INSURANCE BINDER (2)
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C. IT Y 0 F C LEA R W ATE R
Interdepartment Correspondence Sheet
FROM:
Tom Bustin, City Attorney
Elizabeth Haeseker. Assistant City Manager
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TO:
COPIES: Gerald Weimer, Assistant City Manager
SUBJECT: Insurance Binder .. South Beach Pavillion
DATE: May 10, 1979
Enclosed is a copy of the insuranc e binde r on the South
Beach Pavillion issued by Reliance Insuranc e Company.
This was sent to me and I assume that it should be filed
with the latest lease on this property.
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1b.e Tegbte AgeDq
P. o. Box 1560
C1earnter. lit 3351T
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BellBDCe 1uuraDce ~1V
Effective 12iau m ~/1/19 . 19
ExpiresXJ 12:01 am 0 Noon 6 . 19
o This binder is issued to extend coverage in the above named
company per expiring policy # (
except as noted below)
Description of Operation/Vehic\es/Pro~rtr .
Yeb1c1ea: 19'1'l Doc1&e P1ck" ft
1978 GMC ~ Ie.
J!R6 Q1da a/W 13
19f1 Cbw. r 10 A
NAME AND MAILING ADDRESS OF INSURED
Pa1a PavWOIl ot Cl.earIf&ter, IDe. .
!be 'our BaDa. IuI:.
10 Bar bpl".a.
Cl.e&rvater Beaeh, D, 33515
Type and location of Propertr
Coverage/ PerilslF orms
Amlof Insurance Oed.
eor..
'llo
8toek. 2~ Clesrwater a... Cl..eazwa.teZ'
I'urD1tvres 'A ftsturea at Uon
.,Hd1qs at abon
I'.ualDip at aban
ConteDta, 332 Galb1a Bbd.. ~ter
~ at alKJn
CoIltsb, ba~_
nz.e~ IC . yo . . .
nre. s: . y . . .
J'1re. s: II . . . .
11re. Ie . Y . . .
J'1re, !C . Y . . .
J'hoe. lC . . . . .
J'Jre. iC . Y . . .
35.000
30.000
110.000
Ito.OOO
20.000
36.000
6,000
80
80
.
80
25
80
Type of Insurance
Coverage/Forms
limits of liabili
Each OccUrTtmC8
o Scheduled Form ~Comprehensive Form
IJ Premises/Operations
D Products/Completed Operatio,",s
o Contractual .~
o Other (specify below)
o Meet Pay, $
Personal Injury
Bodily Injury
Property
Damage
$ 300.000 $ 300.000
$ J.OO.ooo $ 1.00,000
Per
Person
$
Per
Accident
A
~B
~C
Bodily Injury &
Property Damage
Combined
Personal Injury
limits of liabili
Bodily Injury (Each Person) a
Bodily Injury (Each Accident) 500.000
Liability ~ Non-owned
Comprehensive-Deductible
Coli ision,Deducti ble
o Medical Payments
Uninsured Motorist
lZ No Fault (specify): ~
o Other (specify):
~ Hire.<1
$ N:f
$ 100.
$
$ )Jj,r:aJ/20.ot>>
. 10.000
Property Damage $ 100.000
Bodily Injury & Property Damage
Combined $
IJ EMPLOYERS' LIABILITY - Limit
$100.000
SPECIAL CONDITIONS/OTHER COVERAGES
~ect to V1D4" JIaU ~)na1Cl1l ea4cl~ lJto Xl61.
~AAA~~~GAliE2~~~_ ~SURED
C1.esrwateI' .-~ .. LOAN NUMBER
.1&23 ,......., V AftIme
Clearwatezo ., V. II. 3>>15
5/2/79
Date