MEMO AND CERTIFICATE OF INSURANCE
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CITVIOF CLEARWATER
Interdef)8rtment Correspondence Sheet
TO: . Elizabeth S. Haesekert Assistant City Manager
FROM: William C. Heldt Jr., Harbormaster
,/
COPIES:. Cyndie Goudeau, Ci ty Clerk
SUBJECT: Insurance Policy - Colony Marina restaurant,
DATE: February 27, 1987
I have received and reviewed the insurance policy for Colony Marina
Restaurant. This policy meets the requirements of their lease agreement
with the city. Expiration date is December 28, 1987.
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MAR 2 1981
CII:1 Cl..ERK
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ISSUE DATE (MMIDDIYY)
2/24/87
Rhodes Insurance Agency, Inc.
P.O.' Box 5164
Clearwater, Fla. 33518
THIS CERTIFICATE IS ISSUED AS A i:lATTER 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
INSURED
Colony Marine Restaurant
71-75 Causeway Blvd.
Clearwater, Fla. 33515
COMPANY A
LETTER General Accident Insurance Company
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
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THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED.
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 CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTM POlICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
DATE (MMIlJO(YY) DATE (MMIOOIYYl EACH AGGREGATE
OCCURRENCE
BODILY
12/28/86 12/28/87 INJURY $ $
PROPERTY
DAMAGE $ $
BI & PO $ 300, $ 300 ,
COMBINED
GENERAL LIABILITY
COMPREHENSIVE FORM Bi nder
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTs/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CDNTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
Owners, Landlords, & Tenants
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS,)
ALL OWNED AUTOS (~~W=Rpl~~N)
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
PERSONAL INJURY $
. E G 2 G 198,
BOOll Y
INJlIllY
(PER PERSON) $
IIOOll Y
INJURY
(PER ACClOENT) $
/Ty OFClEA..vvA Efl
HA BORMASTERS OF ICE
PROPERTY
DAMAGE $
BI & PO
COMBINED $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
~t,~~ED $
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
Binder
12/28/86
12/28/87
STATUTORY
$ 100 (EACH ACCIDENT)
$ 500 (DISEASE,POllCY LIMIT)
$ 100 (DISEASE,EACH EMPLOYEE)
1 Plate 60 X 24
3 Plates 68 X 60
6 Plates 78 X 38
6 Plates 76 X24
3 Plates 74 X 24
3 Plates 70 X 24
OTHER
A Plate Glass Coverage
,B i nder
12/28/86
12/28/87