CERTIFICATE OF LIABILITY INSURANCE
7/ ~flj/Uj 14:~1
r / L/ 441 /b'l~
connelly Ins Iracy KatKleWlcz-'veOOle KelO
~ C" ~~/\JC\i '1(~0L
1IL
ACORD", CERTIFICA TE OF LIABILITY INSURANCE OP ID T Z I DATE (MM/DD/VY)
TARPO-8 05/13/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
630 Chestnut Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax: 727-442-7695 INSURERS AFFORDING COVERAGE
INSURED INSURER A Zurich American Insurance Co.
Tarpon Woods Country Club &
Clearwater Golf Assoc. Inc dba INSURER B:
Clearwater Exec. Golf Course
H&M Investment of Clw Inc dba INSURER c:
1100 TarEon Woods Blvd INSURER D:
Palm Har or FL 34685
I INSURER E:
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.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTlYE POLICY EXPIRATION LIMITS
LTR DATE IMMIDDNYI DATE IMMIDDNYI
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
r--
A X COMMERCIAL GENERAL LIABILITY CP02780201 01/10/03 01/10/04 FIRE DAMAGE (Anyone lire) $ 100,000
I ClAIMS MADE [!] OCCUR MED EXP (Any one person) $ 5,000
X Liquor Liab lmil/ PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
r-- $ 1,000,000
A ANY AUTO CP02780201 01/10/03 01/10/04 (Ea accident)
r--
ALL OWNED AUTOS BODILY INJURY
r----- $
SCHEDULED AUTOS (Per person)
r-----
-.!.. HIRED AUTOS BODILY INJURY
$
...!... NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: M3G $
EXCESS LIABILITY EACH OCCURRENCE $
P OCCUR D ClAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WC STATU, I IOTH-
TORY LIMITS ER
EMPLOYERS' LIABILITY
EL EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
OTHER
A Equipment Floater CP02780201 01/10/03 01/10/04 Special 216000
Ded 5000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADOED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is listed as additional insured with respect to the
following location: 1875 Airport Drive, Clearwater, FL 33755.
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION
CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAVS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL
City of Clearwater
P.o. Box 4748 IMPOSE NO OBUGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, 1T5 AGENTS OR
Clearwater FL 33758-4748 REPRESENTATIVES.
AUTHO~ _ ~ /.-.-
I , . r v.~ -
ACORD 25-S (7/97)
@ACORD CORPORATION 1988