INSURANCE BINDER
Contents- Fire
Including Improvements and
Betterments
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COMPANY t'i;
Aetna Casualty & Surety Co. [;1
Effective 12:01a m 9/30 , 1981 ~'!!
Expires XJ 12:01 am 0 Noon 1030 . 1981 __ ':
o This binder is iSSU,',ed to extend coverage in the above named',I',...:-=
company per expiring policy # f
(except as noted below) ;c.
Description of Operation/Vehicles/Property \,'"..1."-
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Amt of Insurance Dad. ~ ff:l
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81- 1116
NAME AND ADDRESS OF AGENCY
Rodgers & Cummings. Inc.
P.O. Box 6600
Clearwater. Florida 33518 RECEIVED
NAME AND MAILING ADDRESS OF INSURED
OCT 5
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Ross Yacht Service. Inc.
279 Windward Passage
Clearwater. Florida 33515 CITY ~
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Type and location of Property
279 Wi ndward Passage, Cl earwater. Fl.
Coverage/Perils/ Forms
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P
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250,000
A
QB
QC
Bodi!y Injury
Property
Damage
Bodily Injury &
Property Damage
Combined
Personal Injury
Limits of liability
Bodily Injury (Each Person)
Bodily Injury (Each Accident)
$ 500,000
$100.000
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I 0 Scheduled Form
~ ex Premises/Operations
I Q{ Products/Completed Operations
l ex Contractual
I XJ Other(specify below)Broad Form Comprehensi ve
T 0 Med, Pay, $ Per $ Per
V Person Acc:cent
}p Personal Injury
Type of Insuiance
Coverage/Forms
Limits of liabilit
Each Occurrence
XJ Comprehensive Form
i abil i ty Endt.
$
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$
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U 0 Liability 0 Non-owneJ
T 0 Comprehensive-Deductible
o 0 Collision.Deductible
~ 0 Medical Payments
B 0 Uninsured Motonst
I 0 No Fault (specify):
l 0 Other (specify):
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o Hired
$
$
$
$
$
$
Property Damage
BodilY Injury & Prop~rtyDamage
Combined
$
)(J WORKERS' COMPENSATION - Statutory Limits (specify states below) )tJ EMPLOYERS' LIABILITY -- Limit
$100,000
SPECIAL CONDITIONS/OTl-IERCOVERAGES
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NAME fiNO ADDRESS OF 0 MOflTG,^,GEt CJ LOSS f>P.'r'EE )(0 ADD'L INSUR~O .
LO.',N NUMbE'i
City of Clearwater
City Clerk's Office
P.O. Box 4748
C1 e a rwat.ar~Ely_~~_~~_____~___n~_____~___
.! t~CORD 75 01.77)
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