CERTIFICATE OF INSURANCE FOR EMPLOYEE DISHONESTY AND FORGERGY
I
C~Y OF CLEARWATER
Interdep.rtment Correspondence Sheet
TO:
Sue Lamkin, City Clerk's Office
FROM:
Joseph R. McFate, Community Development
c-,ordina7JP'1
COPIES:
SUBJECT:
U.S. Home Mortgage Corporation
DATE:
May 9, 1979
.IECEiYE~
MAY 10 1979'
CiTy CLERl(
I am enclosing the original Certificate of Insurance for employee dishonesty
and forgery, together with all of the Financial Statements which I have
maintained in my files for your records.
JRM/sn
Enclosure
~.,
I
I
rate: May 7, 1979
CERl'IFICATE OF INSURANCE
This is to certify that the p:>licy of insurance described below has been issued
to U.S. HOME CORroRATION and its wholly owned subsidiaries including U.S. HOME
M:>R'ffiAGE CORP. and is in force as of the date of this Certificate. A ten
(10) day rotice of policy alteration or cancellation will be sent to THE CITY OF
ClEARWATER, DEPARrMEN'l' OF CC>>M.lNITY DEVElOPMENT, P.O. Box 4748, Clearwater,
Florida, 33518.
COVERAGES FOR WHICH
INSURANCE IS AFFORDED
LIMIT OF
LIABILITY
R)LICY EFFECTIVE
NUMBER DA.TE
Employee Dishonesty
$5,000,000
~CDA.-151T629-7-78 11/1/78 - 11/1/79
Depositor's Forgery &
Credit Card Forgery
(OUtgoing)
$5,000,000
"
"
"
"
"
The insurance afforded is subject to all the terms of the policy, including
endorsements, applicable thereto. The policy is for the sole benefit of the
insured and does rot bestow upon any other person or organization any rights or
benefits.
'!HE 'ffiAVELERS INDEMNITY CCMPANY
By: ~?7. e!~,
Authorized Representative
"
j:~_,~'1_~-,~t .".,t.::.:~- .....- '."\.-..' ~~,~-~...,~--
~
The 'r ravelers
---~~"r--"""'" "-=,-""-"
Inc~mnity Company
..~,
I
J
Horlford, (orlJlc~cli(ut
(^ Sl(".~ (rll'fll1Jl)', h"""11 cC'II,:d Ih" Compony)
POLICY
T-CDA-151T629-7-77
NO.
NO. $-1066 (S-6~)
DECLARATIONS:
Item 1. Name of Insured:
(herein called .the I IIsured)
POLICY FOr~M
Principal Address:
U S HOME CORPORATION
THOSE liSTED ON ENDORSEMENT 596
ONE COUNTRYSIDE OFFICE PARK
CLEARWATER FL 33518
RECE'V[~f;~
MAY '1 1 ..,
..
Item 2. --po)[cy-l>edod:' from noon Oil
SEE ENDORSEMENT 64$
r~DEVE1~__.____
H' tono()'n ()[lIbWItctive date of
\IlIl"lItl1. (LII', Yf";U)
the cancellation or termilliltioll of this Policy, stall,Ll[(J tilTlP :11. the Principal Address as to each of said dates.
Item 3~--Ur~lt'oTLrab,Tity:
Blanket Crime Policy....')'otal Limit of Liability
COOl-prehensive 1S-515'Folic'y=1;';~f;le(ltCiinit~ of Liability
._J.t._...._ .___
Insuring I
--.!~~_emel~_t_..I..
Employee Dishonesty-.Form A
_~~ggr.eK;I~':.h~litof lial)ili.~r as. ~o. ~dl t:ll~i)l()yccs}
Em ployce D ishnnesty- Form H
(limit of liability as to each employee) $;
----IY..-.-- T:o~~-T;;~~T(:t};(.I)f(:I;; i~;.-;;n.. ..... .. ..u .. -. .r-'-'---
____,.,_,_,_~_w_____.__ ___.____._____
III Loss Outside the I'rcmises $
--- -- --,.---- - .--- ----------,,_._-,--,,-
---.--rv---..l\r<~.i~ey Urders ;lIld ('olllltcrf('it 1';1j IlT CWlc'rln $
--V-.n -- )?~ii<~~it().~.I;c:rg~r Y_ n. .-.-....1 !'~:I;O q~~;(jOQ_.
t $ .__._.._____.
--'-.---' T"".. .... ..~.._...__.____
=~~jt~G'~'e'"B,,' ;f~"dJ,d I" ,,,d,,,,,,,,,,,, ~_u ".~."""-~"
The insurance a/Tordcd is \lI1I" with resp('('t t(l "ll<h (('\'.1 ,," .(; ;; II1dil;LtCr! hy specific <'Iltr)' of ;1 limit: of liability.
~~~~ll~0.~[l.~~~rX.~]l.;ll~S. tlLltllo illSW,llj,C j,; all (Irril-c1 \\ I th lcspect: thereto; . .un._._ ....___..um______
Item 4. The liability of the COlllpallv is subjeel In the tnnls of the endorsemellts attached hereto:
Coverage
Limit of Liability
$
5,000,000
5
L.6A
90' 10 SA
162
165
196^
200
201
203
520M' 596
" ' ". ~
:: > ":\
645"
8000 (1-2)
,...... \r:
....,~ ;."~
,.
,/,
I.
.-'\, ;"
." ,
Item 5.
----'-~_._-----~
The Insured by aeCep1.lllce of this Policy gives notie" to the Company terminatill':: or canc:eling prior
bond(s) ur policy(ies) r\o.(s) TR-C OA-1 36T7l12- 3-76 TR-BC- 1 35T256- 3-76
such termination or (.111< ell.l! iOll to he dTect ive .I', of tlH" lillH" this I'olicy becomes e/Tective.
:=~~e_-_l=19;Z8MK/LB " ("o"nle",g""'I,,~?1__...
THE DECl.ARATIONS PAGE AND ALL ENDORSEMENTS ISSUED TO FORM A PART HEREOF, TOGETHER WITH THE
POLICY JACKET BEARlNG THE POLICY FORM NUMBER STATED ABOVE, FORM YOUR COMPLETE INSURANCE POLICY.
---~-..------ --.. - -. ~._- - -
5-2099 Rev.9-69 "'.HD ,. .0.'.',
- -~_....-,., --_.~'~._.
. . 1 ~r' ., I I <" 1<:--'f.)11 ':,.R
Ii' ,~.' r~ P' I l:., to- i, < \, .. ,/ !. I. ~ ~ ' .' ," ~
~..U"'V.K\:)t'.,!Vl.t.l"!:L:Ul'Y-IJO NOT ATTA' 'TO POLICY ~
'-ll"";; '"....'- ."'~C'."~'''''''' '. ~'~. n - "co. ,,, ",,' "",",""" "'1''''' ~ "OJ'~I ~,~. ,,~~ I ,,,,,,";:;,,,~ 0;;;,."" I
.- I ~.. -- - -j -.------1' I
'L.~,_ ~-=IU I:~:~-- -=~- ; : - '--r--- r-- !
HICE I pnoo. f'noo. I' MODE 0'F-.- TYPE l:ill
COOE I CODE ADJUST, , ~ ~_I _
z- ..
02 -------.
~~"__-~J'i~:':- ~;::,. I::::"" j ~;\: % I::;~" zr" III
If any adclitioll:d prcmiulll i~ Ilotcd Iwlo\V, Ibis \,11,j'Jr,"III(l11 is iS~II\'d ill "JlI;;ideratiOII thereof. If allY return premium is
noted below, the receipt thercof is ackllowledged 1I11011 dU'('J>ldIH"> of thi,; el1dorsement. PAGE 1 OF 3
!\;ncl1di,,/( T -CDA-151T629-7-77
Effective from___...._._.._._.______ ...... _._..__a t the.J il1lc of day IIH' polin' J"."'(I'II(": ..:';'e((;"". Polin:-';" _______....___.__._._
(JHollth. Di'lY. r tar)
III
PO
PPO
I RUed to:____.____..__...___.___.___....
Date of Issue:
\cJd i tilll1a J I'rrlll i '.Illl S
---. -- - - --. - .-----------.-----------,---- -~-----,._-~-----_.~,------_."'----
Return Prcmium $
(The information provided for abo"., neel'll thc 1'"1;,,,' "'~I1,I,,'r, j, rc.".I,,;rc'.I.11l Iw ,Lllcd ')III~' WhCII this clldorscn:cllt is issucd for attachment to
th.,' pohc:/ sl~L;-~eqllc!lt tr; Its dlectlvc dateo)
It is agreed that as ot the effl't'tt\O,," d:dc ht"rl'ilf tht' J.'lljic~' j..; ;LlllI.'lldl,'d iil the r(lll()w;1i:~ p:lrliu:i.\r~:
THE INSURED UNDER THE ATTACHED POLICY AREa
U.S. HOME CORPORATION
U.S. HOME CORPORATION OF NEW JERSEY
U.S.H. REALTY CORP. A SUSSIOI~RY OF U.S. HO~E CO~paRATION OF NEW JERSEY
U.S.H. CORPORATION OF NEW YORK, A SUBSIOIARY OF U.S. HOME CORPORATION OF NEW JERSEY
BUILDING CORPORATION OF AMERICA, J\ SUBSIDIARY OF U.S. HOME CORPORATION OF NEW JERSEY
CANDLEWOOD SWIM & FIELD CLUB, lIiC., 1\ SUBSIDIARY OF U.S. HOME CORPORATION OF
NEW JERSEY.
WYHNEWOOD SEWERAGE UTILITY COMPANY, A SUBSIDIARY OF U.S. HOME CORPORATION OF
NEW JERSEY.
SPRUCE lAND CO., A SUBSIDIARY OF U.S. HOME CORPORATION OF NEW JERSEV.
STONEMOUHT CO., A SUBSIDIARY OF U.S. HOME CORPORATION OF NEW JERSEY.
CENTRAL JERSEY WATER COMPANY, A SUBSIDIARY OF U.S. HOME CORPORATION OF NEW JERSEY.
U.S. HOME OF FLORIDA, INC.
U.S. HOME INTERIORS, INC., A SUBSIDIARY OF U.S. HOME OF FLORIDA, INC.
U.S. HOME REALTY CORPORATION, A SUBSIDIARY OF U.S. HOME OF FLORIDA, INC.
JORDAN-CALDWELL, INC., A SUBSIDIARY OF U.S. HOME OF FLORIDA, IHC.
SOUTHWEST MANAGEMENT CORPORATION, A SUBSIDIARY OF U.S. HOME OF FLORIDA, INC.
IMPERIAL HOMFS CORPORATION, A SUBSIDIARY OF U.S. HOME OF FLORIDA, INC.
NAPLES UTILITY CORPORATION, A SUBSIDIARY OF U.S. HOME OF FLORIDA, INC.
ENVIRONMENTAL EQUITIES CORP.
CONQUISTADOR CORPORATION
U.S. HOME MOBILIFE CORPORATION
U.S. HOME MORTGAGE CORPORATION
DEE WOOD INDUSTRIES, INC.
CLEARWATER CONCRETE INDUSTRIES, INC.
RECEIVED
MAY
1
1979
(CONTINUED ON PAGE 2)
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SYMBr-JL No,
596
"he Travelers Insurance Companies
>11820B REV.J1,i6 P.'.,,[, ,,' U,S...
Till.'" (.11111)!".....'.:I,;.111 ),-; 1"'-'1""11 i \, :;1;11 ii;I'!idH'r ~Ir Th.-, Tril\'pl('r_" rl1."'\lnHlr_"~' C.':cn1pr.lnics
\\'!lii.'h i."iSlli"d th/' j,(,jll',\' <ii' ",.,.1:1\ hiLI.,", t'rtrlnrsf.'lIl('jlt fOllli'-l {l p<lrt.