EVIDENCE OF PROPERTY INSURANCE
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL.
THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER COMPANY
AIM Insuraace Agency, Inc.
P.O. Box 5025
Clearwater. Fl. 34618
Shelby Insurance Company,/; ,On .
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CODE
SUB-CODE
LOAN NUMBER
INSURED
Clearwater Group AA
P.o. Box 518
Clearwater, Fl. 33517
POLICY NUMBER
MP069ll45
EFFECTIVE DATE (MMlDDIYY)
8-16-87
THIS REPLACES PRIOR EVIDENCE DATED:
ROPERTV INFORMATION
LOCA TION/DESCRIPTION
712 Osceola Avenue, Clearwater, Florida 34617
OVERAGE INFORIVIATION '
COVERAGES I PERILS IFORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
Building
Contents
$50,000
$ 6,000
$100
$100
MARKS (Including Special Conditions) ,,- .
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CS. s~~
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ANCElLATION .. . _ :"
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD,
SHOULDI~E ;>OLlCY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED
BELOW 3t} nays WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY
THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED
BY LAW,
DDITIONAL tNlEREST ' - -, .. - - ~
NAME AND ADDRESS
City of Clearwater
ATTN: ~rr. Hensley
P.O. Box 4748
Clearwater, Fl. 33518
/
NATURE OF INTEREST
MORTGAGEE
~ ADDITIONAL INSURED
SIGNATURE OF A
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