INSURANCE BINDERS
THE VEGHTE AGENCY
P.O. :BOX 1.560
CLEARWATER} FL
33517
Effective 1 9
Expires ~ 12:01 am [l Noon 07/0~g
o This binder is issued to extend coverage in the above; named
company per expiring policy #
Description of Operation/Vehicles/ Property
NAME AND MAILING ADDRESS OF INSURED
THE COLONY LTD
STIFF ~ BRAI.JEf~
33 N FT HARRISON
Cl.EARWATER Fl..
:~3515
Type and Location of Property
Coverage/ Perils/ Forms
Amt of Insurance Oed,
730,000 o~T-
I
421. -29 CLEVELAND ST} CL~I
AL.L RISK
REPLACEMENT COST
RECEIVED
I Type of Insurance
LI
I LJ SChe~d Form Comprehensive Form
~ Premises/Operations
I Products/Completed Operations
~ 0 Contractual
~ :'1 Other (specify belo'!!')
~ Med, Pay, $ 1.} uOO Per $:l.0} 000 Per
~ Person Accidenl
LJ Personal Injury
Coverage/ Forms
limits of Liability
Each Occurrence
Bodily Injury $
CITY CLE K
Property Damage $
Bodily Injury &
Property Damage $
Combined 1. 000000
$
CAD B
r--,
LJC
Personal Injury
Limits of Liability
Bodily Injury (Each Person) $
Bodily Injury (Each Accident) $
['I Liability 0 Non.owned 0 Hired
o Comprehensive.Deductible $
U Collision-Deductible $
o Medical Payments $
[J Uninsured Motorist $
[J No Fault (specify)
D Other (speGify):
Property Damage $
Bodily Injury & Property Damage
I
i Combined -$
[J WORKERS' COMPENSATION - Statutory Limits (specify states below)
o EMPLOYERS' LIABILITY - Limit
$
SPECIAL CONDITIONS/OTHER COVERAGES
CITY CLERK) P.O. BOX 4748, CLEARWATER. FL 33518 CLOSS PAYEE)
NAME AND ADDRESS OF
MORTGAGEE
o LOSS PAYEE
o ADD'L INSURED
REPUBLIC BANK
PO r-fOX 7010
CLE:Ar~WATER} Fl.
LOAN NUMBER
33~'H8