BUSINESSOWNERS POLICYC ADDITIONAL INSURED COPY
POLICY #: 77 BO 770-184-3001
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33758
- - .-__. Policy For:
CLEARWATER FOR YOUTH INC
DBA CLEARWATER FOR YOUTH
1501 N BELCHER RD STE 236
CLEARWATER FL 33765
RECEWD
CiT' OF CLEARWATER
y ?01)
RISK MANAGEMENT
9173
Cas. 4369
ADDITIONAL INSURED COPY
III
Q
POLICY NUMBER:
BUSINESSOWNERS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -CONTROLLING INTEREST
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Name of Person or Organization: CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33758
The following is added to Paragraph C. WHO IS AN
INSURED in the Businessowners Liability Coverage
Form:
4. The person or organization shown in the Schedule
or in the Declarations, but only for their liability
arising out of:
a. Their financial control of you; or
b. Premises they own, maintain or control while
you lease or occupy those premises.
This insurance does not apply to structural altera-
tions, new construction and demolition operations
performed by or for that person or organization.
c yOF CL AaD TER
JAN ._d 9 ?O?r)
R'SKMANAGEMENP
9173
* Information required to complete this Schedule, If not shown on this endorsement, will be shown In the Declarations.
BP 04 06 01 87 Copyright, Insurance Services Office, Inc., 1985