900l IS AMENDED TO READ:
3.97 116.000 $4.605.00
RECEIVED
JUN ,J 0 198~
CIty CLEBK
.L OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. a,--LJ.-t: .J f) (]
OS/29/85 STP 03 ( ~~)h /~
'UE DATE AUTHORIZED REPRESENTATIVE' ,'_
np1703(7-76) INSURED'S COpy /90/6 -/6 '