CERTIFICATE OF LIABILITY INSURANCE (4)
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A.~.tlrlt~ CERTIFICATE OF LIABILITY INSURANCE ~~~DDIYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Northeast Assurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
POBox 7506 ' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4790 1st Street North ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sl Petersburg FL 33734-7506
INSURED
Countryside Golf Practice & learning Center
2987 McMullen Road
Clearwater
FL 33761
TBD
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GENt AGGREGATE LIMIT APPLIES PER:
I POLICY n ~r8r n LOC
AUTOMOBILE LIABILITY
-
ANY AUTO
-
ALL OWNED AUTOS
~
SCHEDULED AUTOS
~
HIRED AUTOS
~
NON-DWNED AUTOS
I--
r'
I
I
GARAGE LIABILITY
R ANY AUTO
EXCESS LIABILITY
tJ OCCUR
RDEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
B EMPLOYERS' LIABILITY
i
,
I
o CLAIMS MADE
L.t4;'
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IACRUB.1432A95.1-01
OTHER
INSURERS AFFORDING COVERAGE
Burfington Ins Co,
Travelers Insurance Co.
INSURER A:
INSURER B:
INSURER C:
INSURER 0,
INSURER E:
~WY EF~E IV~
Pi?H~Y 'AA~I
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,
1~~R TYPE OF INSURANCE POLICY NUMBER
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [!J OCCUR
06/21/02
06/21/03
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09/19/01
09/19/02
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THE CERT I FI CA TE HOLDER I S HEREBY NMlED AS AN ADD I T I OOL INSURED
CQ\JNECT I Q\J WITH THE CCM.lERC I AL GENERAL LI AS I LI TY OOVERAGE PART,
Alln: Mike Fax # 727.799.6076 6.20-02 RS
CERTIFICATE HOLDER
I I ADDITIONAL INSURED; INSURER LmER:
City of Clearwater
Atti1: Ream Wilson
PO BOX 4748
Clearwater
FL 34618
I
ACORD 25-8 (7/97)
CANCEUATlON
IN
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS, COMP/OP AGG
COMBINED SINGLE LIMIT
lEa accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
d.ROPERTY DAMAGE
fer accidenl)
,AUTO ONLY, EA ACCIDENT
EA ACC
OTHER THAN
AUTO ONLY:
EACH OCCURRENCE
AGGREGATE
x I T~~VS,I,M~ I 10J~'
E.L EACH ACCIDENT $
E.L DISEASE ' EA EMPLOYEE $
E,L DISEASE - POLICY LIMIT $
LIMITS
AGG
$ 1,000,000
$ 50,000
$ 1,000
$ 1,000,000
$ 2,000,000
$ 2,000,000
$
$
$
$
$
$
$
$
$
$
$
$
100,000
500,000
100,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRmEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
W. A. Waters III . A278401
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@ ACORD CORPORATION 1988
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