INSURANCE BINDER
.,'~'.." '. ,,' ,. ~ " ,
CITY CLERK
Aetna Insurance
Effective J2:0JA m 4/1/ ,)9
ExpiresXl 12:01 am 0 oo~ 1 7 ,19
This binder is iss~~d to e~te ve~~ ~dt.Qv~~a~c
CQffipanVlnng policy # j ,j
&: ~^' 0 j.L (except as noted below)
Description of Operation/Vehicles/Property
Vehicles: 1974 Dodge Pick Up :/J1.
).978 Gl-C Jilm\V fJ2
1916 Olds S/W #3
1977 Chevy Camaro i4
'-be Veghte Agency
P. o. Box 1.560 APR 4 1919
C~enn;ater, FL 33511
NAME AND MAILING ADDRESS OF INSURED
Pal.1n Pavillon of Clearwater, Inc. 8&
The Four Suns, Inc.
1.0 Bay EspJ.anede
Clearwater Beach, FL 3351.5
Type and location of Property
Coverage/Perils/F orms
Amt of Insurance Oed.
Coins.
%
Clothing,. Beachwear at
2-8 Clearwater street
Reporting Form
Fire,. :Ee & V 8: Mil
$35-,000
100
:'\1
- 1 :
'l,,' ')
Type of Insurance
Coverage/Forms
limits of liabilit
Each Occurrence
r,egate
~A
~C
Bodily Injury $300,000
Property
Damage $100,.000
Bodily Injury &
Property Damage
Combined
Personal InjurY
limits of liabili
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
$ 1.00,.000
o Scheduled Form ~ Comprehensive Form
Xl Premises/Operations
XI Products/Completed Operations
o Contractual
o Other (specify below)
hi Med, Pay. $
~ Personal Injury
Per
Person
$
Per
ACCident
llB
$
$300,000
A
U
T
o
M
o
B
" I
l
E
~ Liability ~ Non-owned
XI Comprehensive-Deductible
XI Collision-Deductible
o Medical Payments
1':1 Uninsured Motorist
No Fault (specify): Basic
o Other (specify):
{g Hired
$ ACV
$ 100.
$
~ 10,OOO/20,fX)()
, 10,000
50 J 000
$500,000
Property Damage
$100 ,000
Bodily Injury & Property Damage
Combined $
awORKERS' COMPENSATION _ Statutory Limits (specify states below) XXI EMPLOYERS' LIABILITY - Limit
$1.00 J roc
SPECIAL CONDITIONS/OTHER COVERAGES
LOAN NUMBER
!jl'
i''{:JJ)
v+
11
t4
NAME AND ADDRESS OF 0 MORTGAGEE m LOSS PAYEE
Car H4
, Clearwat.er Beach Bank
423 Nandalay Avenue
Cl.eanlater Beach, FL 33515
o ADD'L INSURED
ACORD 75 (11-77)
3/3C
Date
1he Vegh te Agency
P.. o. Box 1560
Clearwater, FL 335J.7
St. Pnul Insurance
Effectivel2:0lA m 4/1/79 ' 19
Expires,xOO 12:01 am d Noon . 19
o This binder is issued to extend coverage in the above named
company per expiring policy #
(except as noted below)
Description of Operation/Vehicles/Property
NAME AND MAILING ADDRESS OF INSURED
Palm Pavilion of Clearwater,
'n1e Four Suns, Ine.
10 l3ay Esplanade
Clearwater Beach, FL 33515
Inc. &
Type and location of Property
Coverage/ Perils/ Forms
Amt of Insurance Oed.
CcinL
%
Type of Insurance
Coverage/F orms
limits of liabili
Each Occurrence
regate
Per
Person
$
Per
Accident
oA
DB
DC
Bodily Injury $
Property
Damage $ $
Bodily Injury &
Property Damage
Combined
Personal Injury
limits of liabilit
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
o Scheduled Form
o Premises/Operations
o Products/Completed Operations
o Contractual
o Other (specify below)
o Med. Pay. $
o Personal Injury
o Comprehensive Form
o Liability 0 Non-owned
o Comprehensive-Deductible
o Collision-Deductible
o Medical Payments
o Uninsured Motorist
o No Fault (specify):
o Other (specify):
o Hired
$
$
$
$
Property Damage $
Bodily Injury & Property Damage
Combined $
o WORKERS' COMPENSATION - Statutory Limits (specify states below)
o EMPLOYERS' LIABILITY - Limit
$
SPECIAL CONDITIONS/OTHER COVERAGES
.$1,000 J 000 U:ribrell.a Pollcy
NAME AND ADDRESS OF 0 MORTGAGEE
o LOSS PAYEE
o ADD'L INSURED
LOAN NUMBER
3/30/75
Date
ACORD 75 (11-77)
. .
_ . _ _ - _. ~ _ _ .. ...u._ ~_"
NAME AND ADDRESS OF AGENCY
The Veghte Agency
P. O. :Box 1;60
C1ean"8, ter, FL 33517
Royal Globe
EffectiJ2:0lA m 19, I . 19
ExpiresJU 12:01 am 0 Noon 5/...., 79 . 19
o This binder is issued to extend coverage in the above named
company per expiring policy # '
(except as noted below)
Description of Operation/Vehicles/Property
NAME AND MAILING ADDRESS OF INSURED
Falm' P-avillon of C1earwo. ter, Ine. ,.
~e Four SWlS, Inc.
1Jl Buy Esplanade
Clean-later Beach, FL 33515
Type and Location of Property
Coverage/Perils/Forms
Amt of Insurance Oed.
Coils.
'"
Loss of Earnings
Location 1fJ.-2-8Cl.earwa.ter Street
Fire, l.C &: V & M K
~,ooo
Loss of Earnings
Loca tdlnn #2-332 Gult'viej m. vd.
Fire. EX: & V & M H
$36,000
Type of Insurance
Coverage/Forms
Limits of Liabili
Each Occurrence
o Scheduled Form
o Premises/Operations
o Products/Completed Operations
o Contractual
o Other (specify below)
o Med. Pay. $
o Personal Injury
o Comprehensive Form
Per
Person
$
Per
AccIdent
OA
DB
DC
Bodily Injury $
Property
Damage $ $
Bodily Injury &
Property Damage
Combined
Personal Injury
Limits of Liabili
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
o Liability 0 Non-owned
o Comprehensive-Deductible
o Collision-Deductible
o Medical Payments
o Uninsured Motorist
o No Fault (specify):
o Other (specify):
o Hired
$
$
$
$
Property Damage $
Bodily Injury & Property Damage
Combined $
o WORKERS' COMPENSATION - Statutory Limits (specify states below)
o EMPLOYERS' LIABILITY - Limit
$
SPECIAL CONDITIONS/OTHER COVERAGES
:>,:
";'.,
NAME AND ADDRESS OF 0 MORTGAGEE
o LOSS PAYEE
o ADD'L INSURED
LOAN NUMBER
~_-J J, /T
SI nature of Authorized R presentative
3/30/79
Date
ACORD 75 (11-77)