CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY
INSURED NAME AND ADDRESS
P31t 2: TIllS DECLARATION PAGE, WITH POLICY PROVISIONS - PART 1 AND ENDORSEMENTS, IF ANY ISSUED TO FORM
A PART TIIEREOF, COMPLETE THE BELOW NUMBERED CITIZENS PROPERTY INSURANCE CORPORATION POLICY.
CITIZENS PROPERTY INSURANCE CORPORATION, WIND ONLY POLICY
6676 Corporate Center Parkway, Jacksonville, Horida 32216-0973
~'I.~~E.~,~
THIS IS A
CLEARWATER BEACH SEAFOOD AND RESTAURANT
PO BOX 99
INDIAN ROCKS BEACH, FL 33785
GENERAL BUSINESS
POLICY TERM 6/04/2007 TO 6/04/2008 AT 12,01 A.M. (EST) CITIZENS POLICY NO. 150904
INCEPTION DATE EXPIRATION DATE THIS IS YOUR POLICY DECLARA nON PAGE - This is not a Bill
PAGE 1
Item AMOUNT OF INSUl<ANCo; Percent of DEDUCTIBLES
Coinsurance
No. Building Contenta Applicable
$ $ % $ $
1 334,000 90 10,020
209,000 90 6,270
Territory
Premium
$
T-42
T-42
904
566
TWO STORY MASONRY RESTAURANT LOC:
37 CAUSEWAY BLVD CLEARWATER BEACH, PINELIJAS FL 33767-2003
RECEIVED
MAY 1.,;. 2007
OFFICIAL R
LEG/SLATlV/CORDS AND
SRVCS DEPr
RECEI\/J='l
MAY 11. 2007
RISK MANAGEMENT
$
1,470.00
2005 FHCF Emer Assmn
$ 15.00
Reins/Cat Fin':lncing
P - I
'TY"l'1'llT.
DO NOT PAY
'1'n'1'1l1 llMnlTIIT" n"
$
543 000
Subject to F01~ No(a) ,
Tax-Exempt Sur 26.00
221.00
1 732.00
($100 RETAINED)
CIT CP2
Mortgagee/Loaa Payee,
CIT-W06
CITY OF CLEARWATER
C/O RISK MANAGEMENT
P.O. BOX 4748
CLEARWATER, FL 34618
Agent,
Payor,
STAHL & ASSOCIATE INS INC 0483
110 CARILLON PARKWAY
ST. PETERSBURG, FL 33716
INSURED
~-~
G&-:~
~1J tL
(727) 391-9791
CIT-W03 (7/02) 04837 Team 2
Date, 5/02/2007
MORTGAGEE COPY -01
QSY R 40111
1924
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STAHL & ASSOCIATE INS INC 0483
110 CARILLON PARKWAY
ST, PETERSBURG, FL 33716
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AGENT
184639
0483
000627