BUSINESS OWNERS INSURANCE POLICY
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III
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ADDITIONAL
INSURED
COpy
POLICY #: 77 BO 826-682-3001
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OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
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C I TV OF CLEARWATER
100 N OSCEOLA AVE
CLEARWATER FL 33755
Policy For:
BOOKWORM CAFE
100 N OSCEOLA AVE
CLEARWATER FL 33755
Cas. 4369
III
ADDITIONAL
INSURED
COpy
t po.L1CY 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
100 N OSCEOLA AVE
CLEARWATER FL 33755
The following is added to Paragraph C. WHO IS AN
INSURED in the Businessowners Liability Coverage
Form:
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.
4. The person or organization shown in the Schedule
or in the Declarations, but only for their liability
arising out of:
* Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations.
BP 04 06 01 87
Copyright, I nsurance Services Office, Inc., 1985