CERTIFICATE OF INSURANCE (6)
10/03/2003 14:46 7274629786
--. -- ~WU~ ~~'~q Ron Risk Serulces, Inc.
Certificate of Insurance
PAGE 02
216 623 4188 P.02/02
THIS CERTIFICATE IS ISSUED AS A MATTtR OF INFORMATION ONLY AND CONFERs !'fa RIGHTS l1PON THE CERTlfH:!A,'tE BOLDER.
TBlS CERTmCAJE OOES NO'J' A.JWi:ND, EXTIND OR AL'tER TQJ COVERACE AFFORDED Dvmr: POLICIES BILOW.
N_e and A.ctcIrcs. bf AaCllCy COMPANIES APFORDING (:OVJtQAGESIBINDEll OR POLICY NO,
Aoo Risk Serv'_11l1:. 01 Oblo COMPANY UIT1'ER A Jadi!DlDlty IlISIIhnct OJ. of N.A.
ui60 West Saoad Street
Suite 650
Clevelaqd.. Obio 4411j Policy Number: 8V N1I08163'19
Wume Il8d A/ldress orrnSUred! COMPANY
Dolphin. Elleou..te.-
Clearwater Ferry Scrvh!c, ~I:.
P,O. &1: 3563
~terJ FL 33167
Thb: Is 10 mtI~ tI1It IIOllcies otiDsmQnce 1isIaf IIavt: beaa Is$UCIf liD die insured IBlltd aIJovc _ ... in or4cr _Ibis IlIne. No~ifl& JIll.)' te4uircmatt, If:nn af
aOndldan or auty CtItlllllCt or otIM:r dclClllllCnt wilb ~ 10 ~I" ~ GaIIfQfe frlay be iMIe or III8y pcftam. IbI: i..... ~ It)' chc jXOIicia dawibc4l1mr in
IMbleCf; to In tile tIemIl, exc'-siol1S ;md ~ orevcu llOlicim.
CO. 1.TR. TYPE OPINSlJHANCI!: POLlC\' TERM LIMITS
A Pri...~ P.I Per Vase' 1010J1Z803 TO ~tI03lZ004 11,000.000
B EnesI PAl tBbmbtnh_t)
Spedfa: CertiGcatc Bolder is .-.... as Additlonel Allured A. their k1itml:sb ..ay appear.
OI.ceIlaUon: Should au)' of the above desct'ibed poJi~ics be canc:eled bcfo~ the expmrtioD date thereof, the !&suina cornp&rl)' win
endeavor 10 mail E..days wri~ notic:e to the below named ceniticate bolder, but failure to mail such .,otice shan
~t impose obligatiDll or liability of any kiad upon lbe company.
Date ksacd: Odober 3, 2003
Name and Add..-aa of 4:;ertifieate Holde"
B*rbor Ma$ter
City of Clea...,..
25 Call$eqy Blvd.
C'Junvater n. 33767
~ 7f,,:u-
Authorized Repnsentative
TOTAl P.02
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ut.1-~l-~J 13~29 Aon Risk SeruiCI!i'SI Inc.
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216 623 4188 P.12l2/04
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EVIDENCE OF IlllARJNE INSURANCE
PASSENGER VESSEL ASSOCIATION INSURANCE PROGRAM
ASSUBED:
DoIPIIln Encounter loss Payee; AssUNd or Order
Clearwater Ferry Service, Inc.
P.o. Box 3563 Policy#: HU N00876379
Clearwater, FL 337'7
PERIOD OF INaURANCE~
From~ 1G1312003
To: 1013/2004
100% Indemnity Insurance Company of North Amel1ca (Ace)
A xrl Best Rating A nag Standard & POOI'Q Rating
A$$URER:
LAY..UP PERIqg;
COVERING ON:
NMe
Section It: Hid. & Mae;hlnery, Schedule Attached
Policy Form: Amencan Institute Hull Clauses (61211977)
Section UI: ProtectIon & Indemnity
Policy Fonn: SP.23 (RevJsecl)
Including Excess Collision UabtJity, VOluntary Wreck Removal, PoRution
Liability, Per&OnIll Effects, Medical Payments, Incidental USL&H.
Premises Liability
UMrr OF LIABIUTY:
Section 11- Hutl & Machinery;
As per- schedule
Section III - Protection & Indemnity: $1,000,000 Combined Single Limit inCluding Crew Liability
to PD88engers and Collision Liability in the ~gregstli!
anyone aCCident and/or occurrence, with exceptlol'l of:
Person.. Effects
Medical Payments
VOlu~ry Wrede ~emoval
$1,000
$2,500
$25,000
per OCCUrTerlce
per per$On
per OCCUtrence
OEDUCTIBLES:
Subject to each and ewry oceunenca and/or accident
Sectfon 11- Hull & llIaClunery As Per ScheC'JUIe
section III - ProIectIon & Indemnity:
Passenger U.biffty
Medical Payments
Crew UabiJity
All Other
Personal Effc!ds
$5,000
$0
$5.000
$5,000
$100
Aon Risk Sclrvrcell
10/1103
10/03/2003 11:17 7274629786
SEP-OO-2003 1a:39 Ron Risk Seru ices. Inc.
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216 623 418S P.02/02
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Dolphin Encounter
2003/2004 Summary of Certificate Holders
State of Florida
Florida Department of En\'Q-oDJDeIltaJ ProteetioD
C/o RObey MOGlllsland State Park
1 Causeway Blvd.
Dunedin, FL ~3528
Additional Assured
&roor Master
City of Clearwater
25 Caoseway Blvd
CJeanvatert FL 33767
Additional Assured
Fint National Bank of FIoI'iQ
P.O~ Bo~ 1177fJ
Nsaplel, FL 34101
Attu~ Rita Dowaing
Additio...1 Assured
Gator Tours, IDe.
10!' N. KirklWUl Road
Orl.:ado, FL 32811
Atb1: Tori SUllivu
AdditiGDal AssW'ed
TOTAL P. 02