CERTIFICATE OF LIABILITY INSURANCE (15)
04/09/2008 14:16
7274469147
SANDBERGEN
PAGE 01/01
,> I
AaJRQ.. CERTIFICATE OF LIABILITY INSURANCE OATIa(MMIDOlYYYY)
04/08/2008
PI'lODUCER (727)442-0012 FAX (727)446-9147 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sandberg_" Insuran~e, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
2121 N.E. Coachman Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater, Fl 33765-2616
INSURERS AFFORDING COVERAGE NAIC#
INSURED Marl na Restaurant INSURER A: Capacity Insurance Co.
Thomas & Patrcia Wolkowsky INSURER B:
2S Causeway Boulevard INSURER c:
Cl~arwater Beach, Fl 33767-2064 INSVRIiR D:
INSURER E:
COvr;;RAGES
THIS POLICIES OF INSURANCE I.IS~O BEI.OW liAVE BEI:N ISSUED TO THE INSUREO NAMED ABOVE FOR THE POI.ICY PERIOD INOICAtED. NOIWITHS'rANOING
ANY REQUIREMENT. TEFtM OR CONCITION OF ANY CONTRACT Oft OTHER OOCUMENT WITH RESPECT TO WHICH THIS CEFtrlFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORCED BY THE POLICIES DESCRIBED I-IEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH
POLICIES. AGGREGATe L.IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI.AIMS,
IN$1'l gg" TYPE OF INSURANCe: POLICY NUMBER PCUCY EI'I'I5OTIVE PDLlCY EXl"IRA TION ~I""ITS
CENERAL LIABILITY ClPOO9277 04/01/2008 04/01/2009 EACloI OCCURRENCE $ 1.000,00(1
-:-:-
X COMMeRCIAL GENERAL LIABILITY r>AMAGE TO ReNTED oa' S 100,00Cl'
= :J C\JI.IMS MADe: m OCCUR MeD EXP (My one pelllo") $ 5,000
A X I"ERSDNAl. f AOV INJURY $ 1,OOO,OOIl
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGReGATe LIMIT APPLies PER: PRODuCTS. COMP/O!" AGG $ 1,000,000
II 'np~O. n
POI,ICY JECT LOC
AUTOMOBILE lIAll:lUTr COMllolNEo SINGLE LIMIT $
I-- lee accklen!)
j...- ANY AUTO
ALL OWNED AtlTOS BODILY INJURY
I-- (I"er~on) $
f-- SCHeDULEO AUTOS
f-- HIRED AUTOS BODILy INJURY S
NONoOWNeo AUTOS (Per BCCkIent)
f--
f-- PROPERTY DAMAGE $
(Pet actiQon1l
RAGE UABIU'T'l' AUTO ONL Y - EA ACCIDI;NT $
ANY AUTO OTHER THAN eAACC $
AUTO ONLY: ACG $
EXCIOSSlUMSRELLA LlA15IUTY EACH OCCURRENCE $
b OCCUR 0 CLAIMS MIIDE AGGREGAte: $
$
R OI;"DUCTIBLE $
RETeNTION $ $
WOll.IIER9 COMPENSATION AND I WC STAru-. I IO~'
EMPLOyeFtS' ..lABILITY E,L, EACH ACCIDENT $
ANY PROPRIETORll"AR1l\IERlEXECUTlVE
OFFICeR/MEMBER EXCLUDe!)? E.L DISEASE. eA EMPLOYEE S
II ~eB. deBerlb~ ~nder E.L. DiseASE - POLICY LIMIT $
S ECIAl, PFlOVISIONS below
OTHEI'l
DESCRIPTION 01' OPERATIONS 11.OCA TIONS I VEHICI.ES I EXCLUSlONll ADDED BY ENDOR5S..EIft I SPECIAl, PROVISIONS
ertificate Holder is landlord Additional Insured
City of Clearwater
Marine & Aviation Division
2) Causeway Boulevard
Clearwater Beach, FL 33767
ACORD 25 (2001/08) FAX: (727)462-6957