RENEWAL CERTIFICATE FOR POLICY NUMBER 310 19 19
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~ I P.O. DRAWER 56770
~_'_"_~_"_ ~ACKSONVILLE, FLORIDA 32241-6770
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RENEWAL CERTIFICATE
COMMERCIAL PACKAGE POLICY
No_ Cpp 3:10 19
Named Insured and Hailing Address
CLEARWATER HISTORICAL SOCIETY INC.
P.O. BOX 175
CLEARWATER PINELLAS FL 34617
19
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Designated Premises
1 1350 S. GREENWOOD AVE. CLEARWATER'FL
2
3
The Named Insured is: CORPORATION
Policy Period From
1/20/93 TO 1/20/94 12:01 A.M" Standard Time at location of designated premises.
Insurance is provided with respect to the designated premises and with respect to those coverages and kinds of property for which a
specific limit of liability is shown, subject to all of the terms of this policy including forms and endorsements made a part hereof,
COVERAGE
Section I - PROPERTY and INCOME
A. Building
B. Personal Property of Insured
C. Personal Property of Others
D. Business Income (25% each 30 days)
E. Extra Expense
F. Bailee Coverage
G. Valuable Papers
H. Accounts Receivable
I. Exterior Glass - $250 deductible
J. Sign -- $250 deductible
K. Mini- Computer Coverage - $250 deductible
'..
LIMIT OF LIABILITY
Loc. No. 1
$ 100.000
10.300
o
o
o
o
o
o
COVERED
o
o
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Section II - LIABILITY All Designated Premises
A. General Aggregate Limit (Othel" Than Products-Completed Operations)
B. Products;-Completed Operations Aggregate Lim}"t
C Personal and Advertising Injury Limit
D. Each Occurrence Limit
E. Fire Damage Limit
F. Premises Medical Payments
G. Ernplo}'ers Non--Ownership Automobile
$1.000,000
1,000,000
500.000
500,000
50,000
5,000
500.000
Any One Fire
(jny One PerS;Ofl
Per Occu JTe nee
.._.~_.__.__.__..__._~._._.__._-_._-_._._----._----_.-.----.--------.-.----------------------------------------,-----
Section III - CRIME ($ 250 deductible)
A. Employee Dishonesty - Aggregate Per Loss
B. Robbery - Inside
Outside
C. Safe Burglary - Limit
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Loc. No. 1
o All Designated Premises
o
o
o
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Section I - Coinsurance - Buildings 90% Personal Prope~'ty 90?;;;
- Deductible - $ 250 Per Occurrence
- Mortgagee - NO - Loss Payee - NO
Causes of Loss: Building - SPECIAL Personal Property - SPECIAL
TOTAL ADVANCE PREMIUM $ 959
09-0091
Countersignature Date: 12-02-1992
Agency at: DUNEDIN FL
THIS CERTIFICATE EXTENDS YOUR POLICY FOR AN ADDITIONAL TERM. PLEASE ATTACH TO YOUR POLICY
(e) Copyright 1985, 1988 . SIR Softwarf, Inc,
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Old Dominion Insurance Company
HOME OFFICE
PO. DRAWER 56770
JACKSONVillE, FLORIDA 32241,6770
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POLICY NUMBER: 310 19 19
COMMERCIAL PROPERTY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-MANAGERS OR LESSORS
OF PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY
SCHEDULE
1. Designation of Premises (Part Leased to You): 1350 S. GREENWOOD AVE. CLEARWATER FL
2. Name of Person or Organization (Additional Insured):
CITY OF CLEARWATER
CLEARWATER FL
3. Additional Premium: INCLUDED
"
(If no entry appears above, the information required to complete this ~ndorsement will be shown in the Declarations as applicable
to this endorsement,)
WHO IS AN INSURED (Section II) is amended to include as an insured t~ person or organization shown in the Schedule but only with re-
spect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the
Schedule and subject to the following additional exclusions:
This insurance does not apply to:
1. Any OCCURRENCE which takes place after you cease to be a tenant in that prelises.
2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in
the Schedule.
CG 20 11 11 85
Copyright, Insurance Services Office, Inc., 1984
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Old Dominion Insurance Company
HOME OFFICE
P.O. DRAWER 56770
JACKSONVILLE, FLORIDA 32241.6770
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CPP 310 19 19
Forms and Endorsements made part of this policy at time of issue in addition to
Commercial Package Policy Conditions and Definitions: