CERTIFICATE OF INSURANCE (5)
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VEGHTE
INSURANCE
AT FEATHER SOUND PLACE
2575 ULMERTON RD~ SUITE 300
POST OFFICE BOX 17305
CLEARWATER, FL 34622
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JACK VEGHTE
BRUCE VEGHTE
DANIEL AMEND
CHERYL HALL
MARILYN LEBO
RICHARD STACY
PHI UP ERICKSON
DAVID HOLLOWELL
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APR 1 1 1988 (,-'
April 7. 1988
Mr. Don Petersen
Risk Manager
City of Clearwater
P.O. Box 1;71;8
Clearwater. Fl. 33518
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REI Howard Hamilton
South GuHvlew Blvd.
Dear Mr. Petersen
Enclosed Is a cop-y of the Windstorm Insurance for the property
located at 332 South GuHview. Please review and advise if there
are any Questions or corrections.
Sincerely.
~4
Marketing Asistant
/f-'
RECEIVED
cel Ken Hamilton
Palm Pavilion
if/
APR 19 1988
CITY CLERK
INSURANCE. BONDS & INVESTMENTS. SERVING FLORIDA SINCE 1958
PINELLAS (813) 579-0055
(.,.~
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TAMPA (813) 221-1166
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- - - - -',-- --~-------
PART 2 THIS DECLARATION PAGE. V/ITH rot1t;;.._____,,---. ,_ . ..on:' u-l"OORSEMENTS, IF ANY ISSUED TO FORM A PART
THEREOF, COMPLETE THE BELOW NUMBERED FLORIDA WINDSTORM UNDERWRITING ASSOCIATION POLICY,
FLORIDA ytlNDSTORM UNDE'RWRITING I\SSOCIA TION
1000 RIVERSIDE AVE.. SUITE 408, JACKSC;:>NVILLE. FL"MIDA 32204
INC.,
THIS IS A
INSURED'S NAME AND ADDRESS
PALM PAVILION OF CLEARWATER,
ET AL "
10 BAY ESPLANADE
CLEARWATER BEACH
POLICY TERM
ITEM
NO,
GENERAL BUSINESS
DECLARATIONS PAGE
4 /0 5 /8 8 TO
INCEPTION DATE
FL
33515
4/05/89 AT 12:01 A"M, (STANDARD TIME)
75283
1
POLICY NO,
EXPIRATION DATE
s
s
PAGE
'AUTOMATIC IHeRE'"
PROVISION APPLICM
IF PERCENTAGE SH~
FL 3351
.0
.0
FL 3351
.0
FL 3351
.0
FL 3351
.0
.0
FL 3351
.0
! TOT AL AMOUNT OF COVERAGE I PREMIUM PREMIUM PREMIUM '!'OTAL ANNUAL PREMIUM
I APPLICABLE TO AUTOMATIC OTHER I FOR AUTOMATIC FOl'\ OTHER FOR REINSURANCE
INCREASE PROVISION I S INCREASE PROVISION
is S $ S
I
( B T F RM N
: }\:",?,\,AMo.~~:~OF INSUR.ANCE " "
:: .:~,'" BUILDING :':;,; ''''", CONTENTS
% $
s
1
ONE STORY FRAME SNACK BAR ANO'BEACHWEAR'LOC:
2'!"'8"CLEARWATER ST CLEARWATER 'BEACH
PINELlAS
633
2
, '
, 16LJ, 000 80 500! 9~, 1';-;
CONTENTS' OF ABO:~ 000 80 ,4~~ 0 f\;, .;~~,'
',~;. i . 'I
, CONTENTS: IN' A ONE STOR Y'~I"AS,()NRY RESTAURANT ,ilOC:
332, GUiLFVIEW $,,, \":/ CLEARWATEjR' B.:TA:CH,
o ! ' LJ 0 , 00 0 . 8 0' 5 0 0 i 90;L "
I ,: !
CONTENTS" IIN A ONE STORY MASONRY BATH.tHOUSE !LOC:'
330 ;'G~LFVIEW S ~LEARWATE:R "BE~CH'
010,000 80, 500,! 90!
I "
I
ONE STORY :'MET AL STOR AGE 'BtJILlHNG LOC: !
R-IO ESPLANADE ~LEARWAT8R
c~:;::~s-J ABOVE 80 sooel
.285
PINELLAS
5LJ
.386
.386
212
.285 '
'PINElLAS
l1LJ
3
PINELLAS
29
';'285
4
I
, BEA:CH
90 i
:':1'
20,000
80
500
.285
57
90
5
TWO STORY 'MASONRY MERCAN'TILE'AiND APARTMENT:BLDG
lOC:
385 MANDALAY AV CLEARWATER BEACH
PINELlAS
675
237,000
500
.285
o
80
90
SU JEC TO 0 O(S)
~ MORTGAGEE/LOSS PAYEE
I
( PRODUCER:
VEGHTEAGENCY
I 2575 ULMERTON RD
, P.O. BOX,17305
CLEARWATER'
\.
I PAYOR:
INSURED
J:300
FL
3/30/88
34622
I DATE
POLICY DECLARATION COpy
0221
DEE
FWUA 3 (ED, 7/87)
8911
FLORIDA WINDSTORM UNDERWRITING 4SS0CIATI~:N.L
1000 RI1RSIDE AVE.. SUITE 408, JACKSONVILLE. FLOIID" 32204
:5URED'S NAME AND ADDRESS THIS IS A
JALM PAVILION OF CLEARWATER, INC.,
:T AL
lO-BAY ESPLANADE
:LEARWATER BEACH
JLlCY TERM
FL
33515
4/05/89
EXPIRA TlON DATE
"'05/88 TO
INCEPTION DATE
AT 12;01 A,M, (STANDARD TIME)
oM
0,
DEDUCTIBLE
;.AMOUNr.,,~
% $
AUTOMATIC ~(
PAOvISION ~1CA1IU:
II' ~AClHT AGe IHOWN
" ' ,AMOLlNT "OF INSURANCE , ,,". ",
.' ,", ::.....'..J"'."".,.. ' .
BUILDINa~\J4~:...'i'. ; ," CONTENTS':;.:'
$
$
6
ONE STORY FRAME SNACK BAR
332 GULFVIEW BLVD S
,128,000 0 80
ONE STORY ~ASONRY BATH HOUSE
330 GULFVIEW BLVO S
52,000 0
LOC:
CLEARWATER
500 :
,BEACH
90 I'
LO C : I' ~" i
CLEARWATER:BEACH
50 0 I . 90 "j
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I "-;::;;'11
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,
,;"'1"
7
.-80
i
I
I
,
I
'j
,
,
!
I
;
TOTAL AMOUNT OF COVERAGE
,-!CABLE TO AUTOMATIC OTHER
INCREASE PROVISION
PREMIUM
FOR OTHER
PREMIUM
FOR AUTOMATIC
INCREASE PROVISION
$
$
$
2,416.00
o
8JECT TO FORM NO(S):
725,000
.00
ADDITIONAL INSUREDS LIST ON PAGE 3
)RTGAGEE/LOSS PAYEE
CLEARWATER BEACH BANK
423 MANDALAY AVENUE
CLEARWATER BEACH,FL
33515
JDUCER:
'VEGHTE'AGENCY
2575ULMERTON RD #300
P.O. ,BOX '''17305
CLEARWATER FL
34622
PAYOR;
3/30/88
" 3 (ED, 1/87)
DATE
POLICY DECLARATION COpy
0221
~~1,jl't!~'!IJrr~1'?'~~}~~;jf~l-"
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GENERAL BUSINESS
DECLARATIONS PAGE
POLICY NO"
75283
PAGE
2
$
%
P INElLAS'
.386 It 9~
FL"3351 '
.0
't,.:
t'
PINElLAS
.285.ci~ 148
_ .1
FL 3:551
.0
, t;{
P - I
PREMIUM
FOR REINSURANCE
TOTAL ANNUAL PREMIUM
$
362.00
2,778.00
DEE
8911
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~~'-;~:....
I n~n~vr, ""'..,""''' ~'- I _ "'_ ___ _. _ . ~__.____ _ .__
"
FLORIDA tlNDSTORM UNDERWRITING IASSOCIATlON
1000 RIVERSIDE AVE,. SUITE 408, JACKSONVILLE. FLtRIDA 32204
INSURED'S NAME AND ADDRESS
fALM PAVILION OF CLEARWATER,
ET AL '
10 BAY ESPLANADE
CLEARWATER BEACH
INC.,
THIS IS A
POLICY TERM
4 / 05/88 TO
INCEPT ION DATE
FL
33515
4/05/89 AT 12:01 A,M, (STANDARD TIME)
GENERAL BUSINESS
DECLARATIONS PAGE
POLICY NO.
EXPIRATION DATE
75283
ITEM
NO,
PAGE
3
$
1
%: $ %i . $
I I !
I, I !
i I /;:'J1l$;:' !
ADOITIO:NAL NAMED, INSUREDS' LJIST,:, ,. ~,~ I~"~::.,.,.,\:;;!,,:;f,'d~\ I'
I fI/('. ',' I;:. , :~~
I ~~\:1' ',"1~' I
· I~8 ~g~MU~~HI~~g~~,\ ~~' ~;;.. . ~k
CI~,'Y OF CLEAtUIA. TEII~~\:, R'ESPECTS ~ ~l.. ~l1:';
" ITEMS' ,6,. ,&-' 1", . , \.:f- I l!il'" ~; 'g I ;
{ '?\~;~~.~',.'....,:,:~'; i~~~_:'~~:, I~ I "'. ,;:.~: \;1
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v,";;
I
I
I
I
j
$
2
.->4
r';
, TOTAL AMOUNT OF COVERAGE PREMIUM PREMIUM PREMIUM TOTAL ANNUAL PREMIUM
I APPLICABLE TO AUTOMATIC OTHER FOR AUTOMATIC FOR OTHER FOR REINSURANCE
i INCREASE PROVISION INCREASE PROVISION
S $ $ $ $
l
I u
, SUBJECT TO FORM NO(S),
I
i
> MORTGAGEE/LOSS PAYEE
. . \ -, . ~ . .
.i;',
. ".", ,. '--"""'-
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"" :-~-' - .~.;:. .....-;
..,...,.'.:~:t{i~stt;~f
> PRODUCER:
. VEGHTEAGENCY
2575.ULHERTON.RD
P.O.'BOX,l'7305
CLEARWATER
I PAYOR:
INSURt.D
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#300
.34622
FL
-3/30/88
FWUA 3 (EO, 7/87)
I DATE
POLICY DECLARATION COPY
'-
0221
DEE
8911