CERTIFICATE OF INSURANCE
ACORDN
CERTIFICATE OF LIABILITY INSURANCI;LEf~~~ DA~~~~~~)2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES ,BELOW.
PRODUCER
Bouchard-Starcrest
101 Starcrest Drive
POBox 6090
Clearwater FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267
INSURERS AFFORDING COVERAGE
INSURED
Clearwater Shuffleboard
Attn Mr Kinney
1020 Calumet St
Clearwater FL 33755
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
AUTO OWNERS INSURANCE CO
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER ~~HflM'fX~57-AA'E P~l-f~~~~~J.}?N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 500000
-
A X COMMERCIAL GENERAL LIABILITY 2054089802 12/13/02 12/13/03 FIRE DAMAGE (Anyone fire) $ 50000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 500000
-
GENERAL AGGREGATE $ 500000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 500000
I nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IU~~-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E,L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
SHUFFLEBOARD CLUB / 1020 CALUMET ST, CLEARWATER, FL
CITY OF CLEARWATER IS INCLUDED AS AN ADDITIONAL INSURED AS RESPECTS GENERAL
LIABLITY.
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYCLW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...3..0....- DAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: JAN HARRISON
P o BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758 4748 REPRESENI,6.TIVES.
I AUTHOR\!yt:;:Z
ACORD 25-S (7/97)
@ACORDCORPORATION 1988