EVIDENCE OF PROPERTY INSURANCE (3) " DATE(MNIIDWYY r)
A400R
EVIDENCE OF PROPERTY INSURANCE 1-417/2012
THIS EVIDENCE OF PROPERTY INSURANCE 15 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST,
A GENCY COMPANY
E173.6393000
Commercial Lfir[es-(613,1639-3000 Travelers Indemnity Co ol Amenca
Wells Fargo Insurance,Services USA, ID
2502 N.Rocky Point DrIve,Sufte 400 1 Tower Square;
Tampa,FL 33607
FAX 913 61P 71 So E-MAIL --M cerIrequest@wellsfargo coo Hatif• rd,CT 06183
!rtlo CODE:
AGENCY 25666
--CUSTOMPRID-A—,
N FURVD T
LOAN NUMBER POLICYNIUMSEIN
Alexandra of Clearoiakef Beach, Inc.clba fckJ (30 40397
P.0- Box 3337 ErPECTIVE DATE EXPIRATION DATE 0VT1hu1,,-D LINN
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09,106/2DI2___ 01DA �2'0 3 _CKED
Clcarwaltg,FL 337(!7
LACrS PRIOR EWDENCE DATED:
SID44082,33 9/712012
PROPERTY INFORMATION
LOCKNOWDESCRIPTION
10 Pler 60 Drive
Clearwater Beach FL 33767
................ .......
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICKI'ED.
NOTWITHIS,TANDING ANY PPQ1JIf,F-MFNT, IFIRM C-)R CONDITION OP ANY C'ONTRACT OR OTHER F)CIC1-4MFNT WITH RESPECT To VVI-41 CH 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 POLIC ES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-
COVERAGE INFORMATION
OVERAGE I PERILS I FOR MS AMOUNT OF INSURANCE DEDUCTIBLE
ff—qujP4�enFB—rea-k-d--o w-n----1-0—Pi—er -—- -— --- -------------- -------2-50,000 1'DD0
REMARKS AtqqgL� I I Cc>r�cistla raS .
CANCELLATION
'0 C' All 0 F THE ,AE(] E D�Se 11'SE11 CIE AN CELLED BEFORE THE E'PIRATICIN TE I 1017EOP N(31�,CE 'FILL
R D C E T
DELIVERED IYNAC�OROANC 'W THE POLICYOFIROVI�IONS
ADDITIONAL INTEREST
NAMf-,ANUAUURtby TL ACDffK-),%1AL WSU RED
0 L
-LOSS PAYPE
City of Clearwater
A Muriiapal Corporation
25 Causeway Blvd AUTOOREED REPRESeNTAtIVE
Clearo)ater,FL,33767
ACORD 27 rnnu,ard lo-c
,R q-,are rc�qiMored rrark,of ACORD Q,1993-2009 ACORD CORPORATION, All flghts reserved,
406234 evideiice re4,,la.ces evidencefl,'408233 isvuedram 9,702012
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EVIDENCE OF PROPERTY INSURANCE 8)3112012
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 AFFIRMAIIVELY 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 r
LIPLI�`O�-1,g8o� -'13,639,3000 COMPANY
|
Coninnercial Lines-(813)639-3000 Citizens Property Insurance Coqp
Wells Fargo lnsuranc.e Ser-vices USA-Inc,
2502 N-Rocky Point Drive,Suite 400
Twnpa FL 33607
CIA, HUN"ER
Sl�);40641Z 8`31,2012
PROPERTY INFORMATION
10 Pier 6',0 Drive
Creardva!er Beach F!, 33767
THE POLICIES OF INSURAiNCE LITFED BELOW HAVE BEEN ISSUED TO THE INSURED rbAA1FD ABOVE FOR THE POUCY PERIOD INDICATED
N0-PNITH,cffANf)1NC4 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR, OTH9H DOCUMENT WITH RESPECT TO WHICH THIS
EVIDENCE OF PROPERTY INSURANCE MAY RE jSSUED OR MAY PERTAIN,THE IN-SURANCE AFFORDED BY 'THE POLICIES D'ESCRIBED HEREIN IS
SUBJECT TO ALLTHE TERMS,EXCLUS IONS AND CONDITION S OF SU C�I POLICIES. LIMITS`�-IOWN MAY HAVE BEEN REDUCED BY PAI D CLAIMS,
COVERAGE INFORMATION
52,000 3%
3%Wind Deductible-Named Hurricane
3%Wind Deductible All Othef Wind
proof of coverage
CANCELLATION
--I E �ANOELLED I-IEF13RE 11�TE ��r4PATLIO
ADDITIONAL INTEREST
MEANDADDRUS
LOSSPAYFE
25 Causway Blvd
Clearw,ater FL�3'7 67
ACORD 27(2009M2) ACC`-WO nannYand nr,�y-, 'D-1993-2009 ACORD CORPORATION, AlI rights reservod.
Hai ,nrNrtuc yr^r}
CERTIFICATE LIABILITY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY €HE POLICIES
BELOW THIS CERTIFICATE OF ]INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUNFIORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE BOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poft.y(ies) must be endorsed. if SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain Relines, may rerluh'a an erkdorserrenL A statement or)this certificate€oes not conifer rights to the
certificate holder in lieu of such enclorsernei
PRODI.IC.F.4 CC3NTAI T n L��
NAME.' tee".It"r.vrJ.CE 7t IiLIT.=1lt
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Wells„a;go 1s,surancr? SHH vices £!,.,A FIt E-MAIL
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2,502 i. R,,,-;kv ,.. Sui e 4 SLi3
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COVERAGES CERTIFICATE.NUMBER- 4734081
0 1� REVISION NUMBER! _
CIE F 1's L CE s f I BEEN ISSUED HE IN 'RED NAMED ABOVE ]H P I F.iHlS t r+
INC,,ATFID r!OTV,111 .,FANDiN,ANY T .,JIRF!A rJ i 1,rA OR €., NC)Hk-,',t1 CIP ANY i e NTT T OR t rr]ER. F)fl
t'F HIF r ATL MAY BE 1 UF,D rR MAY PERTAIN,IN Pa t Fret :.c ! FORDED Err r'1 THE POU ITS [ E RIF D HEREIN IS .UB_E i TO ALL 1HE ERTASS,
EXCLUSIONS AND, _f NIDI,ION F H P l f:ii- LIP�I S SHOA IN K11 i i'�,'�,r BEEN r 1 H. t t�PAID L I?1t�.
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CERTIFICATE HOLDER CANCELLATION
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Pa,ks aniii' r ti on THE EXPIRATION DATE THEREOF NOTICE. '04LU ER DELIVERED IN
ACCORDANCE"PATH THE POLIC'r PROVISIONS,
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THIS CLRTIF6CATEIS ISSUED AS A I IATTFR OF Iht3"ORNIA"I'lC]IN f3C1I Y AND CONFFIRS NO RIGHTS IJP0N TI-IF CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEEA IIVLLY AMEND, EXTEND OR ALT ER THE COVERAGE AI FCURDED BY THE P0LJCI ES
@ELOVV. THIS CERTIFICATE OF INSURAN E DOER NOT CONSTI TOTE A CONTRACT EETV)EEN THE ISStUI1dG INSURMSp, AU'lHORI?Err
REPRESENTATIVE OR PRODUCER AND THE CERTIFICAT E HOLDER,
W I RTANT If th, ertific tsh.1d,r-€s are ADDITIONAL INSURED,the policvOest must be endorsed- H UBROG TIONIS WAIVED,subject to
the terms and condit ons Lot the policy,certain a'r nar re quire an tarn II..t'.inerit. A state°rtRent n this cerfificaw toes nr,t ccrrofer nghis to the
certificate holder in lieu of such endarsom e ro.Is!
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PAYC,L7.E..':h TNSURAINCE Ad,s214f. Y IN /PH 5 PHONE
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COVERAGES _ CERTIFICATE fUIJIB—ER - REVISION NUMBER.
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THIS, IS TO CERTIFY THAT — —I
THE r F tNSU (t(r- I FL) �l{ `,' EuEO I`,"=1sFC ii ,-I?' RhJ I> F i PI PA"D A90 tk_ Intl s her.,lr°rtj
NDICA'fED. (Jarwi HSFA'(tileING ANY REOU#1'3:L1tIEN- f,'Erw CH C't'IJL?I(IoJ Or Afid'"r' CONTRACT OR OTHER DOCUMENT W11 RESPECT 10 r4iiICH THIS
r'Eq'OFJC 1 !E MAY BE I SIDED OR MAY PERTAIN, THE INSURANCE A ONDE D BY T IALL POLICIES DESCRIBED RIBE.D AEki}...IN IS S,..L8 3EC( TO ),,,LL 12-IE TEFO I:E.., !
Est I-USSt)NS AND f..,jC'vrw tONS()h. , i H POLICIES LIMITS Si ei,tit N MAY t,1 AVE BEEN REDUCED BY PAID rriAlMS,
vs�' wuEa s✓ fir r trr I' t$tivx
iR TYPE 01'WSURANG'� w ElpSfi��S'6ttS F't7Lf�k� tad!i&�i3" ��r1v3 6L rl1'v'7 i rr3�P,'rP?L?L3..',�rr;�� LWITS
GLIVE#.IL L ABAItY °°.........._.._. _
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C w"RnFICAT E HOLDER CANCELLATION
SHOULD ANY QF 1 HE ABtOVE DESCRIBED POLICIES BE CANCELLED
I
BEFORE THE EXPIRAFION DATE THERE()), NOTICE WILL E.E
Vie C U t r earW.H.€e-c DELIVERED R U EI`4 ACCORDANCE ORDA CE Bdv'l fH 'f HE POLICY PR u'1SI NS.
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i
I DATE VftdWDD,Yr(Y{rt
EVIDENCE OF PROPERTY INSURANCE 8!1512012
12
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS IIPOF THE
ADDITIONAL INTEREST NAMED BELOW.W. TEAS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSIHTUTF A CONTRACT S TWEEN THE
ISSUING INSURE (S),AUTHORIZED REPRESENTATIVE OR PRODUCER,ARID THE ADDITIONAL INTEREST,
MG NCY E Nf4PdE COMPANY ---- ---..----
CornmerGiai Lines-(E i 3)039-3000 dilshire Insurance C-o.
Wells Fargo hi,suratt ea Services USA, Inc, $
2502 N.Rocky Pont Drive.Suite 400
Tampa,FI`33607
�AX S 13'R> 11 50 E-MAIL cj%v oe rlrequ sI,cf)'veII a rg c,cor,1
SUB C;ODC:
AGENCY --.._..__. _.... -.......
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ENSURED �XIAN z'tlw9TIF,ER......... PCX CY FIt,MSER
_ _ •J � ,"Ar xand-a C Reach, n H {Pier s_ 66
F.0.Box i 3-S7 i_E=Ef.tI E CtrcTE -XR RAIIIOIJ DATE
L.NI
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205/2012 2115/2013 hF' l G6 Al1ti
1 F Ce-T—:N4h�',
C:Hv.r3 aya La,,,(": 537Ct
THS REPLACES PRIOR EUDENCE DATED:
D#29217" 2M,,512012
PROPE RTY INFURMA[ION
LAC ATIONIDESCRIPT*
0 Pier"r?i_1Ddve
:Clear,dator Fs(,vxh IT 33761
_ - -- -- _ ®.
THE P(iLIC[ .S OF 9�StjRAr4CE LISTED BELOW HAVE BEEN IS ;NED T-O THE fib..@&$-ED NAMED 1473'(.4.:: FOR THE POLICY PERIOD INDIC ED-
o-i- rill-ISTr`ENC33ING ANY RECUJRFMFNT, TPRKA f)R, Ct'bI I-flFIC)rd OF ANY i:r'PN"I"RA T C"R OTHER DOCA-)ME f t WE'TH PI-LSPECT O WHICH THIS
EVIDENCE OF PROPERTY T'Y IF`URfiN E MAY BE t4 .IU,Ers OR MAY PERTA1N,THE INSURANCE AFFORDED BY THE I"OUCIES DESCRIBED HEREIN IS
SUBJEt T'l-0 ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SU0 I POLICIES, r IMIT=SHOWN MAY HAVE BEEN REDUCED BY 11YA D CLAIMS,
COVERAGE INFORMATION
_ .... COVERAGE t PERILS t'FORMS .A°MOki NT OF INSURANCE DEDUCTIBLE
F3E a°11111 p 3tYC Slroa t �h as lon Starrl ITS werl eRat"(�ot. - - _.-� 250 000% 1,01:70
Bush rr,< ;=Personal Properly-Actutal Cast,VRILAI 50,000' 1,00
Business Interruption `11+4 Monthly Limitation 150,000
Special Forrn oxtiludir qWiradAlail
'1
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C
PEMARK InclqsTl('€ I a DgLic!LjgSo n s
proof of ;auFrage
4
CANCELLATION
S�#abuLLi ANY Eat THE�A3rr IF �E�T�I�EH I-'KTLI�IEE EE -All ;ELLEFz SEE JOE THL C� tPP I}C� FBI @'FE F 3Fw 4^ILb610 fS A,,
L n ELIVEPEL+ICI A,CC ITANCE ITT THE P L@CY PITOAtSI ITS
ACICTI"I°1ONAL INTEREST
m w_
N:fLMll AND AD DRE55 F_� (it,Fl Ertl,Eta X
.�. .. ... _,A_
The, �ItT of C rt:ursEaaer
E
?"^.[btu i ';¢aal Corpora` ta^i
A rHOWEa REPRESENTAFIVE
25{ - way Blvd P�1
T a.
i',icc+r`+vater F L 33767
ACOIRIC 2T(2009/ 2 rr. C.v:t7k rir r I uv: ..tr SfE,r I Cg, +JR€a Cr' `1993-211919 AC€RD CORPORATION, All Hgbts reserved.
400785 This evidence replaces r_.w i,C3r ni:,efY.292497 i.,Fu d on 2,1`,2,12