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027-Mayfair Golf Course-Insurancea1:11��i�s CERTIFICJP^E OF INSURANCE '" CSR:BM °10/19,95"" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE J Rolfe Davis Insurance Agcy 2 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 3818 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longwood FL 32779 -0818 COMPANIES AFFORDING COVERAGE Bruce C. Arrow #023324299 COMPANY A St. PauL Fire & Marine Ins Cc INSURED COMPANY B Mayfair Country Club COMPANY Seminole Club, Inc. d /b /a C P.O. Box 950789 Lake Mary FL 32795 COMPANY D CO THIS IS TO CERTIFY THAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE DATE(MM /DDIM PODCYEXPIRATION DATE(MM /DD/YY) LIMITS GENERAL LIABILITY GENERALAGGREGATE $2000000 X PRODUCTS- COMP/OP AGO $ 1000000 A COMMERCIAL GENERAL UABIUTY CK00903382 12/26/94 12/26/95 CLAIMS MADE OCCUR PERSONAL &ADV INJURY $1000000 EACH OCCURRENCE $1000000 OWNERS & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 100000 MED EXP (Any one person) $ 5000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY T $ OTHER TH: '" .........'. ANY AUTO $ TE $ EXCESS LIABILITY EACH CCC $ 1000000 A X UMBRELLA FORM CK00903382 12/26/94 12/26/95 AGGREGATE $ $ OTHER THAN UMBRELLA FORM -- WORKERS COMPENSATION AND - -- -- STATUTORY LIMITS EMPLOYERS' LIABILITY EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE -POLICY OMIT $ DISEASE - EACH EMPLOYEE $ OFFICERS ARE: EXCL OTHER A Liquor Liabi Lity CK00903382 12/26/94 12/26/95 Ea. Pars. 1000000 Total LT 1000000 DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS Certificate Holder is named Additional Insured as respects General Liability and Liquor Liability Coverage. RE: Holder is Landowner of insured Location. CERTIFICATE HOLDER CANCELLATION SANFCIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Sanford Attn: Sandy Moore 30 DAYS wF N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE AIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. BOX 1758 OF ANY KIN PON THE ,ITS N PRESENTATIVES. AUTHORIZED P SENTATI Sanford FL 32772 Bruce C. ACORq 3SS (8/83) 0 ORb CORPORATION 1495 E A4:411:11. CERTIFICR' OF INSURANCE CSR BM DATE(MMiDDiYY) . MAYFCOV 10/16/95 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE J Rolfe Davis Insurance Agcy 2 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 3818 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Longwood FL 32779 -0818 COMPANIES AFFORDING COVERAGE Bruce C. Arrow #023324299 COMPANY A St. Paul Fire & Marine Ins Co INSURED COMPANY B COMPANY C Mayfair Country Club Seminole Club, Inc. d /b /a COMPANY D P.O. BOX 950789 Lake Mary FL 32795 COVERAGES THIS IS TO CERTIFY THAT 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUC POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMMDNY) POLICY EXPIRATION DATE (MM /DD /YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE 5200000 X PRODUCTS - COMP /OP AGG $ 1000000 A COMMERCIAL GENERAL LIABILITY CK00903382 12/26/94 12/26/95 PERSONAL & ADV INJURY S 1000000 CLAIMS MADE [j] OCCUR OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $1000000 FIRE DAMAGE (Any one tire) $ 100000 MED EXP(Any one Person) $ 5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ _ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY ANY AUTO EACH ACCIDENT 3 s AGGREGATE 6 EXCESS LIABILITY EACH OCCURRENCE 51000000 X AGGREGATE $ A UMBRELLA FORM C &00903382 12/26/94 12/26/95 $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY -- ' -'-- -. -' -- ST ATUTOR Y LIMIT EACH ACCIDENT - �3 DISEASE - POLICY LIMIT 3 THE PROPRIETOR/ INCL PARTNERS /EXECUTIVE - OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE B OTHER W NG- 0 DEPT. D I N fF pPERATIONSILOCATIONSNEHICLES /SPECIAL ITEMS Certificate Holder is named Additional Insured as respects General Liability re: Holder is Landowner of insured location. CERTIFICATE HOLDER CANCELLATION SANFCIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Sanford Attn: Sandy Moore P.O. BOX 1788 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Bruce C. Arrow #023324299 -^ "� Sanford FL 32772 ACORD 25-S (3193) OACORD CORPORATION 1993 C L- (�DQ 7 A0401e1). INSURANC "SINDER �' HUAA -A 'IV ; THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAODUCEI COMPANY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : BINDER NO. TOWN & COUNTRY INSURANCE AGENCY ST. PAUL FIRE & MARINE 1886 ..................... . ........... .................................................,........ 735 DUNLAWTON AVENUE EFarnE :.............................. E�awnnoN ................ DATA ............... ` TAME ............... .e............... DATE ................ :........ TIME...... P 0 BOX 290065 i Xi AM € X I2:01AM PORT ORANGE, FL 32129 > RECEIVED >._12./_26.I93....... 2..:_ Ol..... ......._P""........1...::I26/94 ._...., NOON ...... ...................... i THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAME) CODE 8VBCODE /J ! i COMPANY PER EXPIRING POLICY N0: l(�]I ............... ............................... .............................. .. .. ' • ' ('L[ DE OF O (lnclutliro Lxetion) INSURED MAYFAIR COUNTRY CLUB P. 0. BOX 950789 CIiY OF $ YII- PRIVATE GOLF COURSE LAKE MARY, FL 32795 I lW I: k TYPE OF INSIRIANCE COVERAIM'OR&Ie : AMOUNT i DEDUC7161E COINHUI. ........ . . . . . . . . . . . . . . . . . . . . . ................. . ...... . . . . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................ PROPERTY cnvsesoFLOSS BLDG1— CLUBHOUSE .............................. ........... ... . ....... .... . ... . . ... $200, 0 .... 0 .... 0 500 .... ...... ..... : 100$ ... BASIC ..... BROADX €SPEC.; CONTENTS #1 $ 30,000' 500: 100% BLDG 2— MEN'S & LADIES LOCKER ROOMS $ 30,000: 500 100% CONTENTS #2 $ 3,000: 500 100% OENFRK WNBIUTY GENERAL AGGREGATE f 2, OOO, OO .. ...... Xi COMMERCIAL GENERAL LIABILITY i .... ..... ........ .....:.... v . ............................... iPRODUCT&COMP /OP AGG. 000,00 . a 4 ......... .......... CLAMS MADE .. ;OCCUR; ........... .. .f 1 ....... (PERSONAL &ADV. INJURY ,000,00 .. ._...... 'OWNERS& CONTRACTOR'S PROT.i EACH OCCURRENCE OOO, OO ....... > e$1 F RREDAMAGEWryorofire) if 50,00 .......{ ........................ ..............................: RETRO DATE FOR CLAIMS MADE: .......... ..............................: .. ........ MED. EXPENSE (AM*m psnonl': f $ 8,00 AUTOMOBILE LIABILITY ......... COMBINED SINGLE LIMIT :............. i ANY AUTO ......_: ................ ............................... .......................... : BODILY INJURY IPer P .) : 10 :.............................................. b........ ALL OWNED AUTOS .......< ............................... i BODILY INJURY (Pet aeeidem) f :........................................ :........... SCHEDULED AUTOS ........: . ....... ... ................... ...... PROPERTY DAMAGE 4 :....... HIRED AUTOS ........: ................................................. . ............................... MEDICAL PAYMENTS : f i NON-OWNED AUTOS ........; . ................. ............ ... .............. ..i.... ...... ........ ..................... : PERSONAL INJURY PROT. i f :................................................°.... GARAGE LIABILITY ....... ............................... UNINSURED MOTORIST f ............................................... ........... ............................ :f AUTO PHYSICAL DAMAGE DEDUCTIBLE i ALL VEHICLES i SCHEDULED VEHICLES ......... :........: E......... [ ACTUAL CASH VALUE i COLLISION: ........; ..........................:: ......_:.._ .................................. ;STATED AMOUNT : i i OTHER THAN COL: ...._._......_....._..: ............................................... i OTHER B1UTY EACH OCCUflflENCE i f 1 OO OO %CE" .... ............... ............................... ... AGGREGATE 1,000,00 RTAAFfUMBRELLA FORM i RETRO DATE FOR CLAIMS MADE: i SELMNSURED RETENTION f .._ UMITS ^` ' ............................ WORK@PS COMPENSATION EACH ACCIDENT f AND:................................................:........ ............................... EAPLO1ER'8 LIABILITY DISEASE - POLICY LIMIT ...... .... ................................!......... ................... ..... .... ... DISEASE -EACH EMPLOYEE : 8 SPECIAL CONDITIONMTHIER COVERAGES LIQUOR LIABILITY — $1,000,000 EQUIPMENT - $90,000 GOLF CARTS & $130,000 GOLF MAINTENANCE EQUIPMENT GROUNDS COVERAGE — $50,000 PREFERRED PROTECTION ENDORSEMENT WITH SYSTEMS BREAKDOWN COVERAGE NAME &, ADDRESS .. .' .:.. .. .. MOHL GAGEL .. AL':L I IONM.:NSURED b . ,,., .: 'M LOSS PAYEE .......: x ...• ..................................... ............................... ZED REPRESENTATIVE Lac > ye%e. '°d 1 004 11 <9ee..'v dJRS'�o � . p ° `c�: "W.: '. .'ob. g ry tl 'eo^,i 8' R ., n.. e 'F�' H 9t °' ?'.. `i::. c ,'¢.^d •'M' p.:'°' d . .p: °:. >` .. L.. .. :. :l ii ve.. l Aer mp. INSURANCE P -- :ID'ER ISSUI:IAIL YY':. •• ' lS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE IDUCLA LARRY BREEN & ASSOC., INC. 2003 LAKE HOWELL LANE P.O. BOX 940969 MAITLAND, FL 32794 -0969 CODE SUB -CODE Mayfair Country Club Seminole Clubs, Inc. P.O. Drawer 950789 Lake Mary, Fl. 32795 -0789 TYPE Of INSURANCE ROPERTY CAUSES Of LOSS BASIC BROAD X SPEC.: ......... .......... ... ....._ ._. COMPANY BINDER NO. THE TRAVELERS INSURANCE 00171 ........._ ......__,......EFFECTIVE ......... ................. ........... . EXPIRATION ._.. ..._....._... PATE..__.... ..,.._..TIME _.......PATE TIME._.... 01/26/93 12:01 X p 02/26M X 12 :01 AM PM NOON RECEIVED' : X 1 COMPANY PER POLICYNN0 C 660 ABO VE NAMED 55K5252 DESCRIPTION OF OPERATIONSNEHICLESA'ROPERTY (including Location) JAN 27 3536 N. COUNTRY CLUB RD. SANFORD, FL �I OF SA NFORQ COVERAGE /FORMS BUILDINGS CONTENTS AMOUNT DEDUCTIBLE COINSUR. 335,000 1,000 100% 57,000 250. 100% GENERAL LIABILITY ! GENERAL AGGREGATE : :..................................................... $ 2,000 00 ......... X I COMMERCIAL GENERAL LIABILITY ',, PRODUCTS - COMPYOP AGG. ..... ...... $ .... ..................... 1,000,000 .... CLAIMS MADE X OCCUR. I PERSONAL & ADV. INJURY $ 1 0 0 000 OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 1 , 000 , 000 FIRE DAMAGE (Any one lire) $ 50.000 RETRO DATE FOR CLAIMS MADE: MED. EXPENSE (Any one person) ' $ 5,000 AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT :.........,_..._.....,....._...._.___.....;... $ ......... ANY AUTO BODILY INJURY (Per person) ........ S ............................. ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS ! PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS :...................................................... $ ........! NON-OWNED AUTOS PERSONAL INJURY PROT. . .... S .... ..................... .,.. GARAGE LIABILITY UNINSURED MOTORIST $ ......... ! ..,.....,,.._ .. ............. $....... _........ __...... _. COLLISION: OTHER THAN COL UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY RETRO DATE FOR CLAIMS MADE: ... ,..... ............... ... _ ... ..... 1.,... STATED AMOUNT $ OTHER AGGREGATE S 1,000,000 SELF- INSURED RETENTION $ 100 EACH ACCIDENT S DISEASE-POLICY LIMIT $ DISEASE EACH EMPLOYEE S ADDITIONAL INSURED fv4 r e C' I � I� / ! 0 w RECEIVED JAN 0 8 3 j;W Of SANFOR6 January 6, 1993 Mr. Wm. Simmons, City Manager City of Sanford Sanford, Fl. 32771 Re: Club Insurance Dear bill; Enclosed please find a copy of our insurance binder for 1993 with Travelers. I have instructed our agent to send you a copy of the policy when it becomes available naming the City of Sanford as the co- insured on the one million dollar umbrella which, of course, is stipulated in our lease with the city. A happy and healthy New Year to you and your family. Warmest regards, SEMINOLE CLUB INC. --- L A John K. Danie President JKD /ap Encl. Cc: P.O. DRAWER 950789 • LAKE MARY, FLORIDA 32795 -0789 • 407- 322 -2531 INSURANCtPAIDER 12 20 ­2 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM PRODUCEfl '. COMPANY BINDER NO. LARRY BREEN & ASSOC., INC. THE TRAVELERS INSURANCE 00171 2003 LAKE HOWELL LANE ............ .......... ......... ...... .... . .... . .. EFFECTIVE EXPIRATION PATX TIME TIME P.O. BOX 940969 'PAN X 12:01 AM MAITLAND, FL 32794-0969 12/26/92 01/26/93 12:01 PM NOON IS ISSUD TO EXTEND E IN THE x COVERAG ABOVE NAMED CODE SUB-CODE . COM PA BINDER NY PER EXPIRING POLICY NO: 660155KS252 D__ ESRIPTION OF oPEFAnomvvCLES/PRopE6 (Including Location) .............. .............. ...... ... ...... .......... .. .... IXSUREO 3536 N. COUNTRY CLUB RD. SANFORD, FL Mayfair Country Club Seminole Clubs, Inc. P.O. Drawer 950789 Lake Mary, A. 32795-0789 TYPE OF INSURANCE p COVERAGE/FORMS AMOUNT DEDUCTIBLE COIhSUR. PROPERTY CAUSES OF LOSS .......... BASIC BROAD: X SPEC. BUILDINGS . ..... 335,000 1,000 100% ..... ............................... ...... CONTENTS 57,000 250. 100% GENERAL LIABILITY GENERAL AGGREGATE $ 2000 QQQ X : COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/UP AGG. $ CLAIMSMADE OCCUR.; PERSONAL & ADV. INJURY ....... ............. 1 i OWNER'S & CONTRACTOR'S PROT, .. .. ....... ......... .. ... .... EACH OCCURRENCE ... .... .......................................... FIRE DAMAGE (Any ornefire) 50,000 RETRO DATE FOR CLAIMS MADE: MED. EXPENSE (Any one person) 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s ANY AUTO ....... .... .... .... ......... ..... ..... ....... BODILY INJURY (Per person) .. ...... ........ ..... ALL OWNED AUTOS BODILY INJURY (Per acCident) $ SCHEDULED AUTOS ....... PROPERTY DAMAGE ....... HIRED AUTOS MEDICAL PAYMENTS S NON-OWNEDAUTOS PERSONAL INJURY PROT. GARAGE LIABILITY UNINSURED MOTORIST s AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES ACTUAL GASH VALUE ..... COLLISION: . ....... STATED AMOUNT OTHER THAN COL: OTHER EXCESS LIABILITY EACH OCCU RR EN C E 1,900,000 UMBRELLA FORM I . . . AGGREGATE 1,000 00 OTHER THAN UMBRELLA FORM RE7AO DATE FOR CLAIMS MADE: S E L F IN S UR E 0 R E TE N T 1 0 N $ 100,000 STATUTORY LIMITS WORKER'S COMPENSATION .. ......... EACH ACCIDENT AND IiMPLOYERS' LIABILITY DiSEASE-POLICY LIMIT $ . .... .......... .. . ....... I . ....... . .. DiSEASE-EACH EMPLOYEE s .... .. SPECIAL PONOITIONSIOTHER COVERAGE$ EMPLOYEE DISHONESTY - $10,000 - $500 DED. THEFT - $3,000 - $250 QED. EQUIPMENT AND TEE TO GREEN ENDORSEMENT PER EXISTING POLICY NAME:. ARJLESS: IM ... . 1A MORTGAGEE ADDITIONAL INSURED X LOSS PAYEE SOUTHTRUST BANK OF ORLANDO . .. ....... . .. .. ...... . .. . ...... LOAN I .. .. .. ..... . . ATTN: C. PRINCE P.O. BOX 2166 AUTHORIZED REPRESENTATIVE ORLANDO, FIL 32802 ACORD73.S 719Q .! ..... ..... . .. .. ... I Ti 0 039 vR l�0411 9 11♦. INSURED • ISSUE DATE IA MIDDIVY; CERTIFICAI t OF INSURANCE 02 -15 -91 Harmon Insurance AgencItECEIVEO P.O. Box 271090 Tampa, Fl. 33647 l FEB 2 0� Mayfair Country Club & John & Alice Daniels & Seminole C1ubs,Inc. 3536 N. Country Rd. P.O. Box 950789. Lake Marv. F1. 'ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND "RS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COMPANIES AFFORDING COVERAGE A Travelers Insurance COMPANY B LETTER Auto Owners Insurance Company COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER THIS IS TO CERTIFY THAT 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 CERTIFICATE 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MM /DD /VY) DATE (MM/DD /YY) r A GENERAL LIABILITY GENERAL AGGREGATE $l,Uui ' X COMMERCIAL GENERAL LIABILITY YVN660155K5252PHX90 112 - 26 - 90 12 - 26 -91 PRODUCTS COMP/OP AGG $1 ,000, CLAIMS MADE x OCCUR PERSONAL & ADV. INJURY $1' 000, OWNER'S & CONTRACTORS PROT EACH OCCURRENCE $ 000 x Liquor_ Liability FIRE DAMAGE (Any onefire) $ �. �r0 , MED. EXPENSE (Any one erson) $ p B AUTOMOBILE LIABILITY COMBINED SINGLE $1,000, ' ANY AUTO 910412 20203633 01 -01 -91 01 -01 -92 !LIMIT X F ALL OWNED AUTOS BODILY INJURY $ :SCHEDULED AUTOS (Per person) -..X HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accidenq I x 'GARAGE LIABILITY PROPERTY DAMAGE $ EXCES LIAB OCCU RRENCE $ LA FORM UMBRELLA AGGREG GATE IF '.OTHE THAN U MBRELLA FORM ! 1 STATUTORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT $ . AND ._..... ._. .... .. .. _. DISEASE — POLICY LIMIT $ EMPLOYERS' LIABILITY A L DISEASE —EACH EMPLOYEE $ i IOTHER $335,000 - Buildings �A ! Property Coverages !YVN660155K5252PHX90 12 -26 -90 12 -26 -91 57,000 - Contents 372,000 - Inland Marine DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS William Simons City of Sanford Sanford, Florida CG: CA-LqV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 _ U DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED ACHIRID.. CERTIFICATE OF INSURANCE I SSUE DATE(MM /DDIYY) 1 1 0 /3 /90 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Sin let on-Rut chins Sing nson - g O InREC EINED NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P.O. Box 2789 Orlando, FL 32802 * _ COMPANIES AFFORDING COVERAGE D O 5 h990 FE COMPANY A 4.9— LETER American Fire & Indemnity Co. CODE SUB -GOOF ... .. .. .. .. ... /��T /9 A C OF.. SAINFORE TER B .American Indemnity Co. INSURED - SEMINOLE CLUBS, INC. DBA CO Florida Chamber of Commerce MAYFAIR COUNTRY CLUB AND JOHN K. DANIELS & ALICE P. DANIELS COMPANY D LETTER P.O. Box 3911 Lake Mary, Florida 32746 COMPARNY E LETTE THIS IS TO CERTIFY THAT 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 CERTIFICATE 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. Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION. ALL LIMITS IN THOUSANDS L DATE (MMIDD /YY) DATE (MM /DD /YY) GENERAL LIABILITY GENERAL AGGREGATE $ 1000, X COMMERCIAL GENERAL LIABILITY: PRODUCTS- COMP /OPS AGGREGATES $ 1000, CLAIMS MADE X'. OCCUR, CL 607 96 02 12/26/89 12/26/90 PERSONAL& ADVERTISING INJURY $ 500, A OWNER'S & CONTRACTOR'S PROT! EACH OCCURRENCE $ 500, FIRE DAMAGE (Any one fire) $ 50, MEDICAL EXPENSE (Any one person) $ 5, AUTOMOBILE LIABILITY COMBINED SINGLE $ X ANY AUTO LIMIT A : ALL OWNED AUTOS BODI IILY $ ZSO, SCHEDULED AUTOS CL 607 96 02 12/26/89 12/26/90 (Per pers „ X HIRED AUTOS B URY $ SOO, X NON -OWNED AUTOS Per accident) GARAGE LIABILITY PROPERTY $ 100, DAMAGE ... EXCESS LIABILITY B _ ..... ..... _..... .. ........ _ , R! CU 370 63 63 12/26/89 12/26/90 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION C ! AND 00250 12/29/89 12/29/90 $ EMPLOYERS' LIABILITY OTHER .. ........ ._._ .... ._. .. .. _.., A "All Risk" Buildings & Personal Property CL 607 96 02 12/26/89 '12/26/90 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS Additional Insured: CITY OF SANFORD CITY OF SANFORD Att: City Manager P.O. Box 1778 Sanford, Florida 32772 -1778 EACH AGGREGATE OCCURRENCE, $ 1000, !$ 1000, STATUTORY 100, (EACH ACCIDENT) (DISEASE — POLICY LIMIT) (DISEASE —EACH EMPLO) SEE ATTACHED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -30— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. �fI�ar�ltLeA,. _., ' : ^N0111QN00 A31104 NOWWO"' ` AMERICAN INDEMNITY GROUP i -- "— -- COMMERCIAL PROPERTY COVERAGE PART — DECLARATIONS HOME JAN 2 9 90 SINGLETON-- HUTCCHNINSO - NG IO,INC. THESE DECLARATIONS AND THE COMMON DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORMS) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright Insurance Services Office, Inc., 1983, 1984 ,5 198 Form No. CL110 (Ed. I1 -85) A r.rr,Fr•c rnov Named Insured ma HwAIR COuNm cum eta'... IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. DESCRIPTION OF PREMISE PREM. NO. BLDG. NO. LOCATION, CONSTRUCTION AND OCCUPANCY 1 1 ObM STOR1i, APP1DWM ROOD, YMM Bi1ILt 1W LOCAIM AT 3000 W/S DIKE' MARY ROAD, SAt1FOEd3, FIMMA, OOOLIPIED AS 12U C1AJ3 HOUSZ. SM CP1205 FOR ADDITICHM IW-AAG TICW. COVERAGES PROVIDED — INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN PREM. NO. BLDG. NO. COVERAGE LIMIT OF INSURANCE COVERED CAUSES OF LOSS COiNSURANCEt RATES I 1 Bum= 150,000. ✓ 5PE7CSAL 90% .228/.084/.0 1 1 C10D aallS .30,000. SPSICZAL 90% .236/.083/1. OPTIONAL COVERAGES — APPLICABLE ONLY WHEN ENTRIES ARE MADE IN THE SCHEDULE BELOW +IF E %IRA EXPENSE COVERAGE, LIMITS ON LOS S PAYMENT AGREED VALUE REPLACEMENT COST (X) PREM. NO. BLDG. NO. EXPIRATION DATE COVERAGE AMOUNT BUILDING PERSONAL PROPERTY INCLUDING "STOCK" INFLATION GUARD (Percentage) ttMONTHLY LIMIT OF ttMAXIMUM PERIOD ttEXTENDED PERIOD PREM. NO. BLDG. NO. BUILDING PERSONAL PROPERTY INDEMNITY (Fraction) OF INDEMNITY (X) Of INDEMNITY (Days) MORTGAGE HOLDER(S) ttAPPLIES TO BUSINESS INCOME ONLY PREM. NO. BLDG. NO. MORTGAGE HOLDER NAME AND MAILING ADDRESS DEDUCTIBLE $250. EXCEPTIONS. FORMS AND ENDORSE APPLYING TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT TIME OF ISSUE: APPLICABLE TO ALL COVERAGES: CP0090(7/88) CPO01O(7/88) CP1030(7/88) CP0125(4/89) IL0255(11186) CP1650(11/85) CP1205(11/85) APPLICABLE TO SPECIFIC PREMISES /COVERAGES: PREM. NO - . BLDG. NO. COVERAGES PREMIUM FOR THIS COVERAGE PART TOTAL $ 1 1 Payable at inception; $ 1,625 Ist Anniversary $ ; 2nd Anniversary $ HOME JAN 2 9 90 SINGLETON-- HUTCCHNINSO - NG IO,INC. THESE DECLARATIONS AND THE COMMON DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORMS) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright Insurance Services Office, Inc., 1983, 1984 ,5 198 Form No. CL110 (Ed. I1 -85) A r.rr,Fr•c rnov COMMERCIAL PROPERTY COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL DECLARATIONS POLICY NO. NAMED INSURED COMPANY DESCRIPTION OF PREMISES PREM. NO. BLDG. NO. LOCATION, CONSTRUCTION AND OCCUPANCY 1 2 ONE STORY APPROVED ROOF, JOISTED MASCIbW BUILDING, LOCATED AT 3000 W/S LAM MARY ROAD, SANFORD, FLORIDA, OCCUPIED AS A IOCKER ROOM. 1 3 ONE STORY, APPROW ROOF, FMIE BUILDING, IACATED AT 3000 W/S LAKE MARY ROAD, SANFORD, FLORIDA, OCCUPIED AS A PRO SHOP. Cd�Pl7T��t� PREM. NO. BLDG. NO. COVERAGE LIMIT OF INSURANCE COVERED CAUSES OF LOSS COINSURANCE- RATES 1 2 BUILDING 15,000. SPECIAL 908 .181/.084/.028 1 3 BUILDING 25,000. SPECIAL 908 .228/.084/.028 1 3 OONtEM 15,000. SPECIAL 908 .236/.083/1.956 9F EXTRA EXPENSE COVERAGE, LIMITS ON LOSS PAYMENT ' OPTIONAL COVERAGES PREM. NO. BLDG. NO. AGREED VALUE REPLACEMENT COST(x) EXPIRATION DATE COVERAGE AMOUNT BUILDING PERSONAL PROPERTY INCLUDING "STOCK" INFLATION GUARD (Percentage) - MONTHLY LIMIT OF -MAXIMUM PERIOD -EXTENDED PERIOD BUILDING PERSONAL PROPERTY INDEMNITY (Fraction) OF INDEMNITY (X). OF INDEMNITY (Days) -APPLIES TO BUSINESS INCOME ONLY. MORTGAGE HOLDERS PREM. NO. BLDG. NO. MORTGAGE HOLDER NAME AND MAILING ADDRESS 12 "RETH FORMS APPLICABLE TO SPECIFIC PREMISES /COVERAGES JAN 2 9 90 PREM. NO. BLDG. NO. COVERAGES FORM NUMBE agEGIZO N•HUTCHIN$ON-WINGO, INC. ORLANDO, FL CP 12 05 1185 Copyright, ISO Commercial Risk Services, Inc., 1983, 1984 Page _L of ? COMMERCIAL PROPERTY COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL DECLARATIONS POLICY NO. COMPANY NAMED INSURED DESCRIPTION OF PREMISES PREM. NO. BLDG. NO. LOCATION. CONSTRUCTION AND OCCUPANCY 1 4 CM 9 1 13 W APPKAW WW I ,, 30113M MSLRJ>23t BUILDING, U== AT 3000 W/S LARE KW ROAD, Ste, FLaUDA, OCCUPnD AS . COVERAGES PROVIDED PREM. NO. BLDG. NO. COVERAGE LIMIT OF INSURANCE COVERED CAUSES OF LOSS COINSURANCE* RATES 1 4 BLDG. 20,000. SPEICIAL 90g .181/.084/.028 1 4 CTPS 5,000. / SPWJAL 90% .182/.083/3.004 -IF EXTRA EXPENSECOVERAGE, OPTIONAL COVERAGES PREM. NO. BLDG. NO. AGREED VALUE REPLACEMENT COST(x) EXPIRATION DATE COVERAGE AMOUNT BUILDING PERSONAL PROPERTY INCLUDING "STOCK" INFLATION GUARD (Percentage) BUILDING PERSONAL PROPERTY MORTGAGE HOLDERS - MONTHLY LIMIT OF - MAXIMUM PERIOD -EXTENDED PERIOD INDEMNITY (Fraction) OF INDEMNITY (X) OF INDEMNITY (Days) -APPLIES TO BUSINESS INCOME ONLY. PREM. NO. BLDG. NO. MORTGAGE HOLDER NAME AND MAILING ADDRESS FORMS APPLICABLE TO SPECIFIC PREMISES /COVERAGES PREM. NO. BLDG. NO. COVERAGES FORM NUMBER ? CP 12 05 1185 Copyright, ISO Commercial Risk Services, Inc., 1983, 1984 Page of Z r COMMERCIAL UMBRELLA LIABILITY POLIO RECEIVED . ✓ elevK -o�. ya P ,JAN 3 01990 CU 370 63 63 IL r CA 370 40 93 Amm f OF SANFOR4 Renewal of Number A1 AMERICAN INDEMNITY COMPANY DECLARATIONS Galveston, Texas A Stock Company ITEM 1. Name of Insured and Address: (No. Street, Town or City, State, Zip Code) SEMINOLE CLUBS, INC. DBA: MAYFAIR COUNTRY CLUB AND JOHN K. DANIELS & ALICE P. DAN IETB P.O. BOX 3911 LAKE MARY, :7 —^ ITEM 2. POLICY PERIOD: From: rDECJ ER 26 1989 T D ECEMBER 26, 1990 Years: 12:01 A.M., STANDARD TIME AT H AMED INSURED AS STATE R I . ITEM 3. The Named Insured is: CK Corporation ❑ Partnership Business of Named Insured is: GOLF & COUNTRY CLUB ITEM 4. Schedule of Underlying Insurance: ❑ Joint Venture ❑ Individual ❑ Other TYPE OF POLICY APPLICABLE LIMITS INSURER POLICY NO. POLICY PERIOD (A) Comprehensive Automobile Liability Policy Type and Symbol fY Bus. Auto • Garage • Truckers Bodily Injury $250,000. each person $ 500,000. each occurence Property Damage $100,000. each occurrence AMERICAN FIRE & INDEMNITY CL 607 96 02 12/26/89- 12/26/90 Bodily Injury and Property Damage Combined Single Limit $ each occurrence (B) Comprehensive Commercial 1,000 00 General Liability , %a al Aggregate Limit $ , w cts /Comp /Op /Aggr /Limit AHMC W FIRE & INDEMNITY CL 607 96 02 0, Qrsonal and Advertising Injury Limit 12/26/89- 12/26/90 $ 500 Occurrence Limit $ 50,006ue Damage Limit (C) Standard Workers Compensation & Coverage B - Employers' Liability Employers' Liability Bodily Injury By Accident $ each accident Bodily Injury By Disease ' $ each employee Bodily Injury By Disease $ policy limit ITEM 5. Retained Limit $ 10,000. ITEM 6. Limit of Liability: (a) each occurrence $ 1,000,000. (b) aggregate $ 1,000,000. $ Rate Per $1000 Flat RateU ITEM 7. Premium $ 2 , 2 00. (Minimum Premium, one year or less not subject to short rate adjustment, $250.00) CL54(5/89) CU8(6/81) CU14a(6 /81) CU23(7/8) 0372511/851 /J P� ITEM B. Endorsement Numbers: CU83 (11/85) ���L7Y� r17Tj� Countersigned ORLANDO, FLO HO /ljcf, JANUARY 17 1990 B S CLETON— HUT(SIINSON— WINGO, INC. h11O. »nn qm r tRa Authorized Representative CERTIFICA1 " OF INSURANCE ISSUE DATE (MM /DD /YY) 12/28/88 PRODUCER THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, SINGLETON HUTCHINSON WINGO, INC EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P.O. BOX 2789 ORLANDO, FLORIDA 32802 RECEIVED COMPANIES AFFORDING COVERAGE CODE SUB -CODE _ DEC 2 9 INSURED SEMINOLE CLUBS, INC. CITY DBA MAYFAIR COUNTRY CLUB P.O. BOX 3911 LAKE MARY, FLORIDA 32746 I CO LTF I:1 IA U. COMPANY A LETTER D UMYAIVT ETTER B AMERICAN INDEMNITY COMPANY CONY ^ M MP P = ANY �, ,.Co COMPANY D LETTER .. ......._ COMPANY _. .... E LETTER THIS is TO CERTIFY THAT THE POLICIES OF TNSURANCE'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 CERTIFICATE 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS DATE (MM /DD /YY) DATE (MM /DD /YY) GENERAL LIABILITY GENERAL AGGREGATE $...1, 00C X COMMERCIAL GENERAL LIABILITY PRODUCTS -COMP /OPS AGGREGATE $ 1,00( 'CLAIMS MADE X OCCUR I MP 448 1600 ! 12/26/88'. 12/26/89 PERSONAL I & ADVERTISING INJURY $. 50( OWNER'S& CONTRACTOR'SPROT. EACH OCCURRENCE $ 50( FIRE DAMAGE (Any one fire) $.... 5C MEDICAL EXPENSE (Any one pemon)', $ AUTOMOBILE LIABILITY COMBINED _ ANY AUTO LIM T $ 500, ' ! ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS MP 448 1600 GARAGE LIABILITY EXCESS LIABILITY OTHER THAN UMBRELLA FORM CU 370 34 79 WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY 12/26/88 12/26/89 12/26/88 ! 12/26/89 BODILY INJURY $ PROPERTY $ DAMAGE EACH AGGRE� OCCURRENCE'. 1,000, 1,000, OTHER A "All Risk" Buildings' See Attached Schedule & Personal Property MP 448 1600 12/26/88 12/26/89 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES /RESTRICTIONS /SPECIAL ITEMS ADDITIONAL INSURED: CITY OF SANFORD CITY OF SANFORD Attn: City Mgr. P.O. BOX 1778 Sanford, Florida 32772 -1778 C-.c i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL —3Q— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. c Oesignallorta premises, as slated in the 1" 311ons, Is extended to Include the too lVil"g and insuaa•" ' providsd with respect to Illos'vnrtaaeS describtS below and with respetl to those � Ages and kinds of properly laywlifch a spesitlt "MR , .ability is shown, subHett to all the terms of this polity including terms and endorsements made a part hereof-. tee. Rldr. DESIGNATED PREMISES OCCUPANCY SECtION ► ' COYERIIGE forms and Ceimorame limns of Ne. Ne. (Address, CRY, $late) - Eadenemends Percent agee tlabOny Applicable APPlkable (1) 1 1 3000 w/s Lake Mary Road Main Bldg MP0090 901 $150,000. Club- MPOO13 House 14P0331 MPO420 I 1 1 / " " " " Personal MP0090 901 $ 30,000. Property MPOO14 MP0331 MPO420 1 _2 Locker Bldg MP0090 901 $ 15 Room _ MP001s MP0331 MPO420 1 3 " " _ " " ProShol Bldg M11`0090 901 $ 25,000. Cart MPOO13 Shop MP0331 14PO420 1 3 " " s' " " Personal MPOO90 901 $ 15 Property MPOO14 MP0331 MPO420 1 4 " " " " Maints Bldg MP0090 901 $ 20,000. nonce MP0013 Storage MP0331 Bldg MPO420 1 4 to of 1t of " Personal MPOO90 901 $ 5 Property MPOO14 .MP0331 VPO420 2 1 651 N. Highway 1792 Orivin Longwood, Florida Range No Sect n I covertgo MP 12 05 (Ed. 0177) 10"%< cl� 7 'JAPf 9 1 1988 r �a 19 JANUARY, 1988 Mr. Frank Faison, City Manager City of Sanford Sanford, Fl 32771 Dear Mr. Faison; Enclosed please find copies of our insurance binder which is now with the Spencer -Edens Agency of Titusville, Fl. Our carrier is nooJthe Travelers Insurance Co. A copy of the policy will be coming to you from our agent under separate cover, since it takes several weeks for the formal policy to be issued. we have paid our premium on the policy and if there is further information you require please contact Mr. Ashby our agent. May I thank you in advance for your cooperation. Sincerely, SEMINOLE CLUBS INC. John K. Dan ls, Presi ent JKD /ap Encl. GAO' P.O. DRAWER 3911 • LAKE MARY. FLORIDA 32746 -1363 • 305 - 322 -2531 NAMED INSURED: SEMINOLE CLUBS, INC. D /B /A MAYFAIR COUNTRY CLUB P.O. BOX 3911 LAKE MARY, FL. 32746 B I N D E R INSURANCE AGENCY SPENCER /EDENS AGENCY, INC. P.O. BOX 2606 TITUSVILLE, FL. 32780 EFFECTIVE 12/26/87 12:01 A.M. EXPIRES 01/26/88 12:01 A.M. COVERAGE IS BOUND IN ACCORDANCE WITH THE ATTACHED PROPOSAL WITH THE FOLLOWING CHANGES IF ANY: INSURANCE COMPANY PACKAGE & UMBRELLA; THE TRAVELERS INSURANCE COMPANY WORKERS' COMPENSATION; SOUTH ATLANTIC COUNCIL ON COMPENSATION IN CONSIDERATION FOR ISSUANCE OF THE BINDER A DEPOSIT PREMIUM HAS BEEN MADE IN THE AMOUNT OF $_ S i r SIGNATURE OL REPRESENTATIVE 12 / 1a2 DATE Page 14 of 14 Mayfair Country Club December 16, 1987 1 8PINCIR /IDINS AGCY, INC. ....IS ONE OF THE LARGEST AND LEADING INSURANCE AGENCIES IN THE STATE OF FLORIDA. OFFICES IN TITUSVILLE, MELBOURNE AND TALLAHASSEE PROVIDE A FULL LINE OF PROPERTY, CASUALTY, SURETY, LIFE, HEALTH, EMPLOYEE BENEFITS, AND OTHER INSURANCE COVERAGES, AND RISK MANAGEMENT SERVICES FOR THE GENERAL RETAIL INSURANCE MARKET. FOUNDED IN 1925, THE AGENCY IS HEADQUARTERED IN TITUSVILLE, FLORIDA. P O L I C Y H 0 L E R S E R V I C E All policyholder's service request for premiums, coverage, endorsements, certificates of insurance, claims, or general service matters and questions should be made directly to: Spencer/Edens Agency, Inc. P.O. Box 2606 TITUSVILLE, Florida 32781 Telephone 0 (305) 267 -0551 The agency has established a service organization to insure prompt attention to all your service matters. Every policyholder has a agent of record and a account executive. The ultimate responsibility for all service matters rest with your agent but to expedite your service request routine matters should be directed to your account executive. YOUR AGENT IS: R 0 B A S H B Y YOUR ACCOUNT EXECUTIVE IS: B E T H K I S E R Our goal is to provide you with the best professional service possible. Please do not hesitate to call if we may be of service or assistance. We are in business to service your insurance needs. Page 3 of 14 Mayfair Country Club December 16, 1987 I N T R O D U C T I O N - 1 8PINCIR /IDINS AGCY, INC. ....IS ONE OF THE LARGEST AND LEADING INSURANCE AGENCIES IN THE STATE OF FLORIDA. OFFICES IN TITUSVILLE, MELBOURNE AND TALLAHASSEE PROVIDE A FULL LINE OF PROPERTY, CASUALTY, SURETY, LIFE, HEALTH, EMPLOYEE BENEFITS, AND OTHER INSURANCE COVERAGES, AND RISK MANAGEMENT SERVICES FOR THE GENERAL RETAIL INSURANCE MARKET. FOUNDED IN 1925, THE AGENCY IS HEADQUARTERED IN TITUSVILLE, FLORIDA. P O L I C Y H 0 L E R S E R V I C E All policyholder's service request for premiums, coverage, endorsements, certificates of insurance, claims, or general service matters and questions should be made directly to: Spencer/Edens Agency, Inc. P.O. Box 2606 TITUSVILLE, Florida 32781 Telephone 0 (305) 267 -0551 The agency has established a service organization to insure prompt attention to all your service matters. Every policyholder has a agent of record and a account executive. The ultimate responsibility for all service matters rest with your agent but to expedite your service request routine matters should be directed to your account executive. YOUR AGENT IS: R 0 B A S H B Y YOUR ACCOUNT EXECUTIVE IS: B E T H K I S E R Our goal is to provide you with the best professional service possible. Please do not hesitate to call if we may be of service or assistance. We are in business to service your insurance needs. Page 3 of 14 Mayfair Country Club December 16, 1987 K N N N y N M M M M M M r No -0�, D$ S C R I P T I 0 N O F L O C A T I O N S THE FOLLOWING IS A DESCRIPTION OF THE LOCATIONS INCLUDED IN THIS SUMMARY. PLEASE BE SURE THAT ALL YOUR LOCATIONS ARE INCLUDED. 1 1 1 1 1 1 1 1 2 3 4 6 7 3000 LAKE MARY RD SANFORD, FL SAME SAME SAME SAME SAME 4 Y ._. Page 5 of 14 Mayfair Country Club December 16, 1987 CLUB HOUSE LOCKER ROOM PRO SHOP BATH HOUSE STORAGE STORAGE GOLF CART /STO owl Wrrrorotd >400mma tnm Wpxj a z >e rrQ z z zzz. tnzH00• rzj "aroty - zr-Imm 0 w� m<-3H• H r : za0• 0mfxJ ol 0. • N O • 00 • 00 • 00 r O R z 0 XOOMMC -33CwmwwN x LtUIn U) ED En ~ 1 9 a z to ror� rrc� C zazw% r EnZ•300- �+ zt"mm - 0 NC H -• U "t � za0! ftj p. y . N N 00 r o 0 O a a H t�irrrrorow H m t r row r O XOOM MC O XOOt= MC O Z Hwto'ww" z HwO z oozz" oozz" r H R t a ro rr0 ryh My �� � yy yro�irr0 '.VZ�'%f' • z� zzzW C r mz HOO• r w a00• C d `�zr tdta: d �H aroro d zrt�t�• H to ,za0• • N zC0• r • 0 t+7'iy • C2 tr1 rs7 . 0. O. p. p• --3 : y . N . . . . . . � . . . . O • . . W tT . . . CIS 0 . . . . 00 . . . . 00 - 0 - 0 00 . . . . 00 0 0 . . . . 00 E ro �A O ro x H K r 0 a t�rrrorow x0otr ma O H3Wto WW" z �totncntnr oozz" roM td r c��aro tj rye O Q z m ro NCHH• O < 5 K Oq 1-4 r m ofD zao• m hJ c' H G O) 0 ; O H� O : O• H• . mc+rp • x• CD OD n OD N O . • • • 00 Wrrrorotd >400mma tnm Wpxj a z >e rrQ z z zzz. tnzH00• rzj "aroty - zr-Imm 0 w� m<-3H• H r : za0• 0mfxJ ol 0. • N O • 00 • 00 • 00 r O R z 0 XOOMMC -33CwmwwN x LtUIn U) ED En ~ 1 9 a z to ror� rrc� C zazw% r EnZ•300- �+ zt"mm - 0 NC H -• U "t � za0! ftj p. y . N N 00 r o 0 O a a H t�irrrrorow H m t r row r O XOOM MC O XOOt= MC O Z Hwto'ww" z HwO z oozz" oozz" r H R t a ro rr0 ryh My �� � yy yro�irr0 '.VZ�'%f' • z� zzzW C r mz HOO• r w a00• C d `�zr tdta: d �H aroro d zrt�t�• H to ,za0• • N zC0• r • 0 t+7'iy • C2 tr1 rs7 . 0. O. p. p• --3 : y . N . . . . . . � . . . . O • . . W tT . . . CIS 0 . . . . 00 . . . . 00 - 0 - 0 00 . . . . 00 0 0 . . . . 00 E ro �A O ro x H K r r r r M N M M r w r M M 00�. 100�1 PROPERTY CONTINUED: LOCATION #1 BUILDING #6 BUILDING ............. .......................$20,000 PERSONAL PROPERTY. .. ..........................5,000 PERSONAL PROPERTY OF OTHERS ........................ LOSS OF RENTAL VALUE ............................... LOSS OF EARNINGS / INCOME ............................ EXTRA EXPENSE ....... ............................... LOCATION #1 BUILDING #7 BUILDING ............ ........................$10,000 PERSONAL PROPERTY ... ............................... PERSONAL PROPERTY OF OTHERS ........................ LOSS OF RENTAL VALUE ............................... LOSS OF EARNINGS / INCOME ............................ EXTRA EXPENSE ......: ............................... COVERAGE PROVISIONS DEDUCTIBLE $500 COINSURANCE 90% Under the terms of this clause, you should insure the property at risk to the stipulated percentage of value. If you fail to do so, you will not be,fully reimbursed for a loss that may occur. [ ) ACV: The Actual Cash Value at the time of loss, depreciated [X] RC: Replacement Cost (new for old) [ ] NAMED PERILS: fire, lightning, windstorm, civil commotion, smoke, hail, aircraft, vehicle damage, explosion, riot, vandalism, and malicious mischief [X] ALL RISK: Covers all perils except for named exclusions. Some of the exclusions are wear and tear, earthquake, and flooding. Page 7 of 14 Mayfair Country Club December 16, 1987 m U M Pi 3 K O m �m K O OD m OD m N v0 0' t a Ayro a .1 4 0 t rtHn �4 Z O omm 9yN0 ztzj zC W0Ea m mo>o 0 z z tzj N O m w Pyd H t 0 C tz3wm 3- 0 00 >MO z ry hd M 0 �m z 3 M d W o z mm y ° z ro . o 4 w 0 C m O U) H 0 t+ W �r r M H •c E tc, ro 0 r d tv�ry wma�0 ++�roroatic ay • P7 s± x n. t Wtr K 0 y N• O K (o +"mod y R 23 r 0 c+c+ '1 o 2 K(n9K a 0 m \ m txf W02 moc� o m r+ -� t W w m �+� an d �o , a 3c t t4 p c+ a 0 a s N•O '.�' CT 0 0" 'H a ar• z m rrm 0'o" t H wa0 p.( 0 eU roc 9 w cc+OoggtD ton r a - ` H i H o a m a s K w G O 33 r y r zoo tY+' N9 h 0 � W O hit=dH (D L 7 [=7m ar ooz 0 0 +-z K m t, t3' y0 yH yH C 0 a to +•• a 5 b r a l c+ tl z M tit y roz <P• mw c+0KNt - N. 0Nwtd m td c+ .< 0 y m 1- pi tl a0 w +"0 K a m • ::r r 0!A 11NtoW+iWkfoww`<0z0• 0w"hd 0 t" a 0 r0 o m N•vr crmro• ro:l mtai 04 t'•0 P-N w K rr• R z HM- M H.W :0 O w 0 p to v. c+ w I-- c+ r• r to %<M '<c+r• w C �y �1 to y -t+79• yK O ►� O 0 +'- (+ g `< c+ `< a y y O 0 G) O 0 K 0 o w a N 8 F-4 - H a• 0 N toO t- , + , w mm Wt=JO 0 C3 r t3 G<r•ro8 :� KPLI Z z0 m K m w K w c+ c+ 0y M m• m c+ - z N• m N 0 04 N P- N• Vd • U! 0 a03 W 00 to+may• 9t z iPr O tY 0q rc+ r•N•r• 00 • 0 C2 OD r C] K +'• m r W 0 c+ 00 M to oq N c+0 Oq`< r. w8 • - 0 'C m H , tom] b . t OD t2i c~+ rr 'Q N - '< W tad - : 9 N - L�1 DO w 7 r - y (D : gym• '.S1 r• r y . a : H N Q N •< o y N t�9 td 0 O H to v . : 9a . zzz c C r• t O 0 0 ttzi t t 0 0 0 t7Ctd 0 00 0 t+ W �r r M H •c E } } M M INLAND MARINE CONTINUED: COVERAGE PROVISIONS DEDUCTIBLE $500 [ ] NAMED PERILS: fire, lightning, windstorm, civil commotion, smoke, hail, aircraft, vehicle damage, explosion, riot, vandalism, and malicious mischief. [X ] ALL RISK: Covers all perils except for named exclusions. Some of the exclusions are wear and tear, earthquake, and flooding. B O I L E R & M A C H I N E R Y PROPERTY DAMAGE .......... ............................... BUSINESS INTERRUPTION ................................... Provides protection for sudden and accidental breakdown of the object, or a part thereof, which manifests itself at the time of its occurrence by physical damage to the object that necessitates repair or replacement of the object or part thereof, but does not include wear and tear DEDUCTIBLE: $ F L 0 0 D BUILDING ................. ............................... CONTENTS................. ............................... PROVIDES PROTECTION FROM THE PERIL OF FLOODING TO THE INSURED'S PROPERTY. THIS PERIL IS EXCLUDED FROM COVERAGE UNDER NORMAL PROPERTY INSURANCE. Page 10 of 14 Mayfair Country Club December 16, 1987 lo W O R K E R S C O M P E N S A T I O N PROVIDES PROTECTION FOR OCCUPATIONAL ACCIDENT OR SICKNESS TO EMPLOYES CLASSIFICATION CODE PAYROLL 1. COUNTRY CLUBS 9060 156,800 2. 3, 4. U M B R E L L A LIABILITY ................ .....................$1,000,000 RETAINED LIMIT ........... ........................$10,000 Excess coverage over other liability insurance. When a loss exceeds limits under the primary coverage then the UMBRELLA policy becomes effective. Coverage for which there is no primary insurance or where the primary policy contains an exclusion which is not similarly excluded in the umbrella policy subject to a deductible or retained limit. E M P L O Y E E B E N E F I T S GROUP MEDICAL KEYMAN LIFE PENSION OR IRA KEYMAN DISABILITY OUR AGENCY PROVIDES A FULL LINE OF PRODUCTS FOR EMPLOYEE BENEFITS INCLUDING SELF INSURED BENEFIT PLANS FOR LARGER EMPLOYERS. Page 11 of 14 Mayfair Country Club December 16, 1987 I' RECEIVED "A MAR 1.8 8 C9 aFORD Mr. Frank Faison, City Manager City of Sanford Sanford, F1. 32771 � Z- -O0/ o2 Re; Insurance coverage for golf teams Dear Mr. Faison; Enclosed please find the necessary binders and disclaimers from the golf teams of both Lake Mary and Sanford high schools. This should alleviate any and all claims by students and keep our and the city's skirts clean should a problem arise. Please feel free to contact me for further information you may require. Sincerely SEMINOLE LUBS IN Jo' el , dent JKD /ap Encl. e�: /L f n & P.O. 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"SEINOLE HIGH SC HOOL DEPARTMENT OF ATHLETICS February 4, 1988 Dear Mr. Daniels, Each golfer is insured with his/her parents' health insurance company and /or has school health insurance, If you require proof of insurance, we can provide copies of the individual golfer's parental consent form, A *erel y H. Pose e.tic Dix ctor 306p22 -4352, Ext. 232 2701 GEORGIA AVENUE SANFORD, PL 31771 Home of the Fighting Seminoles January 26, 1988 ?rincipal 4 Me ' raary Ail h S.c hool 3sldt da ...32746 This is to confirm that the Lake Mary High School Golf Team under the guidance of Mr. Earl Roberts is permitted to use the Mayfair golf course during it's golfing sea— son to hold it's scheduled matches with other courses as well as practices. These practices and matches are held only on weekdays (holidays excluded) and after the normal school day (app— roximately 3 :00 -3:30 PM). Students will not be permitted on the course unless either Mr. Roberts (or an adult assistant) maintains supervision. The students will be allowed to play gratuitously during the school's golfing season but will be required to walk and carry their clubs. All matches and practice rounds will be played on the front nine holes unless specifically directed otherwise by the Pro Shop. At no time will fivesomes (or more) be allowed. Paying customers will have priority at all times. If students are on the course, they will move off the fair— way and allow paying customers to play through before continuing. Seminole Clubs, Inc. (dba Mayfair Country Club) at no time will be held responsible for the conduct of the students. This responsibility rests solely with the adult super— vision provided by Lake Mary High School. Any problems arising from the use of the course and it's facilities will be directed to the coach (or his adult represent— ative) for corrective action. Mr. Roberts will provide the Pro Shop with a roster of the students that are participating; to include names, addresses and telephone numbers. P.O. DRAWER 3911 • LAKE MARY. FLORIDA 32746 -1363 • 305 -322 -2531 Should students desire to use the practice range, they may do so with adult supervision. Practice balls are obtained the Pro Shop at the normal charge. Students will not be permitted to move in front of the teeing area on the range for any reason. Snacks or drinks may be purchased by the students at the normal charge. Seminole Clubs, Inc. (dba Mayfair Country Club) is held free and harmless from any damage or injury claims what- soever that may arise while the students are on the prem- iges. 4 FARRoil ignature R. G. SEILER (Signa Coach, Golf Team Gen. Mgr. Lake Mary High School Seminole Clubs, Inc. -2- ,AME AND ADDRESS OF AGENCY GallagWer- Bassett Insurance Service 445 Wymore Road W inter P F1 32789 NAME AND ADDRESS OF INSURED The School Board of Seminole County 1211 Mellonville Avenue Sanford, FL 32771 (Lake Mary High School) terms, exclusions and conditions of such COMPANY LETTER TYPEOFINSURANCE GENERAL LIABILITY A ❑ COMPREHENSIVE FORM ❑ PREMISES - OPERATIONS ❑ EXPLOSION AND COLLAPSE HAZARD ❑ UNDERGROUND HAZARD ❑ PRODUCTS /COMPLETED OPERATIONS HAZARD ❑ CONTRACTUAL INSURANCE ❑ BROAD FORM PROPERTY DAMAGE ❑ INDEPENDENT CONTRACTOF ❑ PERSONAL INJURY AUTOMOBILE LIABILITY A ❑ COMPREHENSIVE FORM ❑ OWNED ❑ HIRED ❑ NON -0WNED I❑ UMBRELLA FORM ❑ OTHER THAN UMBRELLA FORM may POLICY NUMBER COMPANIES AFFORDING COVERAGES O LETTER OMPANY A qualified Self- Insurer COMPANY LETTER B COMPANY { _ LETTER v COMPANY D LETTER COMPANY LETTER me0 above anE are in force at this time. Notwithstanding any repuiroment, farm or condition or may pertain. the insurance afforded by the policies described herein is subject to all dN PoL'cv Limits of LNabilit in Thousands 00) EXPIRATION DATE EACH AGGREGATE ` OCCURRENCE I BODILY INJURY S $ Self- Insurer Per State of Florida Statutes Chapters 768.28 and 111.07 elf- Insurer Per State f Florida Statute hapter 768.28 A WUKKLNS e�rbNSAItN Self- Insurer per State EMPLOYERS' LIABILITY Of Florida Statute 768 28 PROPERTY DAMAGE It $ BODILY INJURY AND PROPERTY DAMAGE 5 2 0 0 f COMBINED PERSONAL INJURY S BODILY INJURY = (EACH PERSON) BODILY INJURY S (EACH ACCIDENT) PROPERTY DAMAGE S BODILY INJURY AND S ,loo PROPERTY DAMAGE BODILY INJURY AND PROPERTY DAMAGE S S COMBINED STATUTORY = 100 Use of Merrill Park for the date of February 27, 1988 only Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the issuing com- pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER: Attn: Bill James Merrill Park Recreation Facility 784 Jamestown Blvd. Altamonte Springs, FL 32714 DATE ISSUED: J 1, 1987 L`_ ACORD 25 (1-79) RECERV, APR 0 0 1908 QTY 13Ke &,' +9 I April, 1983 Mr. Frank Faison, City Manager City of`Sanford Sanford., Fl. 32771 Re: Umbrella Policy Dear Mr. Faison; Enclosed please find copies of our one - million dollar umbrella policy; whereby, the city of Sanford is also the additional insured. Please feel free to contact me for further information you may require. Sincerely, SEMIRTOLE CLUBS INC John iZ ie s, es'dent JKD /ap Encl. P.O. DRAWER 3911 • LAKE MARY. FLORIDA 32746 -1363 • 305- 322 -2531 THE TRAVELERS INDEMINITr vOMPANY Page I of t l tATASTROPH DECLARATIONS PAGE CUP- 995G505 -9 -87 1 -4 POLICY NUMBER 1. NAMED INSURED: L MAYFAIR COUNTRY CLUB. MAILING ADDRESS: P.O. BOX 3911 (Including Zip Code) LAKE MARY, FLORIDA 32746 2. The Named Insured is a corporation unless designated below as a: 0 sole proprietor 0 partnership or joint venture E3 other CLUB 3. POLICY PERIOD: (Month, Day, Year) Effective from 12-26-87 t 12 -26 -88 12:01 A.M., Standard Time, at the Named Insured's mailing address. , 5. 0 The premium for this policy is estimated to be $ Final premium will be determined all audit. rA The premium for this policy is $ 1 y 681 6. On the effective date shown in Item 3, the Catastrophe Umbrella Policy numbered above includes this Declarations Page, the Policy Jacket (Form 1 -5232, which contains the Nuclear Energy Liability Exclusion) and the following schedules and endorsements: 41020, 27801, 35962,' 35980, 31600, 36101 8000(1) 7. The Named Insured is responsible for maintaining in full force and effect during this policy period the policies of primary insurance described below, including their renewals. -, 4. LIABILITY COVERAGE DEDUCTIBLE LIMITS OF LIABILITY Bodily Injury, The deductible amount shall be the greater of $ ,x9 000 000 each occurrence Property Damage, $ 25 ,000 fbiaP'products ` Personal Injury, each occurrence, or the sum liability hazard Medical Injury and of all valid and collectible pri- $ �t,�000 ;000tdtal empbye[ p Advertising Injury mary TRAVELERS INDEMNITY CO. w Z a io N CHARTER OAK FIRE INSURANCE CO. CHARTER OAK FIRE INSURANCE CO. 95G504- 7 -I+ -87 $500,000 CSL (AUTO) 7 $500,000 CSL (GEN. LIAR.) •7 -C -87 $500,000.C$L- (PRODUCT) THI PO L0.)YiGN r3Vcnni ai .� Ir HI 5 POL,IrCY HAS BEEN L WITED �;r^. cNl�f?S;Elv9FNT55�F�. ` 8. Exclusion 6 does not apply to the following: I a. Watercraft shorter than 26 feet; b. Watercraft while on land owned by, rented to or controlled by the Named Insured. C. 9. By accepting this policy the Insured first named in Item 1 above declares that the information on this page is true, and that this policy embodies all agreements existing between the Named Insured and The Travelers,' including its agents, relating to this insurance. The Travelers relies on the truth of such representations. Authorized Agent " insurance applicable to liability hazard the occurrence. TRAVELERS INDEMNITY CO. w Z a io N CHARTER OAK FIRE INSURANCE CO. CHARTER OAK FIRE INSURANCE CO. 95G504- 7 -I+ -87 $500,000 CSL (AUTO) 7 $500,000 CSL (GEN. LIAR.) •7 -C -87 $500,000.C$L- (PRODUCT) THI PO L0.)YiGN r3Vcnni ai .� Ir HI 5 POL,IrCY HAS BEEN L WITED �;r^. cNl�f?S;Elv9FNT55�F�. ` 8. Exclusion 6 does not apply to the following: I a. Watercraft shorter than 26 feet; b. Watercraft while on land owned by, rented to or controlled by the Named Insured. C. 9. By accepting this policy the Insured first named in Item 1 above declares that the information on this page is true, and that this policy embodies all agreements existing between the Named Insured and The Travelers,' including its agents, relating to this insurance. The Travelers relies on the truth of such representations. Authorized Agent " telavelers'j ato Travelers Insurance Companies 9 %P vn p.Tk. ku111'e C —Panrl ml ord, CT 06183 '.a t t� OVAL INSURED: OF`SANFORD * 0 0 ". — BOX 1778 MPAS FL Symbol No. CP T8 00 12 87 PRODUCER SPENCER —EDENS AGENCY, INC. F1057 CP•5230 New 11 -86 Printed in U.S.A. Policy Number: 660- 995G504- 7- COF -87 Issue Date: 03- 08- 88LR /EM Page 1 of 1 OFFICE ORLO 856 •� mo mao m O O O Wo ad o Ww <.O a N N I O w =¢Om " g zf UFU O ! I z ~aF J Oa Oam O a 69 V3 EA E9 ! 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O F OO U O1 O .� O •r i- W - y $ H m i ° a te i s ° m a ¢ a i z W 0 3 w^ O. r-1 •• O 4- D C L W Q m Y wf._z W O U % 6 d 0F+ ++ G O Np, O w Np 1J �xm f7 < X W X O C w Fr 4 ' Qp. N U a z • O¢ Q ¢ m W - Q O n m F i SWIPLEMENTALf46 RATIONS ENOORStnnens I __ ­(Ed. 07 r 1) Designation of premises, as staled in the Declarations, is extended to Include the to ing and insure.._ Is provided with respect to Ulm premes described below and with respect to those coverages amI blonds of property I ch a specific limit of liability Is shown, subject to all the terms " of this policy Including forms and endorsements made a part hereof: ' lot. Bide. DESIGNATED PREMISES OCCUPANCY SEC110N I COVERAGE forms and Coinsurance limils of No. No. (Address, CRY, Stale) - Endersemerds Applicable Pmcenlate Applicable llablllly (S) 1 1 3000 w/s Lake Mary Road Main Bldg MP0090 901 $150,000. Club- MPOO13 House MP0331 MPO420 Personal MPOO90 901 $ 30,000. Property MPOO14 MP0331 MPO420 1 2 to it of " Locker Bldg M170090 901 $ 15,000. Room MPOO13 MP0331 MPO420 1 3 to it " " ProSho Bldg MP0090 901 $ 25,000. Cart MPOO13 Shop FIP0331 MPO420 1 3 " it it of to Personal MPOO90 901 $ 15 Property MPOO14 MP0331 MPO420 1 4 " " " " Mainte Bldg M170090 901 $ 20,000. nance MPOO13 Storag MP0331 Bldg MPO420 1 4 of it to of it Personal MPOO90 901 $ 5,000. Property MP0014 .MP0331 VPO420 2 1 651 N. Highway 1792 Drivin Longwood, Florida Range No Section I coveriLge MP 12 05 (Ed. 07 77) .♦ SUPPLEMENTAL DECLARATIONS ENDORSEMENT MP 12 05 (Ed. 07 77) Designation of premises, as slated in The Declarations, is extended to incluti�( the following and Insurance Is provided with respect to those premises described below and with respect to those coverages and kinds of property for which a specific limit of liability is shown, subject to all the terms of this policy Including forms and endorsements made a part hereof: Loc. Bldg, DESIGNATED PREMISES OCCUPANCY SECTION I COVERAGE forms and Coinsurance Limits of No. No. (Address, City, Stale) Endorsements Percentage liability Applicable Applicable ($) 1 1 3000 w/s Lake Mary Road Main Bldg M1 901 $150,000. Club- MP0013 House MP0331 MPO420 1 1 of " " " " Personal MP0090 901 $ 30,000. Property MPOO14 MP0331 MPO420 1 2 to " " " Locker Bldg MP0090 901 $ 15,000. Room MP0013 MP0331 MPO420 1 3 it to to " ProShol Bldg MP009O 901 $ 25,000. Cart MP0013 Shop MP0331 MPO420 1 3 to of it it " Personal MP0090 901 $ 15,000. Property MP0014 MP0331 MPO420 1 4 to or " " Mainte Bldg MP0090 901 $ 20,000. nance MP0013 Storage MP0331 Bldg MPO420 1 4 it to to or of Personal MPOO90 901 $ 5,000. Property MP0014 MPO331 YPO420 2 1 651 N. Highway 1792 Drivin Longwood, Florida Range No Section I coverage MP 12 05 (Ed. 07 77) a At x'i.,lr . So } d rEo+✓�� ` . � yy Yy f•RUDUCE.H ` Ir C. CLHI Jf W I E l5 1 ULO AS A MAT ICf U1- Ir USiF:AT WN ONLY AND CONFERS ^ f �' b HINbi 0 UPON TI£ , HI.CAI E HOL Ob H. PN J CL" (YF I CE DOES AMEND, Er= t X , I YNU OR AL CESt PRt L. CO V1 aAiiE :1 atlIRJ£D UY YHL POLICIES UkEOW. OW. qP yr r SINGLETON- MTCHINSON- WINGO INC. I Orlando Florida 3280���� ut�Urr �� C(1YV16�APV6ES AFFSYR4�6NG Ct3A�EFRAGL it 4 $ .+ COMPANY A lr IILH AMERICAN FIRE AND_.INDEf9NITY__C NY - --- �' ANNI `ri�P )MHANY INSURED - ._.. . I I I L i AME RICAR NDFMIIATY Seminole Clubs Inc. CO ANY IILH V dam. DBA Mayfair Country Club Post Office Box 3911 u,ml•nNV Lake Maryp Florida 327 LH �y��{,, ypy� _. _x .t r .• _ e (r:.. �� Jufi�.: ; .:•W M .1- '' ���""�57�5 �Y:v'. C:1 ., �. bw d�a��Kri1'��t my l I I t Y7N � rwc I -'. ��.:. r�'.1Jl�.f�•�„�'rv." .'.. 5 ��� .'. '� t BE IJSUtU OR MAY PEIif AIN I ML IN Att VYtJtU d! HL P 1 iWa,r LI Jt.HItIGb YSeYitIN 1� aUCJLC I I V ALIry rf]Y_ YPnNIS tAl. Usl INJ, ANU (UNJ< TIONS Of SUCH M� 1 9LICUiS e CC) n, l,•, } — n 0 i fl GENERAL LLIABILYIVHAfv(,L _ un. (.Y NII .I,c,l - ,d I n r... ,n� I,nu l rlm ullnv -- rJ'`1hxF:vIIII V IM11I1 ry C L7 A rE i' Kf fdd i ..i t,UMPRcHENSIVt fOflPA .� `$ A x PHthfISESlOPEHAIIUNS ,:1 — x' t tl v UNULRGAUVNU r AMA( .� au:y '! ERI OSION & l OL APSI: IIAfAHD ' - fl Pi �DEanDEUrPCONTIwcunaRAnO "s SMP 448 16(30 112/25/85 112/26/86 „i:'; 500, 500 { Ek �� X BROAD FORM PIIOPEWY OAMAU. 'K^ 1 r•t it ONAL INaUHY a PERSONAL INJUHY 5�F E s x' k R AUTOMOBILE LIABILITY f t I ANY AUTO �lthItk rl' ALL OWNED AUTOS (PRIV. PASS) ALL OWNED AUTOS WHIR UTAN i uu ,`Ei �� HIRED AUTOS . I I 'r HUY th IY d A NON OWNED AUTOS SMP 448 1600 1 12/26/85 1 12/26/86 -„ GARAGE LIABILITY t a I n �" � lYrJ ! 500 EXCESS LIABILITY 10 _ II j Binder 12 26 8 } UMBRELLA OHM / / 12/26/$6 �rUlaI COO Is lr e OTHER INAN DINBRtILA R1RM __srh' w : Ir nmY.IV � K rys. WORKERS' COMPENSATION I� A t tcn tf l) , AND s EMPLOYERS' LIABILITY I$ IIII r A FI L Y NTH 1J; aI5L•SI LAHLMI IUYILI,+,� A O THER Bui I y S din i S 448 16 00 112/26/85 12/2 _ 6/86 ` See Arta 1 DESCRIPTION OF OPERAIIONSiLOOAIIONSIVEHI ('LLSISFCCIAL IIt 02 ADDITIONAL INSl1REDs CITY OF SANFORD A l 1 , SYYi�M+W'�1x \ . ;yW�: J Y�� a � � ! Y'I+ �J L1 1. ~'lV.. -. R y ... f y}Y J . 5 4S� l 7Jr' . . IIYX � Y': S' �. ....r..a. i. ....�sx Y. . ?_.. e_..i twat..,., :'_.Y.i'`,._......'..i� ..-- -- -- ....,. .w. _ ._. ..•.'!.. _ _. _. r!w .. ..,.. .. � 5¢. __Y `a. .x.�.:.... .� City of S.rfuri J �n At Warren ?n6vles City Mar, F � 6 W. Bam 177 !�S� 4h ANY KIYJI (IP,,Y YfG f- t)MPANY 11 .. A(J.Lf 17 t)H it YfiG SLIVIAIIV�S. ) _ fy` ,i SUPPLEMENTAL. f➢E �a..., :Jt•.. :.: ,er (I'd. 07 71) Designation .of premises, as staled In the Dee« rations, is extended to include me following and insuranc.. , provided with respect to those premises described below and with respect to those coverages and kinds of property for which a specific limit of liability is shown, subject to all the terms of this policy Including forms and endorsements made a part hereof: Loc. Side. DESIGNATED PREMISES OCCUPANCY SECFION I COVERAGE forms and Coinsurance , Llmils of No. No. (Address, City, Stale) Endorsements Percentage Liability Applicable Applicable (S) 1 1 3000 w/s Lake Mary Road Main Bldg MP0090 90% $150,000. Club- MP0013 house MP0331 MPO420 1 1 " " " " " Personal MPOO90 904 $ 30,000. Property MPOO14 MP0331 MPO420 1 2 " " " " Locker Bldg MP0090 90% $ 15,000. Room MPOO13 J MP0331 MPO420 4i { 1 3 " " " " IProShol Bldg MP0090 90% $ 25,000. Cart MP0013 Shop M170331 MPO420 1 3 " " " " " Personals p MP0090 90% $ 15,000. Property MPOO14 MP0331 MPO420 1 4 " " " " Mainte Bldg MPOO90 90% $ 20,000. nonce MP0013 Storngf MP0331 Bldg MPO420 1 4 " " " " " MM Personal MP0090 90% $ 5,000. 9 Property MPOO14 II MP0331 VPO42D 2 1 651 N. highway 1792 Drivin Longwood, Plorida Range No Sects n I cove ge { { MP 12 05 (Ed. 07 77) O w L QO WE za OH O ZYO HNW >om ZON ow w Z oUO h LL.6 mm, OU Z S m ®hW aw O ¢ k :E w ,4< H w ��O wow y =h w hm W 6 ' H Y. ¢ wx o U ,mw Iz w w 0 a 666 Q It W (S Z 6r LL LL Q 611 Z Q d V Z o C) O U Enw:vwmlTm V C a O d w 9x 6 w p w ¢ w �k �k Mir 2 k �k OJ OW OW OOJ OUJ C) L Q M U ON m V C a O � s N Q C 00 C) L Q M U ON m C C M 'O N F C 3 X L 3 n O 3 1L N X w N4--t- L Y C N O A4- . f¢ V C C O D U' O N.Y C P E Q 9 N O N (70.0 N CI Q. -j WQO h �0 UFO Z MW O m2 M m� J YK O p�h WW J 0 = w_h h Z Z Zw m2w mmN O UN N ?OZ W, w h Y oO w u V ZQO WZN m w >yJ 4,0 9 H LLW OY mom O yZO w00 ZO6 h mQyj Y 7 'w �Mo �Z M > a ho2x mz ONm h rj0 N3yN Nh -Z �Zm d! 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WOzw > W w J Q w K E =XT�O 0< ZO LL m2CN?n J Y¢HW N6S'J L n Y 1 4) M cm R t Y n C N L X LL 03 m i • C 1 O 4• h + . a U Q d V �! o � LLW M gzo as W W \ Jm Ow- mm V H 2 =m zQ� D 5go r�` 0 X . Sal U) O-> (�1 H8 Q IL Z w 3 N O N N M S D S N LL O O w �.O J Z 7 U N T: M H C M ' a 042 0 r L N LL L) r U w 0 4T tZ I- 0 R p� NQ CL -j N 2 w O O 4 � a z z am mo m0 0 O1 N 07 O h M V z z ¢ O R pZ m W w d O � z g O w a gw ° a$ 3 O¢ � a � 0 Q C a Z w U L6 w O Z 0 U o C z Z � Q O H ¢ 2 W M O O z O O „ a w a c t°n G 0 W� WOW _ =0Om w >a QQWm OZZ'OVi c W r � O w 'Wg-c = a° DE ON O W W 'ME ¢ w0 CE t CS �EM N WNO�� � y 0 =z $+ zza oz0 OW d0 k mixl= g = ~O z a � R Z n 00 ~Y k F � F a =Q � LL �uW = N in f L T r V h h 0 M $ t6 t6 C r� 0 G "i x U- H O 3 O 4 C U QO. N J °ac r z �mz 4 UH G Z V OOTj � < ° y� fA fR fA pLL` RR F W = z T WVB HUQ¢ j 7w�w - Of W d c f< >yr �wQ o G � Om0 a3w �S W '' m N mm N =oz w ROOD m B m V D W ' NU zx Q¢ a a¢ ar�Wj W' N ¢ZO W o$= z W O 2 T W E. U J d yzN O N N M S D S N LL O O w �.O J Z 7 U N T: M H C M ' a 042 0 r L N LL L) r U w 0 4T tZ I- 0 R p� NQ CL -j N 2 w O O 4 � a z z am mo m0 0 O1 N 07 O h M V z z ¢ O R pZ m W w d O � z g O w a gw ° a$ 3 O¢ � a � 0 Q C a Z w U L6 w O Z 0 U o C z Z � Q O H ¢ 2 W M O O z O O „ a w a c t°n G 0 W� WOW _ =0Om w >a QQWm OZZ'OVi c W r � O w 'Wg-c = a° DE ON O W W 'ME ¢ w0 CE t CS �EM N WNO�� � y 0 =z $+ zza oz0 OW d0 k mixl= g = ~O z a � R Z n 00 ~Y k F � F a =Q � LL �uW = N in f L T r V h h 0 M $ t6 t6 C r� 0 G "i x U- H O 3 O 4 C U QO. N J sL NO pQZ Otg' w i a V :. Wr0r ' Z Z QZ z = W6 ® a r j O j g 5 Z`z 'c 0 VWV Q r aU2 f/i a fA � fA fy 41� fA U3 O O n WQO 0of0'i r ZZO 0- = r w w_ w a x •O WZZO> °� �O 1j ¢ t .. J t J ,muWc U. y U¢ r <6 M J N w e V pJWrr W Jp Z< W Z O \ J O fA VD f9 ¢ E9 Ea (A io (9 ¢ 4-t 3 Z > W W o ' v �} e: 3 a�u� w o € � w w ¢ 0 c04 W pw ® } w vi m » j N ti! IN w<5 o z o z 'F »v3 En N L 1y at3 !kQ tc mm V r O N > F a, _ ._ �...._• a ¢ ¢�F a J J¢ o0 �+ am pp g a� W 11 a ga 9 s as Of am m2 -am m2 ¢ y N U N N m�IL yN01=110 (� Z WO¢ a ffi no m mU WOWSN ,,a � s¢m W c s- oar a °€ N L AN J00�2 gDi-ya co Mwm � ,., qt N \ Q = -Zi Q LL J it R ,� orZ =< waa <a UI w p,Z„@ .- W u: W M m') = = ta a Q ZZ -w •\O 10 x Z ysh a W �€ N N N m ; W N N N N ~ ,q hzW V W Ofx r00 • WO >> apJ U M,g � Q " w W - 2 LLZ_ w ' o m I, V G W WW a �> N UL3 2 N¢p Q2 QQ Q[[ QQ Q¢ N�y 9m O Q O q WE a 0 xox F -[LW ae O J a� aL a�u ru ak mzw - - ma�2 S a G1 to OJ UJ UJ UJ QU ¢ S a ° W m M O N x mom O O W g pH U CL O a L U Z W rOR 8 ^ a Z Moo H UQO �.- QzQ g 04 O. w 4. N Z n OWZ N w N s 1 CJ N =rq N N Z y. F N N M 1 O • A^ M ' WZy OW N Z N Z p C 41 M'6 N2? m N a+ 0 to M - c lgww r Z O O U O O Y L H Q Op N 0 0 0 m 1100= W q � q - a a¢ 2 F p O � z c �. V O\ �� o 3 LL u RQy =ZWC) U x 11 W O O > iZ g va 5 a :1 w a L Z •s z Q 0 IL (� t> w T ra11- ¢ o z o a J co ¢ M LL tQ 2N J t0 • O N > z > m m `a 5 H F Q O z in W Z X w O t0 0 Paz= w m m o c ° � g n. zmO Q c4 r a z S S a s S a arc o U a W C 1i O O J QQ O a > utN C E . 0 •E WZQU UFOy O w a woz x ca C3 z W Y o w ° w to z ° w m a g 1- in > Q o J N N W L O z o 1-4. c rt 4+ M aJ (9 0 • Z Q 0 N `1 5 9 N Poo P S W r g 511 m ho m'�' O 22 f w p ° O O 0 3 2 - ¢ 5 ° J a S $ w u' J w N m ¢ w �y Y a Q '� 6' GS Z O N {- U Q N W d� 0 V� O O.�l N - f ' /)N W P) 4 6 J 6 S 2 O 3 W _ W F O a M O 1-9 • ¢ a � o t/9d9- O MH < X w p U Q O 2 m Z Mr • N Q Q 8 - J a I a f SUPPLEMENTAL DECLARATIONS P``' ORSEMENT MP 12 05 (0 ff (Ed. 07 11) Designation of premises, as stated in the Declarations, is extended to include the following and insurance is provided with respect to those premises described below and with respect to those coverages and kinds of property for which a specific limit of liability is shown, subject to all the terms of this policy including forms and endorsements made a part hereof: Loc. Bldg. DESIGNATED PREMISES OCCUPANCY SECTION 1 COVERAGE Forms and Coinsurance Limits of No. No. (Address, City, State) Endorsements Percentage Liability Applicable Applicable (j) b1P0090 1 1 3000 IY /S Lake Mary Rd. Main Bldg. 1 900 150,000. Sanford, Fla, lubhou a MPO420 1 1 Same As Above Main Personal Clubho se Proper y MPOO90 900 30,000. MP0014 1 1 2 or " to of it Locker Bldg, b"090 900 30,000. Room MP0013 1 1 2 " " " " " Locker Personal URN 900 5,000. Room Property MPO420 1 3 " " " " " Proshor Bldg. 1-11 900 25,000. Cart Stop MPOO13 MPO420 1 3 " " " of is Pro Shp Personal MP0090 90% 15,000. Cart Sop Properly MPOO14 MPO420 1 4 " " " " if Bath House ?IPO090 900 10,000. P Ofc. Bldg. MP0013 MPO420 1 4 to it it or " Bath Muse MPO090 900 2,004. P, Ofc. Personal 14P0014 Property 1-11"0420 1 5 it It or of " Storag , Bldg. MP0090 90% 10,000. tainten ce MP0013 NPO420 1 5 to it it " it Storag Personal 111POO90 900 2,000. Mainte ance Prop rty MP001 MPO420 1 6 n n n n n Maintei ance 14P0090 90% 20,000. Storag Bldg, ORB 1 6 " to it it to Mainte ance Pers 111P0090 900 5,000. Storag Prop. MP0014 1 to of to to 11 Golf Cart Bldg. MPO420 141"0090 900 10,000. Storag 0 420 2 1 651 N. Hwy. 17 -92 Longwood,Fl Storagt wolf Dri ing No ection I Coverage MP 12 05 (Ed. 07 77) O4, - a try � Sanford }� G 32772.1778 ' �� ° Commission Plan July 26, 1984 WARREN E. KNOWLES CITY MANAGER Mr. Jack K. Daniels, President Mayfair Country Club & Golf Course Post Office Box 3911 Lake Mary, Florida 32746 Re: Insurance Dear Jack: 305/3223161 P. O. BOX 1778 300 NORTH PARK AVENUE I received a certificate of insurance from Singleton, Hutchinson, Wingo, Inc. and note it does not conform to the lease requirements, Section 3, subparagraph (19) Liability Insurance, page 12 of the lease. I called your insurance agent and told Maralyn of the lease requirements. She said she would get out a new certificate to conform to the lease and state specifically this also insures the City of Sanford. Maralyn told me they do not have your umbrella coverage of a million dollars but she knew you had one with another coverage. This one expires in September, 1984. Jack, please obtain a certificate from your umbrella coverage and be sure the City is named as "additionally insured ". Attached is a copy of the particular lease paragraph. Very truly yours, CITY OF SANFORD W. E. "Pete" Knowles City Manager WEK /mjh Enclosure "The Friendly City" T..., SUPPLEII I DECLARATIONS '" ORSEMEIiI - svrr ac vu - (Ed. 07 77) Designation of premises, as stated in the Declarations, is extended to include the following and insurance is provided with respect to those premise: described below and with respect to those coverages and kinds of property for which a specific limit of liability is shown, subject to all the term! - of this policy including forms and endorsements made a part hereof: Loc. Bldg. DESIGNATED PREMISES - OCCUPANCY SECTION I COVERAGE Forms and Coinsurance Limits of No. No. (Address, City, State) Endorsements Percentage Liability Applicable Applicable (j) 1 1 3000 N/S Lake Mary Rd. Main Bldg, g P0090 Sanford, Fla. - lubhou a MP0O13 904 125,000. 1 1 Same As Above Main Personal MPO420 lubhou a Propert MP009O 904 30,000. MP0014 IAPO420 1 2 " " " " Locker Bldg. MPO090 904 30,000. Room MP0013 MPO420 1 2 it " '+ " Locker Personal MP0090 904 5,000. Room Property MP0014 MPO420 1 3 " " " " Proshol Bldg. MP0090 904 25,000. Cart Stop MP0013 14PO42O 1 3 Pro Shp Persona MP0090 904 15,000. - rt Shc p Propert 0014 W0420 1 4 Bath House MPO090 904 10,000. 4 Ofc. Bldg, MPO013 MPO420 1 4 " n " " Bath Hc use MP0090 904 2,000. 4 Ofc. Personal MPOO14 Property MPO420 1 5 Storage, BLdg. MP0090 904 10,000. Pla intenance MPOO13 0420 1 5' " " " n Storag Personal MPO090 904 2,000. H aintensualle Propetty MP0014 MPO420 1 6 " " " " ' Maintenance MP0090 904 20000. Storage Bldg. MP0O13 MPO420 1 6 Maintenance Pers. MP0090 904 5,000. Storage Prop. MP0014 W0420 1 7 Golf MPO090 904 10,000. art Bldg. MP0O13 651 N. Hwy 17 -92 tora a 01f �r ving RPO420 2 1 Longwood, Fla. go No Section I Covera e MP 12 05 (Ed. 07 77) ,, tic /oil ' 44 (19) Liability Insurance Supplementing the insurance indemnification.-provision of this lease, Lessee agrees to carry a policy of public liability and property damage insurance in which the limits of liability shall not be less that $500,000.00 per person, and $1,000,000.00 for each accident or occurance for bodily injury, and $50,000.00 for property damage. Said policy shall name Lessor as co- insured and shall be insured by such companies as are first approved and acceptable to Lessor. M JOHN K. DANIELS PRESIDENT ANTHONY CARIONE SECRETARY TREASURER THOMAS FONSECA GOLF DIRECTOR ALBERT O. LOVATO HEAD PROFESSIONAL :,funfair Tountry 0 1 August, 1984 Mr. Warren E. Knowles, City Manager City of Sanford Sanford, F1. 32771 Re:. Insurance PHONE 305- 322 -2531 I am in receipt of your letter dated 30 July 1984 regarding Limits of Liability on insurance . I have contacted. Marilyn at Singleton Hutchinson & Wingo who is forwarding to you the increase of $500,000 BI & PD. Wingo had a copy of my lease when he prepared the policy so I can only conclude that it was an oversight on the agency's part. Thank you for calling this to my attention. Very truly yours, SEMIN CLUBS INC. John K- Danie President POST OFFICE BOX J - SANFORD. FLORIDA 32771 l SUPPLEMENTAL DECLA fdnS Er."imatmtns mr tc vo ° (Ed. 07 77) Designation of premises, as stated in the Declarations, is extended to include the following and insurance is provided with respect to those premises described below and with respect to those coverages and kinds of property for which a specific limit of liability is shown, subject to all the terms of this policy including forms and endorsements made a part hereof: Loc. Bldg. DESIGNATED PREMISES OCCUPANCY SECTION I COVERAGE Forms and Coinsurance Limits of No. No. (Address, City, State) Endorsements Percentage .Liability Applicable Applicable (S) 1 1 3000 W/S Lake Mary Rd. Main Bldg. MP0090 Sanford, Fla. C lubhow a MPO013 901 125 1 1 Same As Above Main Personal MPO420 lubhoute Propert MP0090 901 30 MP0014 MPO420 1 2 if " " " Locker Bldg. MP0090 901 30,000. Room MP0013 MPO420 1 2 ^ " n " Locker Personal MP0090 901 5,000. Room Property MPO014 _ MPO420 1 3 it it TM of Proshol Bldg. MP0090 904 25,000. Cart Stop' MP0013 MPO420 1 3 n of s. it pro Shp Persona MP0090 901 - 15,000. art Shp Propert MP0O14 MPO420- 1 4 " If of of Bath HC use MP0O90 901 10,000. &'Ofc. Bldg. MP0013 MPO420 1 4 " " " " Bath Ik use MPOO90 901 2,000. 4;Ofc. Personal MPOO14 Property MPO420 Storage, Bldg. W0090 901 10,000. Ila intenon cie, MP OO13 0420 1 5' it If If n Storag Personal MPO090 901 2 Wntensane Propetty MPO014 MPO420 Mainteranco MP0090 901 20,000. Storag . Bldg. MP0013 " MPO420 1 6 " " : " " Maint ce Pers. MPO090 901 5 Storage Prop. MP0014 MPO420 1 7 Golf. '' MP0090 901 10,000. a: Bldg. MP0013 651 N. Hwy 17 -92 tlf C vin MPO420 2 1 Longwood, Fla. go g No Section I Covers e MP 12 05 (Ed. 07 77) �.L -ivona uti o,l r. TONY RUSSI INSURANCE AGENCY R SERVING THE ACTION CENTER OF FLORIDA" 2575 South French Avenue - Post Office Box 700 Sanford, Florida 32771 Phone: 322 -0285 ANTHONY J. RUSSI AGENT OWNER -.- November 9, 1983 Pete Knowles, City Manager City of Sanford 300 North Park Avenue Sanford, FLorida 32771 Re: Seminole_.Clubs,..:Inc- dha... _.. Mayfair Country Club Dear Pete: Per your request attached are copies of the insurance policies on the above captioned insured. Cordially, is)\ Bernardo Rios, Jr. Agent cc.files If you should need any additional information please call. /� �� ,. s7u QfS N, :;Sft a JI E,. t > .D} t.,n a -. r , nt -. 1 iO Apyhol .0 job .. e 5,71E , 3d i. d U! i)p � 43u; .P: _ �: JG a6p val FY J L waymv 0 syp =' Ac V , Aj!�IQF j6' ;!Lw, 5!?l"'CS „ t {am ni d =wd p S, 9 Y to '.:Bh how; A, :0 .; wad vy, "i r {..;r 1A0..+ wll .ahj :r) AaBnr,,n ll o_ l "I ^e4:' SF 1 Jooeu , n V `st `n Y0 1H31NV N yJh Yt /(10 :V( .1 J 3 fi1Ldt & ; No; ..,. ,. rl. .. - 3, s .2 f pw Sw s wupy 5 :.1... :. ..i3, P_. <n 70� , ;lJ lj'd6A We U ounif - 91, y. i 1," 'ICAO 6 9a. d A 7 9 y! KE co-SE MMA "In! one, Un, flaw m 7" lum Jim& 145500 (mns my ou A, D ja um "Ns msup V pu gunsN PaMON , MOP Y-0 Zil mm vltlr MATE 1 lWo , 1 A . sw: OWN "YAP," 40, pm a, a, 10 V e Umo; f ;U A pmau pm wQNs wwwwo 3gams Ac mqq pqo"Q h Q vIUAAU! 't, j.q. 0 a J 5 +'mm Wawa ��2 0, td,[)G'w , '(:I' -sit . 0 "I'M 04 Uv IW 9 y! KE co-SE MMA "In! one, Un, flaw m 7" lum Jim& 145500 (mns my ou A, D ja um "Ns msup V pu gunsN PaMON , MOP Y-0 Zil mm vltlr MATE 1 lWo sw: 10 V e Umo; f ;U A pmau pm wQNs wwwwo 3gams Ac mqq pqo"Q h Q vIUAAU! 't, j.q. 0 td,[)G'w , 9 y! KE co-SE MMA "In! one, Un, flaw m 7" lum Jim& 145500 (mns my ou A, D ja um "Ns msup V pu gunsN PaMON , MOP Y-0 Zil mm vltlr MATE 1 lWo o Ws F Tv on as Weave dam. -:z"Y 'y z. ^e 001,:v : vsWr - 1 ow� IV— UsA "0001, So innundY a- oI. - n v Jc,d by oI,r .Id are locaed ,° r hr no&= q,, s "w worey I Ph. asum an nand hew GS 41,< < ...... . .. — --------- too �lk yi — -1 I o Ws F Tv on as Weave dam. -:z"Y 'y z. ^e 001,:v : vsWr - 1 ow� IV— UsA sub, tl AD NOW ATIMSOV Vann 11 MOTTOU SM W V Z��V;t '0., CU,. Y snot NawQ. poln!", 0, aAj*R111,Wf0d0O, pa,,,oqinv A Paubwaummo . L47 ogle Am "was "';"eng A ANVAo, , ,o.}, QO ;ml mLrA 1pntS Auttc,�Aw aw InAamcm; maw voy Pai"Oueo aq lyqs kwo ON" POi1 aAj*R111,Wf0d0O, pa,,,oqinv A Paubwaummo . L47 ogle Am "was "';"eng ;ml mLrA 1pntS Auttc,�Aw aw InAamcm; maw voy Pai"Oueo aq lyqs kwo ON" POi1 SU } � -x1, „z CUe PK .; " 0 d U0Ad 'L1' qav so * M 's F xy!"n 2M�v jU�Aj ALIP, 1A tMIjP'JIjq( 'vijj ;C' A�M)Jl: K ;r 1VtiU A,, I , jinix, e lil o 1,,� I .o`x Mitt U, m,!u!Ai 1 041,; ILU,-oLUEU� W;-,WjLVA V�j:: "t '"'-owa�d pm�ou�� iunuk Sow i11�j duo! Pa ODUZIJJII: () 0 >v” jOA �X, Y? YUG 0 J} i ,Vq Imman Zs H CA 3 A V IN Ar"N 06 vin M uU ji Im p d pa mV m u m n v q up 11Cf ma 1 A VMWU a I e 0 WIn Ty W f 0 P,, x }Jyv, -5u i s wi C Py 'UM, - M OO, J 1 L X.0 1:11 - 1 Jo -W&I fd N, Z It X NAME ANi) ADDRE$Sr OF AGENCY B. CROCKETT AOENCIES INC. COMPANIES AFFORDING COVERAGES F, 0. B Ox 460 COMPANY A WINTER PARK, FL. 32790 LETTER f1 GRAPHIC ARTS MUTUAL INS. CO. (UTICA) COMPANY B LETTER UTICA MUTUAL INS, COMFAn NAME AND ADDRESS OF INSURED COMPANY LETTER SEMINOLE CLUBS INC F. 0. DRAWER 3911 COMPANY D LETTER LAKE MARLx CL. 32746 COMPANY LETTER This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate 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. COMPANY POLICY Limits of Liability in Thousands (00 0) LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE OCCURRENCE GENERAL LIABILITY ®COMPREHENSIVE BODILY INJURY $ $ FORM /� A ® PREMISES — OPERATIONS FMF� 23254 11 - 1 - 82 PROPERTY DAMAGE $ $ ❑ EXPLOSION AND COLLAPSE HAZARD ❑ UNDERGROUND HAZARD ® PRODUCTS /COMPLETED OPERATIONS HAZARD BODILYINJURYAND ©CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 300 $ 300 ® BROAD FORM PROPERTY COMBINED DAMAGE ❑ INDEPENDENT CONTRACTORS ® PERSONAL INJURY PERSONAL INJURY $ 300 AUTOMOBILE LIABILITY BODILY INJURY (EACH PERSON) $ B ® COMPREHENSIVE FORM BODILY INJURY $ OWNED (EACH ACCIDENT) n BAP 301753 11 -1 -82 Lj(1 HIRED PROPERTY DAMAGE $ NON -OWNED BODILY INJURY AND $ PROPERTY DAMAGE 300 COMBINED EXCESS LIABILITY B ® BODILY INJURY AND UMBRELLA FORM LU 6 /. 9 °Y'i 11 -1 - 82 PROPERTY DAMAGE $ 1 000 $ 1 000 ❑ OTHERTHAN UMBRELLA. y COMB INED t FORM WORKERS' COMPENSATION .STATUTORY A and W 23368 -81 11 -1 -82 $ EMPLOYERS'LIABILITY lOO (ELC H ACCIDENT) OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES OPERATIONS IN THE STATE OF FL. Cancellation: Should any of the above desc bEd policies be cancelled before the expiration date thereof, the issuing com- pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER DATE ISSUED: 9 CITY OF SANFORD CITY HALL SANFORD, FL. 32771 AUTH EPRESENTATIV M6 ATTN: MR. KNOWLES 25 1 NAME AND ADDRESS OF AGENCY B. CROCKETT AGENCIES, INC. P. 0. BOX 460 WINTER PARR, Pt. 32790 NAME AND MAILING ADDRESS OF INSURED SEMINOLE CLUBS, INC. P. 0, BOX DRAWER J SANFORD, FL. 32771 LK1019:T.`t7 Effective 12:01 Am NOVEMBER 1, Expires 0 12:01 am 0 NoonDEC. I. 0 This binder is issued to extend coverage company per expiring policy ft (except as not Description of Operation /Vehfclex /Prnnerty Type and Location of P roperty R BUILDINGS A CONTENDS — AS PER SCHEDULE R 0 ATTACHED P CONTRACTORS EQUIPMENT FLOATER - AS PER E SCHEDULE ATTACHED R MISCELLANEOUS EQUIPEM TT FLOATER - AS PER T SCHEDULE ATTACHED Y L Type of Insurance 1 0 Scheduled Form Womprehensive Form A B XI Premises /Operations 1 X] Products /Completed Operations L ZI Contractual I XI Other (specify below) BROAD FORM CGL ENDORSE. T X Med. Pay. $ Per $ Per Y X1 Personal Injury Perron Accident A U Rl Liability V Non -owned 11 Hired T 0 Comprehensive - Deductible $ 0 0 Collision- Deductible $ IN 0 Medical Payments $ g J0 Uninsured Motorist $ 1 JP No Fault (specify): STANDARD L 0 Other (specify): E COUNTRY CLUB Co verage /Perils /Forms ALL RISK ALL RISK ALL RISK Coverage /Forms Bodily Injury Property Damage Bodily Injury & 19 81 above Am of Insurance I Ded. $195,200. $250 71,250. 1$250 82,425, /t tit "'¢ t9t ttt 0 A 08 0 C I Personal Injury Accident) $ Property Damage $ ly Injury & Property Damage Combined $ 300 BKWORKERS' COMPENSATION — Statutory Limits (specify states below) 0 EMPLOYERS' LIABILITY — Limit $ SPECIAL CONDITIONS /OTHER COVERAGES GLASS COVERAGE — AS PER THE ATTACHED SCHEDULE CRIME COVERAGE - LOSS oB MONEY & SECURITIES — INSIDE & OUTSIDE $3,000. UMBRELLA - BODILY INJURY & PROPERTY DAMAGE COMBINED $1 LESS OUR AND ABOVE NAME AND ADDRESS OF MORTGAGEE 0 LOSS PAYEE IWDD'L INSURED MORTGAGEE: ELLIS NATIONAL BANK OF VOW , NN NCSA UMBER P. O. BOx 908, DEBARY, FL. 32713 ADDITIONAL INSURED: CITY OF SANFORD SANFORD, .. F1.. B. �C&EtGKETAGENCTES, INC. 2t/A✓Jf // s , 10 —aft -8 Signature of Authorized R presentative 'Date ACORD 75 (11 -77) SUPPLEMENTAL DECLARATIONS ® Standard Policy Face (For Optional Policy Face Use Reverse Side) CF 12 05 (Ed. 01 75) Company Policy No. Insured SEMINOLE CLUBS INC hem No Amounifin or Fin and Eateadad Co. treat, a Other fire Per Gent at Cain .... nice Apphodle DESCRIPTION AND LOCATION Of PROPERTY COVERED SAO. total ru[ face , type at .I and ocwWnc, of hwldingO co.ered or conomm, the property to ... ad.If"cupnd as a d.eNm, stall number of fomdies . 1 $ 100,000. 90% Frame, approved roof building located at 3000 W/S Lake Mary Road, Sanford, Florida, Occupied as Main Club House 2 13,000 90% Contents on above building. 3 20,000. 90% Masonry, approved roof, located at 3000 W/S Lake Mary Road, Sanford, Florida, occupied as Locker Room & Office. 4 2,000 90% Contents on above building. 5 14,000 90 0 /o Frame, approved roof, located at 3000 W/S Lake Mary Rd, Sanford, Florida, occupied as Pro Shop and Cart Shed. 6 2,000 90% Contents on above building. 7 5,000w 9 Frame, approved roof, located at 3000 W/S Lake Mary Rd, Sanford, Florida, occupied as Bath House. 8 Nil 90% Contents on above building 9 4,200 90 Frame, approved roof, located at 3000 (Rear) W/S Lake Mary Road, Sanford, Florida, occupied as storage. TO I 1,000 90% 1 Contents on above building 11 14,500 90 ° /, Masonry, approved roof, located at 3000 (Rear) W/S Lake Mary Rd., Sanford, Florida occupied as Mainte- nance Garage. 12 5 90% Contents on above building. 13 14,500 90% Masonry, approved roof, located 3000 (REar) W/S Lake Mary Road, Sanford, Florida occupied as Golf Cart Storage. 14 Nil 90% Contents on above budding. I Minnesota: Insurable Value ❑em 110 a ^° ^ Mississippi: Total Insurance" Item No. $ Item No. $ South Carolina: Valuat C l au se" Item No. $ Item Nu. $ CONTRACTORS EQUIPMENT FLOATER 1970 JACOBSON F10 FAIRWAY MOWER 467992 $8,000. FORD DIESEL TRACTOR 46C405051 2,500. FAIRWAY MOWER DIESEL, JACOBSEN F -20 41F2016116 9,000. JACOBSEN GREENS KING MOWER #2228 2,250. JACOBSEN GREENS KING MOWER 461867 2,250. JOHN BEAN 100 GALLON SPRAYER 46105980 200. JACOBSEN TRAP KING 4688000 -20 1,000. JACOBSEN SOD CUTTER 4131728 500. JACOBSEN TOP DRESSER 41372346 500. BRUTUS ROLLER 4682098 1,100. HECKENDORN MOWER 46176N73 750. JACOBSEN GREENS KING MOWER 41T /F 1,500. BOBCAT LOADER WITH 42" BUCKET 46T /F 1,700. MISC. EQUIPMENT 25,000. TURF KING 84, MDL. 67706 461953 6,000. EXCELL HUSTLER, MDL. 922203 417908522 9,000. $71,250. CLASS SCHEDULE NO. OF PLATES LENGTH WIDTH DE SCRIPTION 6 58 58 PLAIN PLATE 3 98 62 PLAIN PLATE 4 58 34 TEMPERED PLATE 2 54 34 TEMPERED PLATE 1 104 40 TEMPERED PLATE MISCELLANEOUS - PROPERTY FLOATER 1) 34 WESTINGHOUSE 3 -WHEEL ELECTRIC GOLF CARTS @$800. EACH 2) 40 EASY -GO 4 -WHEEL ELECTRIC GOLF CARTS @$500. EACH 3) 15 - 4 WHEEL CLUB CARTS @$1,800. EACH 4) 5 4 -WHEEL ELECTRIC GOLF CARTS @$1,645. EACH $27,200. $20,000. $27,000. $ 8,225. TOTAL $82,425. ClTd OF MEMORANDUM From: CITY MANAGER To: City Clerk Subject: Golf Course lease and insurance coverage Henry: Date September 25, 1981 Attached is the copy of the insurance binder on the golf course that was hand delivered to my office this morning. Yesterday I called the insurance firm and talked with Mr. James Tipton. This is the results from that conversation re the policy they had previously written to replace the canceled policies did not have the City on the umbrella coverage. We had quick words over that and you will note the City is now named on the million dollar coverage. Also note that it was made effective Sept. 28th, 1981. Hold these in your file with the lease. I also talked with Tommie Fronseca and let him know that the City expected to be kept informed in the future of any changes. SANFC.RD Copy: Mayor Lee P. Moore Pete .... .. _ ti_..._ _ .. _ an AD : 00 1 aw, ., i r^ 1 2 ...... C)C ler a — ..^;uo went i MlYmcd El Hwee; y _ my, ;aQW r 'KIP i ebw) �M LE"- 1. 0 _ ccu y _ il. C;1 q o� Sanford F1a,, Commission - Manager Plan October 28, 1981 WARREN E. KNOWLES CITY MANAGER Mr. John K. Daniels President Mayfair Country Club Sanford, Florida 32771 $e• Insuran Golf Club 305/3223161 P. O. BOX 1778 300 NORTH PARK AVENUE Dear Mr. Daniels: I am returning the insuran binder of B. Crockett Agencies, Inc. on the golf club properties. I ask that coverage be furnished as re- quired by the lease re minimum: - a) Liability at a minimum of: $ 500,000.- /person $ 1,000,000.- /accident b) Property damage at $50,000.- c) Fire coverage for restoration: (1) Club house $ 200,000. (2) Office and locker 60 (3) Pro shop.:and cart shed 60,000. (4) Bath house 12,000. (5) Contents of above buildings as listed in binder attachment (6) Remaining structures and contents as listed in binder attachment If you wish to differ with the above values established for fire coverage, I will be glad to discuss them with you. The other values are minimums re- quired by the lease. "The Friendly City" Mr. John K. Daniels, President :. Mayfaar Country Club Re: I nsuran ce /golf club -2- 10/28/81 Insurance coverage as specified is a lease condition and failure to pro- vide this minimum coverage is a breach of the lease. I am sure you do not intend to breach the lease but submission of coverage lower than required has been an on -going problem with your organization. In t alking with Mr. Carpenter today I find the reason for the difficulties may be that the limits and values used were from old insurance policies in excess of ten years ago. The new lease did not follow the old lease in certain aspects and insurance coverage is one. It would be well to read .and follow the new lease. I hope my detailing of the insurance needs has provided guidance to your people and that the City can expect the required coverage with a binder, indemnifying the City, in the hands of the City prior to Sunday, November 1, 1981. Thank you. MX/mjh Encl. - Insurance policy cc: Mr. Walt Carpenter B. Crockett Agencies, Inc. Very truly yours, W. .Knowles City Manager k ccolra kl L COMPANV A B. -Crockett Agencies, Inc. Utica Mutual Tn Company Effective 13;QA_ November 1 19 81 P.O. Box 460 Expires 0­121)1 am 0 Noon Dec. 1 19 81 0 This binder is issued to extend coverage in the above named Winter Park, FL 32790 company per expiring policy # (enept a s rated bet.) NAME AND MAILING ADDRESS OF INSURED Description of Operation/Vehicles/Property Seminole Clubs, Inc. P.O. Box Drawer J Country Club Sanford, FL 32771 Type and Location of Property Coverage/Perils/Forms Amt of Insurance Ded. % P R Buildings & Contents-as per at- "All Risk" See attached o tached schedule schedule 250. 900 P E Contractor Equipment Floater-as per "All Risk" $56 250. R attached schedule T y Miscellaneous Equipment Floater-as "All Risk" $92 I I 250 I 4ted 5ehetittle Type of Insurance Coverage/Forms Limits of Liabili L Each Occurrence Aggregate 1 0 Scheduled Form [RComprehensive Form Bodily Injury $ $ A B CiPremis es/Operations Property I Products/Completed Operations Damage $ $ Bodily Injury & L Co Co ntractual I Other (specify below) BV/CGk END. Property Damage T Med. Pay. $ P,, IPersonal Combined $ 400. nnn $ Personal Injury ---- $300,000. V Injury Pe,son AccOmt DA 0 8 0 C A Limits of Liability U Eltiability 0 Non-owned 0 Hired Bodily Injury (Each Person) $ 1 T 0 Comprehensive-Deductible $ Bodily Injury (Each Accident) $ 0 0 Collision- Deductible $ Property Damage $ M 0 0 Medical Payments $ B Uninsured Motorist $ 1 No Fault (specify): � Bodily Injury & Property Damage L Other (specify): Combined $ 300,000. E 1 ['.WORKERS' COMPENSATION — Statutory Limits (specify states below) 5L EMPLOYERS' LIABILITY — Limit .$ 100,000 SPECIAL CONDITIONS/OTHER COVERAGES Glass Coverage - as per attached schedule Crime Coverage - Loss of money & securities - inside & outside $3,000. T 010)(01 &Zak n n -1 GR0000 NAME AND ADDRESS OF [2 MORTGAGEE 0 LOSS PAYEE Cj AODT INS=URED Mortgagee: Ellis National B nk pz I " P.O. Box 908, DeBaiJOAN N ft?� yy 327 L3 Addtl. Insured: City of Sanford Sanford FL T ln 99 ACORD 75 (11-77) A a 4 n t U 001 y ._- ° i i 'U�.` Company Policy No. Insured SEMINOLE CLUBS INC. NO rag SUPPLEMENTAL DECLARATIONS Standard Policy Face (For Optional Policy Face Use Reverse Side) CF 12 05 (Ed. 01 75) Item No. Amount rise or Fire and Exten COY ttage, o r Other P.1 Pa Cent of COmS..)ne< AppliuDfe - DESCRIPTION AND LOCATION OF PROPERTY COVERED Shnw COn51ru[IiOn.: Pe Ot rppl and O[CU°)M OI DU�dr n Y Y g(si covered or containing, the property covered. It accuped as a dwelling state number of families. $ 85,000 90 Frame, approved roof building located at 3000 W/S Lake Mary Road, Sanford, Florida, Occupied as Main Club House 2 13,000 90% Contents on above building. 3 14,500 90 Masonry, approved roof, located at 3000 W/S Lake Mary Road, Sanford, Florida, occupied as Locker Room & Office. 4 2,000 90% Contents on above building. 5 14,500 90% Frame, approved roof, located at 3000 W/S Lake Mary Rd, Sanford, Florida, occupied as Pro Shop and Cart Shed. 6 2 90% Contents on above building. - 2,800 90% Frame, approved roof, located at 3000 W/S Lake Mary Rd, Sanford, Florida, occupied as Bath House. 8 Nil 90% Contents on above building 9 4,200 90% Frame, approved roof, located at 3000 (Rear) W/S Lake Mary Road, Sanford, Florida, occupied as storage. 10 1,000 90% Contents on above building 11 14,500 90% Masonry, approved roof, located at 3000 (Rear) W/S Lake Mary Rd., Sanford, Florida occupied as Mainte- nance Garage. 12 5,000 90 °k Contents on above building. 13 14,500 90 Masonry, approved roof, located 3000 (REar) W/S Lake Mary Road, Sanford, Florida occupied as Golf Cart Storage. 14 Nil i 90% Contents on above building. Minnesota: Insurable Value Mississippi: Total Insurance" South Carolina: Valuation Clause* *See Forms Attached Item No. S Item No. E Item No. 5 Item No. $ Item No. $ Item No. E s F 1 r CONTRACTORS EQUIPMENT FLOATER 1970 JACOBSON F10 FAIRWAY MOWER #7992 $8,000. FORD DIESEL TRACTOR #C405051 2,500. FAIRWAY MOWER DIESEL, JACOBSEN F -20 #F2016116 9,000. JACOBSEN GREENS KING MOWER #2228 2,250. JACOBSEN GREENS KING MOWER #1867 2,250. JOHN BEAN 100 GALLON SPRAYER X6105980 200. JACOBSEN TRAP KING #88000 -20 1,000. JACOBSEN SOD CUTTER X631728 500. JACOBSEN TOP DRESSER X6372346 500. BRUTUS ROLLER #82098 1,100. HECKENDORN MOWER #176N73 750. JACOBSEN GREENS KING MOWER #T /F 1,500. BOBCAT LOADER WITH 42" BUCKET #T /F 1,700. MISC. EQUIPMENT 25,000. $56,250.00 4 ♦ q f MISCL..LANEOUS PROPERTY FLOATER 1) 34 WESTINGHOUSE 3 -WHEEL ELECTRIC GOLF CARTS @$800. EACH 2) 40 EASY -GO 4 -WHEEL ELECTRIC GOLF CARTS @$500. EACH 3) 15 - 4 WHEEL CLUB CARTS @$1,800. EACH 4) 5 4 -WHEEL ELECTRIC GOLF CARTS @$1,645. EACH TOTAL $27,200. $20,000. $27,000. $ 8,225. $82,425. 0 aIV'Id aaaadwal 07 701 1 aIV'Id aaNadwal 7£ 79 Z alvad Qauadwal 7£ 89 7 alvgd NIvad Z9 86 £ RLV'Id NIVU 85 99 9 NOIIdIsosaa HIQIM HI9Na'I salVZd 30 'ON aanaaxas ssvz� y OF I.rti MO. lO DAY 9 YR. Sl BOP. 880 3019 BOP x 12:01 AM 012:OO Noo 22764 -586 9/25/81 rA Hmu THE HOME; INSURANCE :COMPANY INSURED'S NAME AND ADDRESS THIS City of Sanford NOTICE P O Box 1778 MAILED Sanford, Fla. 32771 TO L ❑ THE .HOME INDEMNITY COMPANY F PRODUCER B.Crockett Agencies,Inc. P O Box 460 Winter Park, FL 32790 J L Applicable item marked []x J CANCELLATION ❑ x You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your insurance will cease at and from the hour and date mentioned above. If the premium has been paid, premium adjustment will be made as soon as practicable after cancellation becomes effective. If the premium has not been paid, a bill for the premium earned to the time of cancellation will be forwarded in due course. ❑ You are hereby notified in accordance with the term's and conditions of the above mentioned policy that your insurance will cease at and from the hour and date mentioned above due to nonpayment of premium. A bill for the premium earned to the time of cancellation will be forwarded in due course. NON - RENEWAL ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned policy that the above mentioned policy will expire effective at and from the hour and date mentioned above and the policy will NOT be renewed. I ❑ To LIENHOLDER OR LOSS PAYEE] v v— You are hereby notified that the agreement under the Loss Payable Clause to you, as Lienholder, which is part of the abovepoli y i ed t e above insured, is hereby cancelled (or terminated) in accordance with the conditions of the policy, said cancellation (or terminatio be ctive on and after the hour and date mentioned above. ❑ To MORTGAGEE You are hereby notified that the above mentioned policy and the Mortgagee Agreement is hereby cancelled. Your interest under the said policy is cancelled on (a) the termination date shown above or (b) 13 days from "Date of Mailing ", whichever is later. NAME AND ADDRESS OF LIENHOLDER, LOSS PAYEE OR MORTGAGEE' AUTHORIZED REPRESENTAVVIR GNL 6630(F) 9/70 INSURED COPY SET TAB STOPS ARROWS hu . NAME 4N[) ADDRESS OF AGENCY B. CROCKETT AGENCIES, INC. COMPANIES AFFORDING COVERAGES ___71 P. 0. BOX 460 COMPANY WINTER PARK, FLA. 32790 ! LETTER T HE HOME INSURANCE COMPANY COMPANY B LETTER NAME AND ADDRESS OF INSURED COMPANY e MAYFAIR COUNTRY CLUB OF SANFORD, INC. LETTER V P. 0. DRAWER J COMPANY SANFORD, FLA. 32771 LETTER COMPANY E LETTER This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate 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 of Liability in Thousands (0 00) COMPANY LETTER TYPEOFINSURANCE POLICY NUMBER POLICY EXPIRATION DATE EACH AGGREGATE OCCURRENCE GENERAL LIABILITY BODILY INJURY $ 500,0© $1,000,00 A COMPREHENSIVE FORM PREMISES — OPERATIONS CC 8 74 95 91 10/27/81 PROPERTY DAMAGE $ 50,00 $ 50,00 EXPLOSION AND COLLAPSE HAZARD ❑ UNDERGROUND HAZARD PRODUCTS /COMPLETED OPERATIONS HAZARD BODILY INJURY AND ❑ CONTRACTUAL INSURANCE PROPERTY DAMAGE $ $ ❑ BROAD FORM PROPERTY COMBINED DAMAGE ❑ INDEPENDENT CONTRACTORS ❑ PERSONAL INJURY PERSONAL INJURY $ AUTOMOBILE LIABILITY BODILY INJURY $ ❑ COMPREHENSIVE FORM (EACH PERSON) BODILY INJURY $ ❑ (EACH ACCIDENT) OWNED ❑ HIRED PROPERTY DAMAGE $ BODILY INJURY AND ❑ NON -OWNED PROPERTY DAMAGE $ COMBINED EXCESS LIABILITY BODILY INJURY AND ❑ UMBRELLA FORM PROPERTY DAMAGE $ $ ❑ OTHERTHAN UMBRELLA COMBINED ORM (WORKERS' COMPENSATION STATUTORY j and EMPLOYERS' LIABILITY $ (EACX ACCIOENn i . BUILDLNGS CC 8 74 95 91 10/27/81 $105,000. A CONTENTS " " $ 23,000. DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES ADDITIONAL NAMED INSURED: CITY OF SANFORD, A.T.I.M.A. Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will endeavor to mail _ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME ANDADDRESS OF CERTIFICATE HOLDER: DATE ISSU CITY OF SANFORD SANFORD, FLA. 32771 ALT IZE PRESENTATIVE ATTN: Mr. Pete Knowles, City Manager ROBERT B. CROCKETT-, JR. ACORD 25 (1 -79) , _ Lion Unkrioritprs,lic. INSURANCE BINDER Effective Date of Binder: May 1, 1981 NAME OF COMPANY BINDING: Zurick American Insurance Company of Illinois INSURED: Seminole Club, Inc. MORTGAGE /LOSS PAYEE: N/A TYPE OF INSURANCE: Commercial Umbrella Liability AMOUNTS OR LIMITS: $1,000,000.00 RATES Flat DESCRIPTION OF RISK, LOCATION AND /OR OPERATIONS: Commercial Umbrella Liability in accordance with the terms and v stipulations of policy number 8942202 being issued by Zurich American Insurance Company of Illinois. SPECIAL TERMS AND CONDITIONS -- CO -INS. %, DEDUCTIBLE CLAUSE $ THIS BINDER EXPIRES August 1, 1981 OR WHEN REPLACE BY POLICY. The above named company assumes the risks indicated, subject to the terms, conditions and limitations of the company's current policy form or forms. Binder subject to premium charges. DATED: June 25, 1981 P.O Box 4� IVIadL 1V' 'Bt%M. `Suite 135 . Winter Parl�` 1 F1 js fflb "s@a h�1`le� remium $575.00 $ar1P ee ° ��. W State Tax $17.40 , jgrter #2 -1 THIS INSURANCE is ISSUED PURSUANT TO TtiE FLORIDA SURPLUS LINES LAWI PREM. $575.00 �-,,� . 7I 10� $I Adm FeT 5.00 St. Tax 17.40 P.O. BOX 20413 ORLANDO, FL 32814 (305) 894 -8797 WATTS 1 -800- 432-4877 TELES 56-4831 TELEX ANSWER BACK LUI ORL LYON UNDERWRITERS, INC. Co. Code AC 11C L ust. VER data or coMount n m . s�.��OP 72 t = Yes, Yes N6 1 1 8 0 3 0 19 X El xiwttm rwft , 1 t0 OFFKX FLORM BUSINESS OWNER'S POLICY DAILY REPORT Insurance is provided by the Stock Company designated by ❑x and hereinafter called the Company. CID ® THE HOME INSURANCE COMPANY `� Manchester, N.H. Audit Period: Annual, unless otherwise stated: ❑ Monthly ❑ Quarterly ❑ Semi - Annual ❑ Othe (Loc. No., Bldg. No. —Show location, construction, type of roof, occupancy and type of operations) Sim PMP 2b {83UM) (UCs 7941) In consideration of the premium, insurance is provided the Named Insured with respect to the described location(s) and with respect to those coverages and kinds of property for which a specific limit of liability or an amount of insurance is shown, subject to all the terms of this policy including forms and endo made a part hereof. Section Limits or Amounts and Coinsurance Coverages $150 ✓ 90 A. Building(s) $ 23,000.,/ 9% _ Personal Property $ ail Nil C. Nil $ Nil D. Nil Basic Perils Part applies to Coverage(s) X1 Basic Perils and Additional Perils Parts applies to Coverage(s) Nil Special Perils Part applies to Coverage(s) A & s $ 250. ✓ Deductible applies to perils A=ll Coverage(s) 1 i S $ 500,000. ✓eac occurrence II $ SM. -- aggregate E. Comprehensive General Liability $ Kil each person $ Mil each accident F. Premises Medical Payments CD ❑ CITY INSURANCE COMPANY (Y) Short Hills, N.J. o ❑ THE HOME INSURANCE COMPANY OF ILLINOIS W Chicago, III. o0ce 874 9591 RENEWAL OF NO. Named Insured and Mailing Address m (Number, Street, Town, County, State & lip No 6 z Salinoiee Clabe, Inc. P. 0. Dr>e11w d SsnfWd, 72. 32771 ✓ Policy Period Years From 5/1/81 ..moo ' /2J82 THE HOME INDEMNITY COMPANY Manchester, N.H. THE HOME INSURANCE COMPANY OF INDIANA 7/7/81 Indianapolis, Ind. 00 DECLARATIONS 22754 5" PRODUCER'S NO. OPC PREMIUM * Total Advance Premium $ —` (Includes 1st Yr. Auto Prem. if any) Payable at Inception $ Each Anniversary $ S —Y (Enter °" for note to apply) Q. Q *Subject to adjustment as provided herein. "� Ip � "'Anniversary premiums subject to rates then c rre�t. 12:01 A.M. Standard Time at the address of the Named Insured as stated above. HS? PRODUCER COPY Policy Form and endorsements attached at inception Saver ___,__'IM {Et32201sr) Mortgagee Clause: Subject to the provisions of the mortgagee clause attached hereto, loss, if any, under the build- ing coverage under Section I shall be payable to the Named Insured and: gZ a6ed 3£SZZ£H •06ed suol;eaepa0 slg; o; Aldde osle (legs aoua 'suol;eaep80 ay; o; SAa }a l uolsl Aollod a aanaaagM tsx I %" (S)30VU3AOO 01 S313ddH g v (s)06eaano0 —— (s)luad o; salldde) algi ;onpa0 — +094"$ S •o ;a.iaq; aouaaa;aa 6ulneq Aollod slg; ;o swaa; aq; lie o ; ;oargns 'umogs sl aoueansul to ;unowy up golgM ao; a6ea9noo goea o; ;oadsaa q ;lm Aluo sl papao} ;e aoueansul agl 3'U103HOS Em Am* !/a O"t 4v PAY sox Peaamdft Pow 4=9 P" dow Om *a VOTOWDO *V'ij"iA `� 8 It A alt */a OW i'r P 411 * JOM POA*2&* * ![ T T at" so vegamm"O O v"Mu O PSON"le ' Lux own P/& GM %V PST OQMrn ;Oat P * *W&U T T suol ;eaado ;o adA; pue :)uedn000'}ooa ;o adAl'uol;ona ;suoo'uoi ;eool nnogS aagwnN aagwnN 6 ulpi1n8 uol;eowl paianoO suol;eiad0 pue A;aadoad }o uol4eoo3 pue uol;duosa0 tbfrod aglto uoneaedald ai luanbasgns panssl sl a38Wf1N A0I auawasJopua slqI uagM h110 pa7aidwo3 aq paau asn?ID Hu C11 go^ , �N�1SN1 03Wt/N ., SNOIIV:)Ol - lVNOIlIOOV— I N01103S (panul;uoo) SNOIIVHV3030, /.8 03f1SSl ANVdWOO )1OO1S tom[ Cwt f {/�iY S 1 � • i'w M rsx r y� /� �(liPr i i � ► i�I M T iAlW + ice. 'q T f. s aoueansul ;unowy sAeO 0£ goe3 ;o;unowy 9;e69a66y ;unowy ;unowy ;unowy aagwnN aagwnN C;aadwd leuosaad -8 (s)6ulplln8 —y 6ulppn8 uoi;ez)o ;uawal3 awll — O S •o ;a.iaq; aouaaa;aa 6ulneq Aollod slg; ;o swaa; aq; lie o ; ;oargns 'umogs sl aoueansul to ;unowy up golgM ao; a6ea9noo goea o; ;oadsaa q ;lm Aluo sl papao} ;e aoueansul agl 3'U103HOS Em Am* !/a O"t 4v PAY sox Peaamdft Pow 4=9 P" dow Om *a VOTOWDO *V'ij"iA `� 8 It A alt */a OW i'r P 411 * JOM POA*2&* * ![ T T at" so vegamm"O O v"Mu O PSON"le ' Lux own P/& GM %V PST OQMrn ;Oat P * *W&U T T suol ;eaado ;o adA; pue :)uedn000'}ooa ;o adAl'uol;ona ;suoo'uoi ;eool nnogS aagwnN aagwnN 6 ulpi1n8 uol;eowl paianoO suol;eiad0 pue A;aadoad }o uol4eoo3 pue uol;duosa0 tbfrod aglto uoneaedald ai luanbasgns panssl sl a38Wf1N A0I auawasJopua slqI uagM h110 pa7aidwo3 aq paau asn?ID Hu C11 go^ , �N�1SN1 03Wt/N ., SNOIIV:)Ol - lVNOIlIOOV— I N01103S (panul;uoo) SNOIIVHV3030, /.8 03f1SSl ANVdWOO )1OO1S STOCK COMPANY ISSUED BY DECLARATIONS (continued) SECTION 1 - ADDITIONAL LOCATIONS NAMED INSUR�Pl Attaching Clause need be completed only when this endorsement POLICY NUMBER is issued subsequent to preparation of the policy.) Description and Location of Property and Operations Covered Location Building Number Number Show location, construction, type of roof, occupancy and type of operations 1 S ftMe, Grp MW*d Mot, 74aals►d at 3000 (ftW) XWY a "Oft "t TUWU& #aid 1 i 7l"awy, awovurd soot, Ueated at 3000 (now) 1t /S W= Xwy 114., SmWlwd IFUvcidit 000apied *A xalAt�s- ar cgs. 1 7 *WWWy VFW~ a 00t UWaMd 3000 (ftW) WIfit lake xWy 16014. 8&*A*td, 1llolrida e00VOird as Golf G"ask mss. SCHEDULE The insurance afforded is only with respect to each coverage for which an Amount of Insurance is shown, s to all the terms of this policy having reference thereto. COVERAGES Location Number Building Number A— Building(s) Amount B— Personal Propert Amount C —Time Element Amount Aggregate Amount of Each 30 Days Amount Insurance 1 S, ; 4,200. $ 1."0. Zu 7ti1 it" 1 i 14 . S,800. z Rif 1[17. su 1 7 24 Itu gal 1ii1 ILL2 $ 25 Deductible (applies to Peril(s) All Coverage(s) A % COINSURANCE1 APPLIES TO COVERAGE(S) 90% a tt a CTIVE DATE OF THIS PA( wnerever a ence shall a H32253F. icy provision refers to the uecit apply to this Declarations Page. Page 2b 1 -eeZ 96ed 36ZZZ£H (•;oaAeq lied a apew pue o; paaja;ai (gajag aie sa6ed 6uiMollo; ay; uo paluLld suolslnoad aq-L) a6ed suolleae1390 sly; o; AIdde osle (legs aoua.la ;ai Bons 'suoi;eaepa(I aq; o; s.la;a.l uoislno.ld A:)Ilod a aana.lagM 1N3JV 39Vd SI Hl 30 31VO 3AI103333 :o; salldde algl ;anpo(] •sallddV 9oue,lnsuio0 % --v7jr spaad paweN :;sule6V peAnsul sllaad •agdo.l ;se ;eo jo A ;lensen 'ssol auo /due ui algell aq lllnn Auedwoo ay; golgne ao; ;unowe wnwlxelu ay; sI . s i�r T •00O * sz r 4 • + r Xwom bu= s>a •0os' -. , £LMLT# UZOPUMPOR SOAOK •09L 860ZS# MTTcns » H 0 00T `T 9KZLF# U"gomr zossom doa •0" stars# r sa Pas •00s OZ -0009" uwgomr BUTS a xa •000 *T ssc :mss 00690T# set utpr UOTT" 001 '00Z ' L98T# r :eO 95UTS * •OSZ z SUN w*gomr s bm gueose •vsz' Oz -a T "*Ta ST191OZO stomp daunt '000 Ts osOVj# P2041 T • 0os' z Z*AOK to•gomr Z66L# A*KXTWJ OTi OL61 1 `000 S J'a,, Roliod siagwnN Put? aa.ln ;ae ;nueyy luawdlnb3 Ja a ;e6a�66 AeO aid 41 aoueansul sllwrs euoll Q s>ljeyy 6u!AI!4uopl ;o uolldl.losa0 ;o;unowV — ; wla i ;ua r . MW 4 •o;aaaq; aouaaa;W 6wneq I uol ;oaS ;o swaa; ay; Ile o;;oafgns'unnogs sI aouejnsul ;o;unowV ue yoignn jo; ula.laq pagiaosop;uawdlnbe ay; o; ;oadsaa q;lnn Aluo papaolle sl eoueansul N38Wf1N A01lOd thilod aql ;o voileiedaid of luanbasgns panssi si luawasiopua s;ql uagm Aluo palapu:oa aq paau asnelo 8utqoelltl gjunSNi 03WVN 3EJV83A001N3WdInO3 SM01WHIN00- I NOLUM— (panul;uoo) SN011.VHV"1030 AG'03nfi51 GLASS COVERAGE ENDORSEMENT (The Attaching Clause need be completed only when this endorsement is issued subsequent to piepatahon of the policy.) NAMED. INSURED POLICY NUMBER SCHEDULE A. Motel or Hotel Glass Description of Rental Units: B. Scheduled Glass LOC. NO. SLOG. NO. SCHEDULED GLASS ONLY DESCRIPTION OF GLASS, LETTERING AND ORNAMENTATION; POSITION IN BUILDING (Glass is plain flat with edges set in frames unless otherwise stated) SPECIFIC LIMIT IF ANY NO. OF PLATES LENGTH WIDTH AREA 9 PULL DlatA 3 94 a plain Slate 4 1 W 34 'k'ASpIt"d plat* f' 9 54 34 1111111111111vand Mate 1" 40 n&to H32209F r 1NLAHD. m:-t:`.•- -' "' � IM 2141c MISCELLANEOUS PROPERTY FLOATER (Attach to Scheduled Property Floater Basic Policy) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) - Attached to and forming part of Policy Number issued to by at its Agency located. (city and state) Date I. On the following described property of the Insured ,.or of others , in n thhe rt the custody or control of the Insured: 1) eaa� 1) 34 Westi iee 3 -1be01 ele(cet is golf cae @M* $27 2) 40 96mysa8e 4*IAMw4 *UC*Wic gall carte 0800• 200000.'' 3) 33 - 4 WWW1 atmb earttw 01800. 27, 4) 8 - 4 %t o" e311alatn" Golf Carts 01645. 8,2x8. � $a2 2. THIS POLICY INSURES AGAINST DIRECT LOSS OR DAMAGE BY: 3. THIS POLICY DOES NOT INSURE AGAINST: (a) Insect, vermin, wear and tear, gradual deterioration or inherent defect, delay or loss of market; (b) Infidelity of Insured's employees or persons to whom the insured property is entrusted, if this policy is written to include theft; (c) Loss or damage due to any process or refinishing, renovating or repairing; (d) Loss or damage due to dampness of the atmosphere or extremes of temperature; (e) Loss or damage due to carelessness or rough handling or disregard of reasonable precautions by the Insured or by the Insured's employees; (f) Mechanical breakdown, or loss or damage resulting from any electrical injury or disturbance to electrical appliances, devices or wiring from artificial causes unless fire ensues and, if fire does ensue, the Company shall be liable only for its propor- tion of loss or damage caused by such ensuing fire; (g) Loss or damage caused by or resulting. from: (1) hostile or warlike action in time of peace or war, including action in hind- ering, combating or defending against an actual, impending or expected attack, (a) by any government or sovereign power We jure or de facto), or by any authority maintaining or using military, naval or air forces; or (b) by military, naval or air forces; or (c) by an agent of any such government, power, authority or forces; (2) any weapon of war employing atomic fission or radioactive force whether in time of peace or war; (3) insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating or defending against such an occurrence, seizure or destruction under quarantine or customs regulations, confiscation by order of any government or public authority, or risks of contraband or illegal transportation or trade; (h) Loss if, at the time of loss or damage, there is any other insurance which would attach if this insurance had not been effected, except that this insurance shall apply only as excess, and in no event as contributing insurance, and then only after all other insurance has been exhausted; (i) Loss by nuclear reaction or nuclear radiation or radioactive contamination, all whether controlled or uncontrolled, and whether such loss be direct or indirect, proximate or remote, or be in whole or in part caused by, contributed to, or aggra- vated by the peril(s) insured against in this policy; however, subject to the foregoing and all provisions of this policy, direct loss by fire resulting from nuclear reaction or nuclear radiation or radioactive contamination is insuied against by this policy. 4. This insurance covers only within the limits of the Continental United States and Canada. S. In event of loss, the Company shall not be liable for a greater proportion thereof than the amount insured bears to the actual value of the property described herein at the time when such loss shall happen. b. If this policy is canceled by the Insured, the Company shall retain an earned premium of not less than $ which is hereby declared to be the minimum premium for this policy. urr v oiv1 +` °" • , .. �i Clause nee! :ompleted only when this endorsement is issued subsequent " of the policy.) LIABILITY CL 20 12 (Ed. 07 66) - L 9110 6 110 (Ed. 10 -66) ADDITIONAL INSURED (State or Political Subdivisions — Permits) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE This endorsement, effective Issued to by (12:01 A. M., Standard time) Designation of State.or. Political Subdivision: City Of Sr � 5n i RIr* 32771 Premium Limits of Property Damage Liability $ XMI* $ NO 000 each occurrence $50:00* aggregate forms a part of policy No. ................._.......... ............ ...................... ...... .._................................................... Authorized Representative SCHEDULE J It is agreed that the "Persons Insured" provision includes as an insured any state or political subdivision thereof designated in the schedule above, subject to the following additional provisions: 1. The insurance applies only with respect to operations performed by or on behalf of the named insured for which the state or political subdivi- sion has issued a permit. 2. The insurance does not apply to bodily injury or property damage (a) arising out of operations performed for the state or municipality, or (b) included within the completed operations hazard. 3. If the Property Damage Liability Coverage is not otherwise afforded, such insurance shall nevertheless apply with respect to operations performed by or on behalf of the named insured for which such permit has been issued subject to the limits of liability stated herein. AUTHENTIC ISSOED ti -r DEPLARATIONS (continued) - SECTION 11 GENERAL L I A BILITY HAZAR SCHEDULE NAMED INSUR _ AS!a4hing Clause need be completed only when this endorsement lit liiuud uubasiluent to preparation of the policy.), POLICY NUMBER ❑ OWNER ❑ GENERAL LESSEE ❑ TENANT ❑ OTHER: LOC. DESCRIPTION OF HAZARDS STATE AND * PREMIUM RATES ADVANCE PREMIUMS NO. AND CLASS CODES BASIS B. 1. P.D. B. 1. P.D. TERR. Premises - Operations Clubs - country, golf, polo or tennis 79472 006 ac) 5700 Incl. Incl. Incl Incl. Golfmobiles- loaned or rented to others by the insured or any conces- sionaire of the insured tA) 92 Incl. Incl. Incl Incl 79433 Grounds in excess of fives acres 82211 tA) 139 Incl. Incl. Incl Incl Swimming Pools or Bathin Beaches (not commercial) tA) 1 Incl. Incl. Incl Incl 729775 Real Estate Development Property tA) 444 Incl. Incl Incl Incl a -Area per 100 sq. ft. A -Unit Months b - Frontage per foot B -Units m- Admissions per 100 C-ea. 100 c -Cost per $100 D -ea. 1,000 r - Receipts per $1,000 (prod) Eea. 10,000 t -Other Fea. 1,000,000 p - Payroll per $100 Independent Contractors Cost Per $100 of cost Products - Completed Operations Receipts Per $1,000 of receipts Restaurants -in which th Annual Sales of alcoho- lic beverages are less 5° of the total annual an rD 75 Incl. incl. Incl Incl fithlill receipts of the restaurant 58151 TOTAL ADVANCE B.I. AND P.D. PREMIUMS [�> Incl. Incl. EFFECTIVE DATE OF THIS PAGE AGENT Wherever a policy provision rerers io ine ueicarauornb, suur ence shall also apply to this Declarations page �NSURAN� xoME ��MPANtE H32217F PRODUCER COPY I Page 2w 1 NAME AND ADDRESS OF AGENCY B. CROMIT AMCI * IM. COMPANIES AFFORDING COVERAGES � y aqb f .}��p�/� a rtum vfl� Yam r R -PAW -, n&. 3i"o LETTER A i.:Ll3? )]�w.e Ls'xv COMPANY O g J LETTER o NAME AND ADDRESS OF INSURED COMPANY M wizxe� nor •ctgM1ff� CUM"" VLBS O SinM'0,s,, . , �y C. LETTER M111 is n �iil F y. . �. y 0� q . m � n.,,` J COMPANY D .'.iti.3v A. 32771 LETTER COMPANY " LETTER This is to certify that policies of insurance listed below have been issued to the insured named above and are inform at this time. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate 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 of Liability in Thousands 0) COMPANY POLICY LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE EACH AGGREGATE OCCURRENCE GENERAL LIABILITY BODILY INJURY $ IL - A ® COMPREHENSIVE FORM T g L �r� jf ' PREMISES- OPERATIONS M a 74 95 91 10127/91 PROPERTY DAMAGE $ *, $ so,, w EXPLOSION AND COLLAPSE HAZARD ❑ HAZARD UNDERGROUND PRODUCTS /COMPLETED OPERATIONS HAZARD BODILYINJURYAND El CONTRACTUAL INSURANCE PROPERTY DAMAGE $ $ ❑ BROAD FORM PROPERTY COMBINED DAMAGE ❑ INDEPENDENT CONTRACTORS ❑ PERSONAL INJURY PERSONAL INJURY $ AUTOMOBILE LIABILITY BODILY INJURY Q (EACH PERSON) $ ❑ COMPREHENSIVE FORM BODILY INJURY $ (EACH ACCIDENT) ❑ OWNED ❑ HIRED PROPERTY DAMAGE $ ' BODILY INJURY AND NON -OWNED PROPERTY DAMAGE $ COMBINED II I, EXCESS LIABILITY BODILY INJURY AND ❑ UMBRELLA FORM PROPERTY DAMAGE $ $ ❑ OTHERTHAN UMBRELLA COMBINEDI�I FORM WORKERS' COMPENSATION STATUTORY and EMPLOYERS' LIABILITY $ (EKM PLCIDENT) Bumm CC 8 76 95 41 10/27/81 $105 A CORTE= Is 230"0. DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES INCREASED LIMITS O'K' ADDITSORAL NAWD INSUMs CITY OF , A.T.I:.M.A. PER CONVERSATION WITH RICHAR ®'_�z� (� -- — BARNES(THE HOME INS. CO.) Cancellation: Should any of the above described policieMbe ca c Iled before the expiration date thereof, the issuing com- pany will endeavor to mail_ days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER: DATE ISSUED: CITY OF SAXPOItt3 C f SANFORD FLA . 32771 AUTHORIZED REPRESENTATIVE REPRESENTATIVE ATM- Mr. Fete Rr"Ies, CxtY Manager / B. CROCdt =, JR. ACORD 25 (1 -79) BUSINESS OWNER'S POLICtl,, T N Insurance is pi, ; ed by the Stock Company designated by Z ._, hereinafter called the Company. ® THE HOME INSURANCE COMPANY No. 801 8 80 30 19 . y Manchester, N.H. - 'O L r Y � U C N A 17 C O N U N � E m c 0 0 m C U q A , U L . a c a c E E au � N � l6 v O o v C M m s � E y i O @ c d a � d � V C i L � U H O Y O V m v m � N C N O .0 A_ 0 a c - ,A ,p _ N T T C C O O c E 0 V 0 :. y E E o .S n L N O � w N N C E �. v N c m R L O E: d E ._ V N F'- u ❑ CITY INSURANCE COMPANY ❑ THE HOME INDEMNITY COMPANY Shoyt Hills, N.J. Manchester, N.H. , ❑ THE HOME INSURANCE COMPANY OF ILLINOIS ❑ THE HOME INSURANCE COMPANY OF INDIANA /s1' Chicago, 111. CERTIFICATE OF INSURANCE Indianapolis, Ind. g � C $74 9551 DECLARATIONS 22764 S" RENEWAL OF NO. PRODUCER's NO. OPC Named Insured and Mailing Address PREMIUM* (Number, Street, Town, County, State & Zip No.) Total Advance Premium $ 7,4 36 . "Simi* clubs, zme. (Includes 1st Yr. Auto Prem. if any) P. 0. IL#ICrIR1113?1 ,J' Payable at Inception $ 7,436. Sauia" !1. 32771 Each Anniversary $ N/A (Enter * * for note to apply) *Subject to adjustment as provided herein. *Anniversary premiums subject to rates then current. Policy Period Years . 0 - 12:01 A.M. Standard Time at the address of From $/Mal To S /1/S2 the Named Insured as stated above. Au dit Period: Annual, unless otherwise stated: 'E] Monthly ED Quarterly ❑ Semi - Annual EJ Other DESCRIPTION AND LOCATION OF PROPERTY AND OPERATIONS COVERED. (Loc. No., Bldg. No. —Show location, construction, type of roof, occupancy and type of operations) + ft" 2b (33=31) (S=t 7941) In consideration of the premium, insurance is provided the Named Insured with respect to the described location with respect to those coverageSand kinds of property for which a specific limit of liability or an amount of insurance is shown, subject to all the terms of this policy including forms and endorsements made a part hereof. Section Limits or Amounts and Coinsurance Coverages $150,,000. 90 A. Building(s) $ 23„ WO. 90% B. Personal Property $ itu nu C. 311111 $ 5111 D. KU Basic Perils Part applies to Coverage(s) -- X131 Basic Perils and Additional Perils Parts applies to Coverage(s) 1�1 Special Perils Part applies to Coverage(s) a & a $ 250, Deductible applies to perils An Coverage(s) 1► 6 B $ SW,000. each occurrence it $ SW,, . aggregate �E. Comprehensive General Liability $ Si1 each person $ ]1 each accident F. Premises Medical Payments Policy Form and endorsements attached reception ' Paar 2a 19222 7 Mortgagee Clause: Subject to the provisions of the mortgagee clause attached hereto, loss, if any, under the build- ing coverage under Section I shall be payable to the Named Insured and: AN4 soft of ]PAW OW OO Countersigned at Date(Mo., Day, Yr.) JJ49td r i :.) :. 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DESCRIPTION OF HAZARDS STATE AND * PREMIUM RATES ADVANCE PREMIUMS NO. AND CLASS CODES BASIS B.I. P.D. B.I. P.D. TERR. Premises - Operations Clubs - . r 79472 5740 %=I. zM1. IM1 1ml.. w loated t* athWs by the 92 IM1. l� S1 f ive 010 ( ) 3. 1=1. 1w1, xwa Independent Contractors rtt +th � ♦ * 1 I I a -Area per 100 sq. ft. A -Unit Months b - Frontage per foot B -Units m- Admissions per 100 C-ea. 100 c -Cost per $100 O -ea. 1,000 r - Receipts per $1,000 (prod) E-ea. 10,000 t -Other F-ea. 1,000,001 p - Payroll per $100 Cost I Per $100 of cost Receipts I Per $1,000 of receipts TOTAL ADVANCE B.I. AND P.D. PREMIUMS IVE DATE OF THIS PAGE IAGENT Wherever a policy provision refers to the ence shall also apply to this Declarations H32217F EXTRA