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CERTIFICATE OF LIABILITY INSURANCE (5) ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE IMM/DDNYI 3/27/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 31666 Tampa,FL 33631-3666 INSURERS AFFORDING COVERAGE INSURED INSURER A: Markel International Ins Co Field's, Inc. DBA Barefoot Beach House INSURER B: P.O. Box 3337 INSURER c: Clearwater Bch FL 33767 INSURER 0: t INSURER E: 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. I~~: TYPE OF INSURANCE POLICY NUMBER ';,'l';!~Y EFFECTIVE P~k!fl EXPIRATION LIMITS A GENERAL LIABILITY MKS1935 1/10/08 1/10/09 EACH OCCURRENCE $ 1000000 - X . COM'J.ERCI!\L GE.'ERI'.llIAB!lITY FIRE DAMAGE {Any or.e !;rel $ 50000 I CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 2000 PERSONAL & ADV INJURY $ 1000000 - GENERAL AGGREGATE $ 2000000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 1000000 I POLICY n P,~,QT n LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY {Per personl $ SCHEDULED AUTOS - - HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS - PROPERTY DAMAGE $ {Per accident! GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO APR O? 2001 OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY /:.' EACH OCCURRENCE $ =:J OCCUR D CLAIMS MADE '>t=CORm: AGGREGATE $ , "C' !'}::.'1 ,...1- $ =1 DEDUCTIBLE $ RETENTION $ $ -Ree TWC STATU.:! 10TH. '., .WOR~ERS C.oMPENSATIONAND -,--.-~- ,-' --. f;::rVE?b ," __~BYJJI\IIITS -,-._~g,'L_. " ._---- ---.--.-...--.- EMPLOYERS' LiABILITY E.L. EACH ACCIDENT $ APR E.L. DISEASE. EA EMPLOYEE $ 0 11 ?fillD E.L. DISEASE - POLICY LIMIT $ OTHER RISK MAN ~GEMENT DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS R EL; I:: I V I::. U RE: BEACH CONCESSION STAND LOCATED AT 332 S. GULF BLVD., CLEARWATER BEACH, FL 33767 EXCLUDES RENTAL OPERATIONS CERTIFICATE HOLDER IS ADDITIONAL INSURED W/RESPECTS TO GENERAL MAR 2 8 2008 LIABILITY - i~:r "I; ATTORNEY FLA STATUTE MANDATES 10 DAYS NOTICE OF CANC. FOR NONPAY OF PREMIUM .. l:: ~ CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF CLEARWATER,A MUNICIPAL DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN C/O CITY ATTORNEY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL PO BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR CLEARW A TER FL 33767 REPRES~TI1ES. ^ /\ "1,'3 lor' tJ/vJ{ ~ t1/L;_ 12 h .JJJ AUT~J~ ACORD 25-S (t'/97Yv . 47- 71 @ACORD CORPORATION 1988 ftM ~of~ MA~/27/2008/THU 11 :47 AM Wells Fargo Ins Svs FAX No. 727 799 5117 P.001/004 . ACORQM CERTIFICATE OF liABILITY INSURANCE I DATil IMMJDDIYYI 3/27/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON. THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 31666 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE INSURED Field's, Inc. DBA lN6URIifIA: Markellntemational Ins Co Barefoot Beach House INSURER 8: . P..O..Box 3337. INSURER c: " ... .,.. . IClearwater Bch FL 33767 INSURER D: INSUReR E: COVERAGES THE POLICIES OF INSURANCE LISTED BelOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOiWliHSTAND1NG ANY IlEQUIREMI::NT. 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 rERMS, EXCLUSIONS AIIID CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS. INSR TYPEOFINSUIlANCE pOUCY NUMSliR POLICY EFFECTIVE PgltCY EXPIRATION 11MIT& L1'R A ~N~"AL UAlIlLlTV MKS1935 1/10/08 1/10/09 EACH OCCURReNCE $ 1000000 ~ O~ERCIAL GENERAlllABIUTY FIRE DAMAGE IAny an~ Ii",) $ SOOOG f-- CLAIMS MADE W OCCUR MEO iXl' IAny one person) . 2000 . PERSONAL & ADV INJURY $ 1000000 f-- '-- GENERAL AGGRmATIl . 2000000 n'lAOOREn UMlY An PER: PRODUCT5 - COMPIOP AGll $ 1000000 POLICY I ~~8r LDC ~TDMoal~ UAlllllTY COMBINED SINGLE UMIT . ANY AUTO '. ;' lEa !lCCIdentl I-- I-- ALL OWNED AUTOS BODilY INJURY ll'er p,r&Oll1 . SCHEDULED AUTOS f--- 3 1 2008 I-- HIRED AUTOS MAR BODilY INJURY lPct l!ICGidBtlIl . I-- NON-OWNED AUTOS f-- , )FCORDS I~; " PROP&IITY DAMAGE e l. \Per acCIdent) RARAOe LlABlllTV l. ::'1 '~.:' ,Y'I' AUTO ONLY - E'A ACCIDENT $ ANY AUTO OTHER THAN eAACC . AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE . o OCCUR 0 CLAIMS MADE AOOREGl'ITE . $ R DCllUCTIBlE . R~ENT10N $ $ WORKERS COMI'&N5ATION AI\lb I.w.;;~ ~'W" I IO~ EMPLOYERB' IJAldUTY Eo!.. EACH ACCIDENT . E.L DISEASE, EA EMPLOYEE $ i.l. DISIWOS ~ pOUCy UMIT . Q1l1ER OlOSCfllPTlON OF OPERATIONSILDCATIONSNEHICU5JiXCLUslOIIIS ADDED BY ENDOASEMENT/SP5CIAl PROVISIONS RE; 332 South Gulf Blvd, Clearwater, Fl. 33767 Rental of Beach Chairs, Umbrellas and Cabanas. The City of Clearwater Is Additional Insured 88 respects General Uablllty . FLA STATUTE MANDATES 10 DAYS NOTICE OF CANC. FOR NONPAY OF PREMIUM CERTIFICATE HOLDER T X T ADDITIONAL IN8URKI; ltoI$UflR'l tnTCR! CANCELLATION SHOULD ANY OF TH~ AIlOV; b~$CAIElI!!D POUClIlS ElE CANCI!!l1I!!O ElJ;F01II!! TilE E)O'IRATION City of Clearwater, DATE THBlEOf, THE ISSUING INSUIlEft WilL eNDEAVOR TO MAIL ~ DAYS WRITTeN A Municipal Corporation NOTICE TO TIIIl CIlRTIFlCAn 1l0LDER NAMED TO THE LEFT, BUT FAlWRE TO DO SO SIlAll 25 Cauaeway Blvd. IMPOIIi NO OIl~lllATION OR L1ABIUTY Of ANY KINO UPON THIlINSURER, ITS AUENT8 OR Clearwater, FL 33767 REPRES!j/tnln,ES. ^ .1'1 A1JTr~vEll I . ~ ACORD 25-S 17/971 47- 71 (j ACORD CORPORATION 1988 MKR/27/2008/THU 11:48 AM Wells Fargo Ins Svs FAX No. 727 799 5117 P. 002/004 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(iesJ must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementlsl. If SUBROGATION IS WAIVED, subject to the terms and oonditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu ot such endorsementlsl. DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does It affirmatively or negatively amend. extend or alter the coverage afforded by the policies listed thereon. ACORD 26-S (7/97) MA~/27/2008/THU 11 :48 AM Wells Fargo Ins Svs FAX No. 727 799 5117 P. 003/004 ACOR~M CERTIFICATE OF LIABILITY INSURANCE I DATE lMM/DDIYY) 3/27/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EX'TEND OR P.O. Box 31666 ALTER THE COVJ:RAGE AFFORDED BY THE POLICIES BELOW. Tampa. FL 33631-3666 INSURERS AFFORDING COVERAGE INSURfD Field's, Inc. DBA INSURER A:. Markel International Ins Co Barefoot Beach House INSURER B: p..O. Box 3337 INSURER C: . '" ,Clearwater Sch FL 33767 INSURiA D: IN6UREfI e: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUeD TO THE INSURED NAMED AllOVE FO" 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 I!'JSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEeN IlIiOUCED BY PAID CLAIMS. I~M TYPE O~ INSURANCE POUCY NUMBER I POuCY mwrt\IE POllCY I!XPlIlA't'ION I UMlT8 A ~NEAAL LIABILITY MKS1935 I 1'10108 1/1 0/09 EACH OCCURRENCE $ 1000000 ~ pMERCIAL GENERAL LIABILITY FIRE bAMAGi /Anv one flrel 9 50000 ct.AIM& MAD!! [Xl OCCUR MED EXP (AIlV one pefaonJ . 2000 f-- I-- PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE . 2000000 f--..- GEN'L AGGREGATE LIMIT An Pal; PRODUCTS. COMP/OP AGG $ 1000000 II POLICY n P,~ lOC AUTOMOBILE UA8ILI1'Y COMBINED SINGLE UMIT - IE.. Bccident) . - AI'N AUTO - All OWNED AUTOS BODILY INJURY e SCHEDULED AUTOS (Pet petSOOl - HIRED AUTOS E10Dll Y INJURY - IPet eccldenll $ ,....- NON-OWNED AUTOS PROPERTY DAMAGE i (P"'B~CllltI GARAGE LIABIUTY AUTO ONl. Y . EA ACCIOEN'l' e ==j ANY AUTO OT~ER THAN EA ACC i AUTO OIlLY; AGG $ EXCi!SS UABIUT'f EACH OCCURRENCE . :=J OCCUR 0 CLAIMS MADE AGGREGATE $ 9 ~ DEDUCTIBLE . ~I!NTION $ $ WORKERS COMPENSATION AJ\ID WC6TATV-' I~' EMPlOYE"S' IJA8ILI1'Y E.l. EACH ACCIDENT $ i.l.. DISEASE. EA EMPLOYEE e E.L DISEASE - POUCY liMIT . OTWER ~CRlpTION OF OPERATlONS/LOCATIONSNiHICLESIEXCLUSIONIi ADDJ5D BY EHOOIlSEMENT/spECIAl PROVISIONS RE: BEACH CONCESSION STAND LOCATED AT 332 S. GUlf BLVD.. CLEARWATER BEACH. FL 33767 EXCLUOES RENTAL OPERATIONS C!:RTIFlCA TE HOLDER IS ADDITIONAL INSUREO W/RE$PECTS TO GENe:RAL LIABILITY FLA STATUTE MANDATE:S 10 DAYS NOTiCe: OF CANC. FOR NONPAY OF PREMIUM CERTIFICATE HOLDER I I ADDmONAL INSURED; INSUfIDI LETTER; CANCELLATION CITY OF CLEARWATER,A MUNICIPAL SHOULD ANY Of THE ABOVe DESClIIIIB) POUCIES Be CANCaLED BEfORE THE EXPIRATION D"TE TIlEIlEOP, THE ISSUING INSURER WILl. ~DeAVOR TO MAIL --1Q... DAYS Wfl''l'T~ c/o CITY ATTORNEY NOTIce TO THE C~ffTlfICATE HOLDER NAMED TO THE LefT. BUT fAILURE TO DO SO SHALL PO BOX 4748 IMPOSE NO OBUGATlOH OR LIABILITY OF AllY KIND UPON THE INSURER. ITS AGENTS OR CLEARWATER FL 33767 ~ ES. ^ " Aur~ I ACORD 25-8 (71971 47- 71 Iil ACORD CORPORAnON 1988 ~ 'MKR/27/2008/THU 11:48 AM Wells Fargo Ins Svs FAX No. 727 799 5117 P. 004/004 IMPORTANT If the certificate holder'is an' ADDri"loNAL INSURED, the policyliesl must be endorsed. A statement on this cert.ificate does not confer rights to the certificate holder in lieu of such endorsemtlntls}. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement's}. DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer's), authorized representative or producer, and the certificate holder, nor does It affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25.S (7197)