SUMMARY OF INSURANCEFor Island Estates Civic
Assoc., Inc.
140 Island Way Box 239
Clearwater, FL
33767 727-461-7305
% Coves e
FMACt.
Prepared: 101
9 P?rnaurn c:ompany.:
General Liability Cincinnati Insurance Co.
Occurrence
General Aggregate 2,000 000
Products/Completed Oper. Aggr. 2,000,000
Personal & Advertising Injury 1,000 000
Each Occurrence 1,000,000
Damage to Rented Premises 100,000
!Vedical Expense (Any One Person) 5,000
Location 001 Building 001
Club - Civic-Service-Social
Class Code_ 41670
Premium Basis: 500
NU) Unit - Per Unit
Z zr 301 Building 001
Additional Insured - Premises Le
Class Code_ 29938
Premium Basis: Flat
(T) Other
Policy Level Add'I Insured:
Add'I Insured: Saint Brendan Catholic C urch 245 Dory ?assage Clearwater FL 33767
Page 1 -
C..... 2 6
OFFICIAL R r.JUr- L,z? , .`.'D
LF(aISLATIvE SR`,/,o 1,6 T
PoG No Eff Exp Premium
CAP5186556 01/14/09 01114/12
MIMARY OF INSURANCE Page 2
Prepared= ion412Oog
or Island Estates Civic
Assoc., Inc.
140 Island Way Box 239
Clearwater, FL.
33767 727-461-7305
g
Covera e.. Arnount
Cdtl Pant -
Policy No
Premium
Commercial Application Cincinnati Insurance Co. CAP5186556 01/14/09 01/14/12
Other Named Insured
Inc.
Premises
Premise 001 Building 001
660 Island Way
Clearwater, FL
r
1
a R T I F I C A T E HOLDER L I S T
Customer:ISLAN--7 Range:All Dates:All
Island Estates Civic Assoc.,
Date 10/14/09
Page I
Code Name Street city ST Zip code Iss Date Queued Days
CITYC_l C't of Clearwater P.O Box 4748 Clearwater FL 33758 01/25/06 No 30
Y
Dept of Parks 6 Rec
Description of Operations
City of Clearwater is listed as additional insured with respects to General
Liability.
SAINBRl Saint Brendan Catholic 245 Dory Passage Clearwater
Church
Description of Operations
Saint Brendan Catholic Church is listed as additional insured.
EL 33767 None No 30