CERTIFICATE OF INSURANCE (4)
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'3fJe 14 1988
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'\ At~~~:Ut. CERTIFICA TEloF INSURANCE
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DA TE(MM/DOrVV)""'-"
Poe & Associates, Inc.
P.O. Box 1348
Tampa, Florida 33601
THIS CERTIFICATE IS ISSUED AS A MATIER 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
,
COMPANIES AFFORDING COVERAGE
..-~-,---,..._._~~------~_...._."--'-----------"-.""--------"--.--.--.------
~~~NY A National Union Insurance Company
CODE
SUB-CODE
__un u u___~_..____~__n__.___.___ '" . "..-, " u._.....,._._"."
INSURED
~~~NY 8 Union Security Insurance Company
Clearwater Beach Seafoods, Inc.
37 Causeway Blvd.
Clearwater, Florida 33515
COMPANY C Employers Self Insurers FUnd
LEITER
COMPANY D North Carol i na Insurance Canpany
LEITER -
", ,_n' .__..__.~.....___u_...______._,._ ._________________.._n_____.___^__.._________."..u .u"_._.u.'.____._ "-,"--'--~--'
COMPANY E
LEITER
i COVERA~~S;., ",__, . .;~"" .
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
..__,.'..__._______.._...____..__.._~___._._ ..___.__.._____.__..u_.__~____,____~______.__._.____._.___-----<.------.----~.-----
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/YY) DATE (MM/DDIYY) .
ALL LIMITS IN THOUSANDS
.CO
I:"
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
----.--.,.--
, CLAIMS MADEX' OCCUR.
OWNER'S & CONTRACTOR'S PROTo
Binder TrOGl
5-31-88
5-31-89
, GENE~~~~~GREGATI:_____...__~1,9QQ_
~ODUCT.~.~~~~/-~~~AG~~~~~:.!--l,POQ,-.
, PERSONAL & ADVERTISING INJURY . $
; EACH OCCURRENC'E------:-SI- 00-6--"
,__........______.._.._';-.1_____.
FIRE DAMAGE (Anyone fire) : $
<
: MEDICAL EXPENSE (Anyone person) : S 5
, AUTOMOBILE LIABILITY
i COMBINED
i SINGLE ; $
j LIMIT
! BODILY
i INJURY : $
i (Per person) ;
j BODILY
; INJURY ; $
i (Per accident)
j PROPERTY : $
l DAMAGE <
,. ~':),.'; ,,:,~,:,i:;.".:--
,._._J ANY AUTO
. i ALL OWNED AUTOS
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t-.; '."
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I:~c:y,.;;.., n
'i-,!;~'-:'-:(:; -c-
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U SCHEDULED AUTOS
i HIRED AUTOS
; i NON-OWNED AUTOS
: GARAGE LIABILITY
''!::-:_',>;,::-'>
EXCESS LIABILITY
'i..,'7T~--..EACH----;----:-AGG'A~~ii'f"....c
, 'c C" ... ....; OCCURRENCE j
;,: .' $ 1,l $
;-, ,
t
r-; OTHER THAN UMBRELLA FORM
C
WORKER'S COMPENSATION
AND
ESIF 830-7324
5-31-88
5-31-89
STATUTORY
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OTHER
B Liquor Liability
. A Property
DFlood
Binder TrOOl
Binder TrOOl
. Binder TrOOl
5-31-88
5-31-88
7-12-88
5-31-89
5-31-89
7-12-89
;~.100 (EACH ACCIDENT)
~500.. (DISEASE-POLICY LIMIT)
j $ .100 (DISEASE-EACH EMPLOYEE
1$500,000 CSL Claims Made Fo
$210,000 Bldg./$150,000 Cont -
$210,000 Bldg./$150,000 Con
EMPLOYERS' LIABILITY
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/RESTRICTlONS/SPECIAL ITEMS
Additional Insured: City of Cleanvater Risk Management
P.O. Box ~748, Clearwater, tL 34618
I CE~I~!cA.I~ ~~L~ER .t,..,.;;;'d,;I;i.::;.::...,.~~2~~;....,i,,~~:~C.~NCELLA !1!>N..:~;;:.j!ddA.Zii'JSJ#."lz$.~~::.;::,I~:.::~f~~.ii;iJ.ilQi.:b\:-f:'f~~>;'"":t:!.~:~':~i:.:i~.::
';;j
City of Clearwater Risk Management
P.O. Box 4748
Clearwater, FL 34618
. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
j EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO
'~ MAIL -l.U DAYS WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
'i LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
t LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ACORD n25:s'(3/88j7:'.:"""7~7-,;;;.;':~":'~7:T....c;T:~'.,...---:'"""?- --~...:-::-.,;""C:
..CORPORATiOt.ii98S-
A.~ttlll... CERTIFICATEJOF INSURANCE
ISSUE DATE (MM/DDIYY)
7-7-88
PROOOCER
Poe & Associates, Inc.
P.O. Box 1348
Tampa, Florida 33601
THIS CERTIFICATE IS ISSUED AS A MATTER 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
COMPANIES AFFORDING COVERAGE
CODE
SUB-CODE
CLEOnMPEARNY A
National Union Insurance Company
INSURED
f~~NY B
Clearwater Beach Seafoods, Inc.
37 Causeway Blvd.
Clearwater, Florida 33515
Union Security Insurance Company
f~~NY C Employers Self Insurers Fund
f~~NY D
f~~NY E
COVERAGES
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR DATE (MM/DDIYY) DATE (MM/DD/YY)
A GENERAL LIABILITY $1,000
x COMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OPS AGGREGATE $1,000
CLAIMS MADEj(" OCCUR. Binder TrOOl 5-31-88 5-31-89 PERSONAL & ADVERTISING INJURY $
EACH OCCURRENCE $1,000
$
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
AGGREGATE
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
C ESIF 830-7324 5-31-88 5-31-89 $ 100 (EACH ACCIDENT)
AND
$ 500 (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY
$ 100 (DISEASE-EACH EMPLOYEE)
OTHER
B Liquor Liability Binder Tr001 5-31-88 5-31-89 $500,000 CSL Claims Made
Form
DESCRIPTION OF OPERA TIONSILOCA TlONSNEHICLESlRESTRICTIONSlSPEClAL ITEMS
Additional Insured: City of Clearwater Risk Management
P.O. Box 4748
Clearwater FL 34618
CERTIFICA TEHOLDER C~NCELLA TION
Ci ty of Clean-later Risk Management
P.O. Box 4748
Clearwater, FL 34618
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
ACORD 25-5 (3/88)
A",""~U~
@ACORD CORPORATION 1988
III