INSURANCE BINDER
ACORDTM INSURANCE BINDER
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PRODUCER PHONE COMPANY BINDER #
SUB CODE:
12:01 AM
NOON
AIM Insurance Group, Inc.
AIM INSURANCE AGENCY
P.O. Box 860
Palm Harbor, FL 34682-0860
CODE:
AGENCY
"
iNSURED
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMEO COMPANY
PER EXPIRING POLICY #:
DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY (Including Location)
Clearwater Group A.A.
P.O.Box 518
Clearwater, FL 33757
01 Seminole Street, Clearwater, FL
3757 - Non Profit Group
'COVERAGES
LIMITS
TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS % AMOUNT
iROPERTY CAUSES OF LOSS
-- D BROAD W SPEC
- BASIC Bui l~ing ACV 1000 80 53,000
.-'l.L XIThtaf'''' Contents ACV 1000 80 6,000
I'y 1 n s, TAT~..~ n...~
GENERAL LIABILITY EACH OCCURRENCE $ ------
--.
._lL 3MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $
CLAIMS MADE W OCCUR MED EXP (Anyone person) $ <;;nnn
---
PERSONAL & ADV INJURY $
---
_eX. GENERAL AGGREGATE $
':.,\.i RETRO DATE FOR CLAIMS MADE: PRO.DUCTS - COMP/OP AGG $ ------
;\UtOMOBILE LIABILITY COMBINED SINGLE LIMIT $
--'----'--
,,:- ANY AUTO BODILY INJURY (Per person) $
--
ALL OWNED AUTOS BODILY INJURY IPer accident} $
~--
---- SCHEDULED AUTOS PROPERTY DAMAGE $
c_ HIRED AUTOS MEDICAL PAYMENTS $
;:-
~i:c:-: NON-OWNED AUTOS PERSONAL INJURY PROT $
UNINSURED MOTORIST $
-'...:-
-, $
\U+O PHYSICAL DAMAGE DEDUCTIBLE ~ ALL VEHICLES U SCHEDULED VEHICLES ACTUAL CASH VALUE
~~
-- COLLISION: STATED AMOUNT $
.: OTHER THAN COLi OTHER
:~AGE LIABILITY AUTO ONLY - EA ACCIDENT $
,- ANY AUTO OTHER THAN AUTO ONLY:
-_.
- - .--. .. -..- ---._------ ..... --~---- ---"' - . ---- ._EACH ACCIDENT $ .
- .. AGGREGATE $
-'XCESS LIABILITY EACH OCCURRENCE $
'~'H UMBRELLA FORM AGGREGATE $
I-~--, OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $
I.... WC STATUTORY LIMITS
1- WORKER'S COMPENSATION E,l. EACH ACCIDENT $
AND
Ie- EMPLOYER'S LIABILITY E,l. DISEASE, EA EMPLOYEE $
-.- E,l. DISEASE - POLICY LIMIT $
:;;PECIAL FEES $
r,:;OI\lDITIONS/ $
-')TriER C~ ~.a.k Rl~ (~ TAXES
~;O\fERAGES O(l. ( <0 !. : ~~~ ESTIMATED TOTAL PREM I UM $
-
City or Clearwater
c/o Risk Management
P. O. Box 4748
Clearwater, FL 33757
MORTGAGEE
LOSS PAYEE
LOAN #
DEe 0 8?n03
:NJ.\ME & ADDRESS
AUTHORIZED REPRESENTATIVE
RISK MANAGEMENT
),CORD 75-S (1/98)
NOTE: IMPORTANT STATE IN
~ ACORD CORPORATION 1993
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CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the
terms, conditions and limitations of the policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company
stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the
Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this
binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the
Rules and Rates in use by the Company,
Applicable in California
When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title
of the form is changed from "Insurance Binder" to "Cover Note".
Applicable in Delaware
The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real
property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if
the binder includes or is accompanied by: the name and address of the borrower; the name and address of the
lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled
within the term of the binder unless the lender and the insured borrower receive written notice of the cancel-
lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to
the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of
insurance coverage.
Chapter 21 Title 25 Paragraph 211 9
-----________~Uc.abJfL inFIOJicI.cL_~___
Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the
duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless
the binder is replaced by a policy or another binder in the same company.
Applicable in Nevada
Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is
required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof
of insurance for actual damages sustained therefrom.
J
.\
..'
:!\CORD 75-8 (1/98)