CERTIFICATE OF INSURANCE (5)
PROOUCER
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DATE (MMiOOIYY)
C'HJ2J97
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERnACATE
HOLDER. THIS CERT1FICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BElOW.
COMPANIES AFFORDING COVERAGE
Northeast Undetwrtters, Inc.
POBox 7506
4790 1st Street NOI1h
Sl Pel8rsburg FL 33734-7506
COMPANY
A
Commercial Union Ins Co
INSURED
CIeanYaf8r Beach Seafoods
Restaurant 100
37-causeway Boulevard
Clearwater FL 34630
COMPANY
B
COMPANY
C
COMPANY
D
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SO N' US
INDICATED, NOTWITHSTANDING Am 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co TYPE OF INSURANCE POlICY NUMBER POUCY EFFECllVE POUCY EXPlRAllON LlUITS
LTR DATE (MMlDDNY) DATE (MMlDDNY)
A GENERAL LIABILITY AZR428285 05/31/97 05/31/98 GENERAL AGGREGATE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGG $ 1,000,000
.. o OCCUR 1,000,000
,~ u, QAIMS MADE PERSONAL & ADV INJURY $
;:-r:;:1
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $
X LIQUOR LIABILITY ONLY FIRE DAMAGE (Any one fifll) $
MED EXP (Arrt one person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (per person) $
HIRED AUTOS BODILY INJURY
NON'()WNED AUTOS (per accident) $
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EXCESS LIABILITY EACH OCCURRENCE
UMBRELlA FORM AGGREGATE
OTHER THAN UMBRELlA FORM
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
$
THE PROPRIETOR! INCl $
PARTNERSlEXECUTIVE
OFFICERS ARE: EXCl EL DISEASE ' EA EMPLOYEE $
OTHER
A PfUlERTY OOIERAGES AZR428285 05/31/97 05/31/98 BUI LD 100 225,600
GLASS SCHEDULE INCLUDED PERSONAL PROPERTY 165,300
EXCLUJ 100 W I NO & FLCXD DEDUCTIBLE FOR EACH 1,000
~RfleRI ?ImrMm8tsrA~'~~C~~f~'5.cED PO.. I CY IS NM4ED AS AN ADDITIONAL INSURED.
5/20/97SW OS/22/97 Ip
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SHOULD AWi OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING ANY WILL ENDEAVOR TO MAIL
~ DAYS WRmEN NOTICE TO TH TIFICATE LDER NAMED TO THE LEFT,
OBLIGATION OR LIABILITY
EPRESENT A TIVES,
CIlY OF CLEAWATER
C/O RISK MANAGEMENT
PO BOX 4748
C~WATER FL
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34618
OS/27 '97 11:03
ID:
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FAX:8134491964
PAGE
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PRODUCER
DATE (MMIDD/YY)
OS/22197
THIS CERTlACATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTlACATE
HOLDER. THIS CERTlACAlE DOES NOT AMEND, EXlEND OR
ALlER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Northeast Underwriters, Inc.
POBox 7506
4790 1st Street North
St. Petersburg FL 33734-7506
COMPANY
A
CommercIaJ Union Ins Co
INSURED
Clearwater Beach Seafoods
Restaurant Inc
37-Causeway. Boulevard
Cleanvater FL 34630
COMPANY
B
COMPANY
C
COMPANY
o
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l '-i~:'tt,I.-"f ,1',-_ ,tr~I~~'l'ti'\ '}j .,~
-'Rt~'" 'bWffiJw: bL It
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, LIMITS SHOWN MAY HAVE BEEN .REDUCED BY PAID CLAIMS,
co TYPE OF INSURANCE POiJCY NUMBER POUCY. EFFECTIVE POliCY EXPIRATION LIMITS
LTR DAlE (MMfDD/YY) DAlE (MMlDDIYY)
A GENERAL LIABILITY AZR428285 05/31/97 05/31/98 GENERAL AGGREGATE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGG $ 1,000,000
h5H; CLAIMS MADE o OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $
X LIQUOR LIABILITY ONLY FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR! INCL
PARTNERSIEXECUTIVE
OFFICERS ARE: EXCL
OTHER
A PROPERTY COVERAGES AZR428285 05/31/97 05/31/98 BUILDIOO 225,600
GLASS SCHEDULE INCLUDED PERSONAL PROPERTY 165,300
EXCLUDING WIND & FUn) DEDUCTIBLE FOR EACH 1,000
~Ff!l~'fl~) 8Af~Affit~~WV~srR~IC~~C~~I.JcED POL ICY IS NN.lED AS AN ADDITIONAL INSURED,
5/20/97SW OS/22/97 Ip
CITY OF CLEAWAlER
C/O RISK MANAGEMENT
PO BOX 4748
CLEARWATER FL
34618
EXPIRATION DATE THEREOF, THE ISSUING
~ DAYS WRITTEN NOTICE TO TH
BUT FAILURE TO MAIL SUCH NOTIC ALL
OF ANY KIND UPON THE COM , ITS
AUTHORIZED REPRESENt