CERTIFICATE OF INSURANCE (2)
JAN-31-03
11 :36
FROM-Acoricla Frontl ine team
727-791-1871
T-654 P.OOI/002 F-l07
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDOIYY)
01/31103
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
O,NLY AND CONFERS NO RIGHTS UPON, THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PROPUCI;R
ACORDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727.796-6666
INSURERS AFFORDING COVERAGE
INSURED
Clearwater Country Club
Management, Inc.
525 North Betty Lane
Clearwater FL 33755
INSURER A;
INSuRel'l B:
INSURER c:
INSURER D:
IN$UAOR .:
FIREMAN'S FUND INSURANCE CO
AUTO OWNERS-09703
BRIDGEFIELD EMPLOYERS INS CO
COVERAGES
THE POLICIES 01" 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 OF! OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AI"FORDED 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.
I~~: POUCY NUMIlER POLICY EFFECTIVE POuCY exPIRATION LIMITS
TYPE OF INSURANCE [)ATE IMMmnrVvl
A ~ERAL L1AIlILlTY MZX60809476 1/01103 1/01/04 EACt1 OCCURRENCE S 1000000
X COMMERCIAL. GENERAL L1AElluTY FIRE DAMAGE (AllY gne tlr.' e 100000
-1 CLAIMS MADE W OCCUR MED .XP (Anyone personl . 5000
-
PERSONAL & ADV INJURY . 1000000
~
f-- GENERAL AGGREGATE $ 2000000
n'L AGGREA LIMIT Ai"n PER: PRODUCTS - COMP/OPAGG $ 2000000
POLley ~~T L.OC
B I~TOMOSIL& LIABILITY 9562406000 1/01/03 1/01104 COMElINEo SINGL.E L.IMIT
lea accident) 8 1000000
~ N>lY AUTP
f-- ALL OWNED AUTOS ElOOILY INJURY
CPar oareon) 8
f-- SCI'lEDULED AUTOS
HIRED AUTOS BODILY INJURY
f-- .
NON.OWNED AuTOS (pe, 8ccl~anl)
f--
f-- PRO PERT'!' DAMAGE $
(P"r ~cddanl)
RRAI3E UAElILlTY AUTO ONLY. EAACCIDENT $
ANY AUTO OTHER THAN EA ACC S
AuTO ONLY: AGG &
A Excess LIAbiLITy BIND482245 1/01/03 1101/04 EACH OCCURRENCE 8 5000000
tlSJ' OCCUR 0 CLAIMS MADE AGGREGATE C 5000000
~
R OEouCTIElLE .
ReTENTION $ 8
C WORI(ERS COMP~$ATION AND 83028251 1/01/0J 1/01/04 I ~~;T :r,~-;" I IOJ~.
EMPLOYERS' L1ABIUTY I;.L. IOACH ACCIDENT
8 500000
E.L.. DISEASE. lOA EMPL.OYEE . 500000
E.L.. DISEASE - PO~ICY L.IMIT ~ 500000
OlliER
DESCRIPTION OF OpEilATIDNSILOCATIONSNEHICLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
FAX: 562.4825
CERTIFICATE HOLDER I I ADDmONAL INSURED: INSURaI ~ET!l:R: CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE [)ESCRIBED POUCIES BE CANCELLE[) BEFORE TIlE ~PIRATlO'"
DATE THEREOF, THE ISSUING INSURER WIL~ ENDEAVOR TO MAI~ ~ DAYS WRITTEN
ATTN: DEBBIE REID NOTICE! TO THE CERTIFICATE HOLDI1R NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. BOX 4748 IMPOSE NO OBLIGATION OR I.lAIlJUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER, FL 33758-4748 REPRE~NTATlvES. /1
AUTHO~REPR~ATIVE
I Tn,,, I r,
. - . "
ACORD 25 S (7/97)
46 54
@ACORD CORPORATION 1988