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EVIDENCE OF PROPERTY INSURANCE (2) OP ID: LW DATE(MMIDDIYYYY) EVIDENCE OF PROPERTY INSURANCE 0210512015 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 OF PROPERTY INSURANCE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AGENCY PHONE 727 461-6044 COMPANY AfC No Ext: _ Brawn& Brown of Florida, Inc. National Casualty Company 83 Park Place Blvd.,Ste 101 One West Nationwide Blvd P.O. Box 2456(33757-2456) Columbus,OH 43215-2220 Clearwater, FL 33759 Sean Tobe FAX :727-442-7695 ! I=-MAIL --__ CODE: SUB CODE: AGENCY CHICH-2 C STONER€D#: _...._._.. INSURED LOAN NUMBER 'KKO00000051 LICY NUMBER 15 000 Chi Chi Rodriguez Youth EFFECTIVE DATE EXPIRATION GATE CONTINUED UNTIL Foundation,Inc. _ 02101/15 02101/16 TERMINATED IF CHECKED 3030 McMullen Booth Rd THIS REPLACES PRIOR EVIDENCE DATED: Clearwater, FL 33761 PROPERTY INFORMATION LO CATIO NID ESCR€PTIO N 3030 McMullen Booth Rd Clearwater, FL 33761 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 I COVERAGE 1 PERILS I FORMS AMOUNT OF INSURANCE _ DEDUCTIBLE Special form RC 80%coinsurance See schedule for locations 6%**Wind&Hall Deductible **All Other Perils Deductible 500 I 1 REMARKS(including Special Conditions CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ADDITIONAL INTEREST NAMEANDADORESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# City of Clearwater P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33756-5520 - ACORD 27(2006107) ©ACORD CORPORATION 1993-2006. All rights reserved. The ACORD name and logo are registered marks of ACORD um F olie PA' BY- y For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, FL 3376'1 Commercial Application National Casualty Company KKOOOO0005115000 02/01/15 02/01/16 First Named insured and Other Named Insureds Chi Chi Rodriguez Youth Foundation,Inc.and The First Tee of Clearwater Premises Premise 1 Building 1 School 3030 McMullen Booth Rd Clearwater, FL 33761 Premise t Building 2 Pro Shop 3030 McMullen Booth Rd Clearwater,FL 33761 Premise 1 Building 3 Maintenance Shed 3030 McMullen Booth Rd Clearwater,FL 33769 Premise 1 Building 4 School 3030 McMullen Booth Rd Clearwater,FL 33761 Premise 1 Building 5 Pavillion 3030 McMullen Booth Rd Clearwater,FL 33761 Premise 1 Building 6 y / �• Tti ) i R For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, FL 33761 Commercial Application(Continued) Pump Station 3030 McMullen Booth Rd Clearwater, FL 33761 Premise 1 Building 7 Workshop 3030 McMullen Booth Rd Clearwater, FL 33761 Premise 1 Building 8 Horticultural Shed 3030 McMullen Booth Rd Clearwater, FL 33761 Premise 1 Building 9 Comfort Station 3030 McMullen Booth Rd Clearwater,FL 33761 Prem€se 2 Building 1 Driving Range Building 2987 McMullen Booth Rd Clearwater,FL 33761 s r fi \ R J 1� J � f h NS F h pae � T For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, FL 33761 Property National Casualty Company KKO0000005115000 02/01/15 02!01116 Poky Level Information Premise 001 Building 001 BUILDING- 315,873 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H CONTENTS- 52,000 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 i Forms# 5%W/H BUSINESS INC- 25,000 Cause of Loss SPECIAL Loss Payee: Club Car,Inc. 3375 All Am rican Blvd. Orlai do FL 32810 Premise 001 Building 002 BUILDING- 259,567 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H CONTENTS- 70,000 Coins% 80 Valuation RC Cause of Loss SPECIAL. Deduct€ble 5000 Forms# 5%W/H Loss Payee: Wells Fargo Equipment Fir ance, ATTN:Inc,its successors&assigns 733 MarqL ette Ave.,Ste,700 Knneapc its MN 55 i 2 � z a J S I",Rft"W For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, Fl- 33761 >l .. ..;; ON Property(Continued) Premise 001 Building 003 BUILDING- 125,954 i Coins% 80 Valuation RC Cause of Loss SPECIAL. Deductible 5000 Forms# 5%W/H CONTENTS- 5,200 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H Loss Payee: National City Commercial TTN:Capital Cop 995 Dalton Avenue Cincinnati OH 45203 Premise 001 Building 004 BUILDING- 839,003 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H CONTENTS- 52,000 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H Premise 001 Building 005 BUILDING- 52,000 Coins% 80 i 7 ; w f � S S.111"Uz For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, FL 33761 Property(Continued) Valuation RC Cause of Loss SPECIAL Deductible 5004 Forms# 5%W!H Premise 001 Building 006 BUILDING- 70,000 Coins% 80 Valuation RC Cause of Loss SPECIAL c Deductible 5000 Forms# 5%WIH E CONTENTS- 13,500 Coins% 80 VaNa€ion RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%WIH i Premise 001 Building 007 BUILDING- 7,500 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Farms# 5%WJH Premise 001 Building 008 BUILDING- 10,400 Coins% 80 Valuation RC Cause of Loss SPECIAL i z For Chi Chi Rodriguez Youth Foundation, Inc. 3030 McMullen Booth Rd Clearwater, FIR 3376'1 Property(Continued) Deductible 5000 Forms# 5%W!H CONTENTS- 2,100 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H Premise 001 Building 009 BUILDING- 10.400 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H Premise 002 Building 001 BUILDING- 365,699 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%WIH CONTENTS- 70,000 Coins% 80 Valuation RC Cause of Loss SPECIAL Deductible 5000 Forms# 5%W/H s Policy Level Additional Interests F \ \ 1