EVIDENCE OF PROPERTY INSURANCEAug 01 2011 10:11AM HP LASERJET FAX
EVIDENCE OF PROPERTY INSURANCE
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ -�
ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE OF PROPERTY INSURANCE DOES NOT AMEND, bcTEND OR
AFFORDED BY THE POLICIES BELOW.
AGENCY
Chris Coleman Agency
1255 Belcher Road
M IAq: (9!7) 441.96:
Dunedin FL 36698
f, .NoI (7_27) 442-REGS s9: okrisIaalemanagemayfi.av
CCDE: y5232320303 I au■rpom:
EMIR ID it 00000288
COIOANY
First Protective
7131 Business Park Lane
Suite 300
Lake Mary
!MIRED
LINDA 8A8IL3
1233 SDENVrLLE AVE
CLEARWATER FL 33764 -14949
FL 32746
P. 1
DATE (NMIbDIYYYY)
8/1/2011
NO RIGHTS UPON THE
ALTER THE COVERAGE
LOAN mass(
9999- 9180- RL -i676
POLICY NUMBER
>!IPM3000033820
SFrUC'nVR PATE
4/3012011
RKNRAI1ON PATE
4/30/2012
OONTINURP UNTL
ELTeRMINATED IF CHECKED
TNId REPLACED PRIOR SVU)RNCI DATPp■
12R212. ERTY INFORMATION
LOCATIIONIDNSCRIPTION
Loa* 0001
1233 ®ffi4VILLE AVE
CLEARWATEI)L, FL 33764 -4949
lone
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OR ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS
SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COVERAOEINFORMATION
covENAGE/PERILSIroAMS
AMOUNT OF INSURANCE
158,1E4
79,093
31,634
300,000
1,000
15.816
■ D�EDYCTIELE
1,000
3, Special Form
Dwelling
Personal property
Loss of use
Personal liability
Medical payments
CVB
Personal prop replacement past
SOAP
Inflation guard
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES d! CANCELLED BEFORE THE EXPIRM1ON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To
MAIL DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW, BUT FAILURE TO MAIL SUCH NOTICE SHALL NPOSE NO OBLIGATION
OR UABD.ITY OF ANY KIND UPON THE INSURER ITS AGENTS OR RE TATIVSS,
ADDITIONAL INTEREST
City of Clearwater
ISA4i7► / ATINA
NDRTOAREE ADDITIONAL INSURED
LOW PAM 1—X-1 AdditLima. interest
LOANII
112 South O•oeola Avenue
Cledrwater, FL 33756
9999- 2180 -RL -1676
AUTNORERoREPSESENTATWE
%%
C
ooltinan /TERESA
INS027 (2ooao7)a
a ACORD CORPORATION 1993.3005. All right* reserved.
The ACORD name and Lepa are registered marks a of ACORD