CERTIFICATE OF LIABILITY INSURANCE (3)
11/0
tHIS BINDER IS A TEMPORARY INSURANOE CONTRACT. SUBJECT TO THE CONDITIONS SHOwN ON THE REVERSE SIDE OF T
PRODUCER .- lJ. ,':~..~JdI:.BB.66' aq'.3-3999.97a-5~7~4?_. ". eoMji~"-- -' BINDER'
...v __ Fed.eralE~~;r:a:nce Com2an ?IND~~~.
Gowrie, Barden & Brett, Inc. .~rs~_L-1JM&._...__D,ATE .
~~s~~~~~k~O~~ 06498 11/06/0~12: 01 . r.i;]Oll~6/~.
SENT BV: GBB;
e80 399 3El98j
NOV -12 - 03 15: 17;
EARCOMMU
I.
ACOBDm INSURANCE BINDER
PAGE 1/1
JE
/03
FORM.
46
...~I\I!L-
X 12:01 AU
NOON
." Jiu.s CoDIi:. .
13438 ..
Clearwater Community Sailing
Center
1001 Gulf Blvd
Clearwater Beach; FL
THIS elNDeR IS ISSUED TO ~o COVERAGe IN THE AaOI/E NAMIOO MPANY
PER EXPIRING rOUCV .:
lIIii8(RlP'llON OFOPERA11QN8NEtKWII'IWPEift'TY "...ludl", ~,IQn)
Loc#l~ 1001 Gulf Blvdi, clearwat
Beach, FL 33767
WIND/HAIL EXCI,USION
COVERAGES
TYPI; Of' INGURANCE
.-.""'-"
PROPER1'I CAl"I$ES Of LOSS
": BASIC L' BI'\OAD I~ SFEC
cOIIaRAGII!IFCRMS
; DlEotJCTIBLE
500
12 hrs.i
Personal Property
Business Income with Extra Expense
GliNERAI. LIABILITY
j(AMEFlCIAI GEN"RA~ .liABilITY
..~.. CLAIMS MADE I ~J OCCUR
, EACH OCCURRENCE
~TO-
p!u!MISES
MED exP (All)' IlI'e petBO/I)
"~R~L a ADV INJUR'I
GENERAL ~~E;GATE
PRODUC1'S - COMPJOP AM
L.CO~INED SINGLE LIr,jIT
.BODlL Y INJUR'( !per 1',",1:7'>>
BODILY, INJlJRY (P~ 8a:idl!nl! .
PRO~ER1Y DAMAGE
MEDICAL ~~YMEt'JT$ ...
PE~L IHJUR\' pROT.
. UNINSURI!C YOTORISf
See Spec. Conditions/Other Coverages
AEmO DATE! FOR CLAIIoI$ MADE:
AUTOMOBILE I.IABIUTY
..J ANV AUTO
i ALLOWNEllAUTOS
SOHEOULED AUTOS
X HIRED AUTOS
X NON.()WKED AUTOS
See Spec. Conditions/Other Coverages
A~ PHYSICAl. DAMAGE DiiPUCTIIILE
! AU. VEfIlCLE$
AC1llAL CASH VALU,?.
STA'rED AMOUNT
OTHER
AUlO ONI,Y . Ell ~C:IDENT
~.!""N."UTO ONL:!,
EACH ACCIDEt!:r.
AGGREGATE
EACH OCCURf;lENGE ....
AGGREGA1!_.
SELF.tNSUA2D RETENTION
X ;.~STATUT()RYLlMIT$
.. E I. . EACH ACCIDENT.
:_~:L .DIll&ASE - lOA .E;up'LOYEE
E.L DISEASE. POLICY LNIT
FEE~__
T~.
E6TlMATHl TOTAL PRIOMIUM
SCH&D\JLED VEHIClES
C(lLUSION~
OTHER THAN COL:
~E UAalLlTY
ANY AUTO
EXCESS LLAIIIUrr
uMBRia-LA FOAM
OTHiR THAN uNBREl.LA FORAI
. .
REllW DAre FOR (".!.AIMS MADE:
WORKER'S CONf'iiNiilAnOl\l
AND
EM'LOY!R'S UA8lUTY
~PECIAL.
~~~~** Continued from~General Liability Section **
C~!~U (See attached S ec Conditions Other Covs a e.)
NAME & ADDRESS
City of Clearwater
Marine & Aviation Department
25 Causeway Elvd.
Clearwater, FL 33767
Faxed to: 727-462-6~57
Attn: Barbara
ACORD n (2001IV1) 1 of 4 # 5 5 a B
M(lRTGAceE
LOSS PA.YEE..
LOII/l tl
AnOlTlONAl. IMSURED
DAB
iii ACORD
~OTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE
;
.0,000.
.ug~
00
...,.~._.
0/..000
0.,000 .
uded
o QOO
s
~
~..
S
$
.
$
$
'~o
~O
sSO
$
S
s
.,.-.
000
,000
,000
RATION 1893
.
1l/10/2003 12:21
860-3gg-3615
GOWRIE BARDEN & BRET
PAGE 02
CONDITIONS
This Company binds tt1e kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the
terms, conditions and limitations of the policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written nOtice to the Company
stating when cancellation will be effective. This binder may be cancelled by the Compaf1Y by notice to the
Insured In accordance wlth the policy conditions. This binder is cancelled when replaced by a policy- If this
binder is nol replaced by a policy, 'the Company is entitled to charge a premium for the binder according to the
Rules and Rates in use by the Company.
Applicable in California
When this form il;; used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title
of the form is changed from "'Jl$urtlnce Binder" to "Cover Note".
Applicable in Delaware
The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating e lien on real
property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if
the binder includes or is accompanied by: the name and address of the borrower; the name and address of the
lender as loss payee: a description of the insured real property; a provision that the binder may not be canceled
witl'1in the term of the binder unless the lender and the insured borroWer receive written notice of the cancel-
lation at least ten (10) days prior to the cancellation: except in the case of a renewal of a policy subsequent to
the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of
insurance coverage.
Chapter 21 Title 25 Paragraph 2119
Applicable In Florida
Except for Auto Insorance coverage, no notice of cancellation or nonrenewal of B binder Is required unless the
duration of the binder exceeds 60 days. For auto insurance. the insurer must give 5 days prior notice. unless
the binder is replaced by a policy or another binder in the same compan}'.
Applicable in Nevada
Any person who refuses to accept a binder ..vhlch provides coverage of less than $1,000,000.00 when proof is
required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof
of insurance for actual damages sustained therefrom.
ACORD 75 (2001101) 2 of 4
#5588
1~/10/20e3 12:21
860-399-3615
GOWRIE BARDEN & BRET
PAGE 03
SPECIAL CONDITIONS/OTHER COVERAGES (Conti from page 1)
Coverage: Employee Theft - Limit: $10,000 - Deductbile: $500
Covera.ge: Depositor's Forgery - Limit: $10,000 - Deductible: $500
coverage: General Liability
Form #: eO-02~2000
Edition Date: 04/01/01
Coverage: Liquor Liability
Form #: 80-02-2008
Edition Date: 04/01/01
Limit 1: 1,000,000
Limit 2: 1,OOD,000
Coverage: Additional Insured-Club Members
Form #: 80-02-2301
Edition Date: 04/01/01
Coverage: Exclusion - Non-Owned watercraft
Form #: 80-02-2333
Edition Date: 04/01/01
Coverage: Exclusion - Specific Products or Work
Form #: 80-02-2340
Edition Date: 04/01/94
Coverage: Who is Insured
Form #: 80-02-2373
Edition Date: 04/01/94
Coverage: Piers &; Docks Exclusion
Form #: 80-02-;2373
Edition Date: 04/01/94
Coverage: Med. Exp. Excl. Deleted for Athletic Activities
Form #: 80-02-2373
Edition Date: 04/01/94
Coverage: Special Liabili'ty provisions
Form #: 80-02-2378
Edition Date: 04/01/01
Coverage: Millennium Date Change Total Excl.
Form #: 80~02-2426
Edition Date: 04/01/98
Coverage: Cap on Certified Terrorism Losses
Form #= 80-02-6403
Edition Pate: 01/01/03
** Continued from Automobile Liability Section **
Coverage: Non-Owned & Hired Car Liability
Form #: 8002
Edition Date: 04/01/94
** Continued from Property Section **
Commercial Property Location Specific Coverages - WIND/HAIL EXCLUSION
AMS 75.4 (2001/01) 3 gf 4 #5588
~1/10/2003 12:21
860-3gg-3615
GOWRIE BARDEN & BRET
PAGE 04
SPECIAL CONDITIONS/OTHER COVERAGES (Cont. from page 1)
Location: 1
Coverage: Personal Proper.ty
Dollars
Valuation: Replacement Cost
Deductible Type:
Coverage: Business Income with Extra Expense Deductible Type: Hours - 12
Coverage: Scheduled Pe~eonal Property - John Deere 1070 Tractor - Value:
$2,000 ~ $500 Deductible
Coverage: Scheduled Perso~al Property - Kawasaki Mule ~ Value: $1,000 - $500
Deductible
AMS 75.4 (2001101) 4 of 4
#5588