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COACHMAN RIDGE HOMEOWNERS ASSOCIATION / INSURANCE CERTIFICATE f' ::ADD!TJONAL rNSURED co o V r f I! POLICY #: 77 BP 703-356-3001 F 1 AUG 0 2 2002 eIT\''' " 1"11".11,1,,,1,1,1.1,,1,,1,.11'111.1,.11,,1,,1.,11,.1,1.1,,1 CITY OF CLEARWATER PARKS AND RECREATION ATTN MILLIE MCFADDEN POBOX 4748 CLEARWATER FL 33758 Policy For: COACHMAN RIDGE HOMEOWNERS ASSN INC ATTN KENNETH A KELLOGG PO BOX 7626 CLEARWATER FL 33758 Cas. 4369 , 'I 1 \, ADDITIONAL INSURED COpy II! I POLICY NUMBER: 77 BP 703-356-3001 F BUSINESS PROVIDER THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADOfTrONAL INSURED - STATE OR PO'-'TfCAL SUBD~V!SlONS ~ PERMITS RELATING TO PREMtSES This endorsement modifies insurance provided under the following: BUSINESS PROVIDER POLICY SCHEDULE* State or Political Subdivision: CITY OF CLEARWATER PARKS AND RECREATION ATTN MILLIE MCFADDEN POBOX 4748 CLEARWATER FL 33758 The following is added to Paragraph C. WHO IS AN INSURED in the Business Provider Liability Coverage Form: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes. driveways, manholes, marquees, hoistaway openings. sidewalk vaults, street banners, or decoration and similar exposures; b. The construction, erection, or removal of elevators; or c. The ownership, maintenance, or use of any elevators covered by this insurance. 4. Any state or pOlitical subdivision shown in the Schedule is also an insured, subject to the follow- ing additional provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. BPP-0074 (7-94) Includes Copyrighted Material of Insurance Services Office, Inc., 1985 POLICY NUMBER: 77 BP 703-356-3001 F BUSINESS PROVID=:R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDfTrONAL INSURED - STATE OR POLrTJCAL SUBDrVrSrONS - PERMITS RELATING TO PREMrSES This endorsement modifies insurance provided under the following: BUSINESS PROVIDER POLICY SCHEDULE* State or Political Subdivision: CITY OF CLEARWATER PARKS AND RECREATION ATTN MILLIE MCFADDEN POBOX 4748 CLEARWATER FL 33758 The following is added to Paragraph C. WHO IS AN INSURED in the Business Provider Liability Coverage Form: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decoration and similar exposures; b. The construction, erection, or removal of elevators; or c. The ownership, maintenance, or use of any elevators covered by this insurance. 4. Any state or political subdivision shown in the Schedule is also an insured, subject to the follow- ing additional provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. BPP-0074 (7-94) Includes Copyrighted Material of Insurance Services Office, Inc., 1985 BUSINESS PROVIDER AMENDMENT OF POLLUT'ON EXCLUSrON - EXCEPTION FOR BUILDING HEATING EQUIPMENT This endorsement modifies insurance provided under the Business Provider Liability Coverage Form. Under Section B. EXCLUSIONS, Subparagraph (1) (a) of exclusion f. is replaced by the following: This insurance does not apply to: (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of pollutants: (a) At or from any premises, site or location which is or was at any time owned or occupied by or rented or loaned to, any insured. However, Subparagraph (a) does not apply to "bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot from equipment used to heat that building. BPP-0172 (1-00) Includes Copyrighted Material of Insurance SeNices Office, Inc., 1996 , r , f I~FLORrDA NOTlCE ISSUED BY: NAiiON'vViDE MUTUAL INSURANCE COMPANY r I Policy Number: 77 BP 703-356-3001 F Na~ed Insured COACHMAN RIDGE Mailing Address HOMEOWNERS ASSN INC ATTN KENNETH A KELLOGG PO BOX 7626 L9LEARWATER FL 33758 ~ POLICY PERIOD: From JULY 19, 2002 to JULY 19,2003 12:01 AM. Standard Time at your mailing address. at THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES FOR YOU. . FLNOTICE , r BUSINESS PROV'DER POLrCY DECLARATlo"rs i ~"'.,.,"".~ issued By: NATIONWIDE MUTUAL INSURANCE COMPANY Policy Number: RENEWAL ! 77 BP 703-356-3001 F : Named Insured COACHMAN RIDGE Form of Business: Mailing Address HOMEOWNERS ASSN INC o Partnership o Sole Proprietorship ATTN KENNETH A KELLOGG =:J Other: [XJ Corporation PO BOX 7626 CLEARWATER FL 33758 Policy Period: From JULY 19, 2002 to JULY 19,2003 at 12:01 A.M. * Standard Time at your mailing address. *Exceptions: 12:00 Noon in New Hampshire Described Premises: Premo No. Bldg. No. Location Address Description of Business 001 01 STAG RUN BLVD HOMEOWNERS ASSOCIATION CLEARWATER FL 33765 Mortgage Holder Name and Address: Premo No. Bldg. No. Mortgage Holder Mortgage Holder IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE TO PROVIDE YOU WITH THE INSURANCE AS STATED IN THIS POLICY. PROPERTY COVERAGES o Standard Form [KJ Special Form LIMITS OF INSURANCE Premises No. Building No. 001 01 Buildings - Replacement Cost $ 4,246 Actual Cash Value $ Automatic Increase 2 % Business Personal Property $ Deductible $ 250 I This Policy Includes Business Income and Extra Expense Coverage. BPP-0001 (7-94) Page 1 of 3 , II r r BUSfNESS PROVIDER POLICY DECLARAT'ONS i . ";"oj"",,,,&, OPTIONAL PROPERTY COVERAGES - Applicable only if an .X. liMITS OF iNSURANCE is shown in the boxes below: o Outdoor Signs $ Per Sign o Exterior Glass D Basement/ground floor level D All floors o Interior Glass D Basement/ground floor level D All floors o Burglary and Robbery (Standard Form only) $ Inside the Premises $ Outside the Premises or $ Inside the Premises o Money and Securities (Special Form only) $ Outside the Premises o Employee Dishonesty $ D System Protector o Earthquake % Deductible $ D $ D $ D $ 0 $ . 0 $ D $ LIABILITY AND MEDICAL EXPENSE COVERAGES LIMITS OF INSURANCE Liability and Medical Expense $ 500,000 Any One Occurrence Personal and Advertising Injury Included in Above - Any One Person or Organization Medical Expenses $ 5,000 Any One Person Fire Legal Liability $ 50,000 Any One Fire or Explosion General Aggregate Limit (other than Products-Completed Operations and Fire Legal Liability) $ 1 , 000 , 000 Products-Completed Operations Aggregate Limit $ 500,000 OPTIONAL LIABILITY - Applicable only if an LIMITS OF INSURANCE .X. is shown in the boxes below: D 1$ D !$ D $ Page 2 of 3 BPP-0001 (7-94) LJ BusrNESS PROVIDER POLrCy DECLARATro~~s FORMS APPLICABLE TO ALL PREMISES AND BUILDINGS: BPP 0166-0398 BPP 0007-0794 BPP 0083-0794 BPP 0006-0102 BPP 0019-1197 BPP 0121-0794 BPP 0167-0398 CAS 3228 CAS 3880-0897 CAS 4847-0501 BPP 0065-0794 BPP 0162-1196 BPP 0004-0794 CAS 2527 B-0794 BPP 0172-0100 BPP 0074-0794 BPP 0096-0794 PREMIUM Total Annual Premium Includes the following miscellaneous charges FLORIDA DOR SURCHARGE F.MAP. SURCHARGE .......................................................................................................................................................... $ 639.64 $ 0.64 $ 4.00 $ $ $ In the event you cancel the policy, we will retain not less than $ 350 premium. Date of Issue: 07 -09-02 P.O. BOX 147080 Issuing Office: GAINESVillE, Fl 32614 Countersignature Date: Agency At: Agent: BARRY J SCARR 0001084-09 BPP-0001 (7-94) Page 3 of 3 LJ FORMS APPLICABLE ONLY TO SPECIFIC PREMISES/COVERAGES: Premises Bldg. No. No. Form Number BUSINESS PROVIDER POUCY SUPPLEMENTAL DECLARATrONS r Policy Number: RENEWAL I 77 BP 703-356-3001 F 001 * Coverage 01 BPP 0117-0794 BPP-0003 (7-94) * If information required to complete the coverage section is not shown, refer to the form indicated at left.