CERTIFICATE OF INSURANCE (241)
A CORD_
CERTIFICATE OF LIABILITY INSURANCE
OP 10 DATE (MMlDDIYYYY)
COREN-1 09 17 04
THIS CERTIFICATE IS ISSUED AS A MA TIER 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
Brown & Brown, Inc.
Daytona Beach Office
P.O. Box 2412
Daytona Beach FL 32115-2412
Phone: 386-252-9601 Fax: 386-239-5729
INSURED
INSURERS AFFORDING COVERAGE
NAIC#
CORENTERPRISESt INC.
2430 ESTANCIA B ~ STE 106
CLEARWATER FL 33761
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
FCCI Ins 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 OFANY 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,
NSR[ POLICY NUMBER P_QId~'Uf.Ff~~E P LIMITS
LTR TYPE OF INSURANCE DATEiMMlDD DATE MMlDDIYYl
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
- ~~lSES (E~~~~';~nce)
A X COMMERCIAL GENERAL LIABILITY CGOOO0380 06/01/04 06/01/05 $
. I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $
..... PERSONAL & ADV INJURY $
-
~ LIQUOR LIABILITY CGOOO0380 $1,000,00 P 06/01/04 06/01/05 GENERAL AGGREGATE $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
I nPRO- n Emp Ben. 1,000,000
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
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 $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUIH-
ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
- .... OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
~~~f~tS~ffJ~~~r~~s below n. ,... -_. "--. .----- ---- - --. ....' .- - .
EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RESTAURANT
RE: SAND KEY PARK - 1060 GULF BL~. , CLEARWATER, FL. 10/1/04 REHEARSAL
CERTIFICATE HOLDER
CITYC22
CANCELLATION
SHOULD ANY OF TltE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE TltEREOF. TltE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO TltE CER11F1CATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR UABlUTY OF ANY KIND UPON THE INSURER, ITS A
ACORD 25 (2001/08)
@ ACORD CORPORATION'1988
CITY OF CLEARWATER
112 S OSCEOLA AVE
CLEARWATER FL 33756
~Vl,".-
Cr:
FULL NAMED INSURED:
COR ENTERPRISES, INC.
ROADHOUSE OF TARPON SPRINGS, INC. DBA CODY'S ORIGINAL ROADHOUSE
FOURTH STREET ROADHOUSE, INC. DBA CODY'S ORIGINAL ROADHOUSE
COUNTRYSIDE ROADHOUSE, INC. DBA CODY'S ORIGINAL ROADHOUSE