CERTIFICATE OF LIABILITY INSURANCE (4)
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP 10 SEI DATE (MM/DDIYYYY)
- CLEAR17 06/16/05
PRODUCER '. THIS CERTIFICATE IS ISSUED AS A MATTER OF= INFORMATION
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax: 727-442-7695 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER Pc SAFECO Insurance Company 24740
INSURER B: FFVA Mutual Insurance Company
Clearwater Golf Associates Inc INSURER C: American Economv 19690
1875 Ai~ort Drive INSURER 0
Clearwater FL 33765
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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDlYYf . "l1k~"e" (MM/DDIYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
I--
A X X COMMERCIAL GENERAL LIABILITY 02CE0795781 06/17/05 06/17/06 PREMiSes '(E~~~~~nce) $ 200000
r--- ~ CLAIMS MADE ~ OCCUR
r--- MED EXP (Anyone person) $ 10000
X Liquor Liability PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
nn PRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1000000
C ~ ANY AUTO 02CE07787510 06/25/05 06/25/06 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
~ NON-OWNED AUTOS (Per accident)
- REI ~E'VEr: PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY jUN 1 7 2005 AUTO ONLY - EA ACCIDENT $
R ANY AUTO EA ACC $
OTHER THAN
- AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY Final Ice I Of EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY L1Mm; I IOl~-
B -EMfJ.QYERn!8~'LJ[Y ... ._-~,-- "- 161~---" .. u~t1:.71fP!J -o3/rr/Oe, "E:L.EACH ACC.uENT -- h1.(}()-6-()-O -'--
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 100000
~~~(:I~~s~~~v~s?o~s below EL DISEASE - POLICY LIMIT $ 500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Clearwater is listed as Additional Insured with regard to General
Liability
CERTIFICATE HOLDER
CANCELLATION
CITOF-8
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ OAYS WRITTEN
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.
AUTH~.HNTA~
"/~ I_
@ACORDCORPORATION 1988
City of Clearwater
PO Box 4748
Clearwater FL 33758
ACORD 25 (2001/08)