EVIDENCE OF PROPERTY INSURANCE (3) 72/1/2018
E(MM/DDYYY)
A�" EVIDENCE OF PROPERTY INSURANCE /Y
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 COMPANY
vc No Ext):727-461-6044 National Casualty Company
Brown&Brown Insurance-Clearwater
83 Park Place Blvd.,Suite 101
Clearwater, FL 33759-3925
A/c No):727-442-7695 A"Ess:Iwaldorf@bbpinellas.com
CODE: SUB CODE:
AGENCY
CUSTOMER ID#:
INSURED LOAN NUMBER POLICY NUMBER
Chi Chi Rodriguez Youth Foundation, Inc. KK00000007253300
3030 McMullen Booth Rd.
Clearwater, FL 33761 EFFECTIVE DATE EXPIRATION DATE
CONTINUED UNTIL
02/01/2018 02/01/2019 El TERM INATEDIFCHECKED
THIS REPLACES PRIOR EVIDENCE DATED:
PROPERTY INFORMATION
LOCATION/DESCRIPTION
3030 McMullenbooth 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 PERILS INSURED I I BASIC BROAD SPECIAL
COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE
Scheduled Equipment 831,510 1,000
REMARKS(including Special Conditions
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 ADDITIONAL INSURED H LENDER'S LOSS PAYABLE LOSS PAYEE
MORTGAGEE
LOAN#
City of Clearwater
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33756-5520
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