EVIDENCE OF PROPERTY INSURANCE 6689
AC"R" EVIDENCE OF PROPERTY INSURANCE DATE(MM/DD/YYYY)
2/9/2011
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST.
AGENCY PHONE 813.639.3000 COMPANY
A C No Ext
Commercial Lines-(813)639-3000 Wilshire Insurance Co.
Wells Fargo Insurance Services USA, Inc.
2502 N. Rocky Point Drive,Suite 400
Tampa,FL 33607
FAX E-MAIL clw.certre uest wellsfar o.com
A/C No): 813.639.7180 ADDRESS: q @ 9
CODE: SUB CODE:
AGENCY
CUSTOMER ID#:
INSURED LOAN NUMBER POLICY NUMBER
Alexandra of Clearwater Beach, Inc.dba Pier 60 Concessions CP00063031
P. O.Box 3337 EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL
Clearwater, FL 33767 2/15/2010 2/15/2011 TERMINATED IF CHECKED
THIS REPLACES PRIOR EVIDENCE DATED:
PROPERTY INFORMATION
LOCATION/DESCRIPTION
10 Pier 60 Drive
Clearwater Beach FL 33767
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 OF 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.
COVERAGE INFORMATION
COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE
Building-Gift Shop&Concession Stand-Replacement Cost 250,000 1,000
Business Personal Property-Actual Cash Value 50,000 1,000
Business Interruption-1/4 Monthly Limitation 150,000
Special Form excluding Wind/Hail
REMARKS(including Special Conditions
proof of coverage
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
ADDITIONAL INTEREST
NAME AND ADDRESS MORTGAGEE X ADDITIONAL INSURED
LOSS PAYEE
The City of Clearwater LOAN#
A Municipal Corporation
AUTHORIZED REPRESENTATIVE
25 Causway Blvd
Clearwater FL 33767
ACORD 27(2009/12) 137927 @ 1993-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD