CERTIFICATES OF INSURANCE
"'---"'-~-'------'-:lI. .-... .---- . -.. ..,,---.--...-....----....-..... ..... ... ... -..-......,
A.~.tlll." CERTIFICA.t OF INSURANCE I ISSUE DATE (MM/DD/YY) ;
-'. . .. ::/::0/96
~RODUCER .AftIIlf'f~A'.~TfWaR'MATION.ONlYAND.. "',
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
LANCASTER INS INC _~~~~TB~~~~~:..~~~~~.~_~~_~~~~R ~.~~ ~_~~_E~AGE AFFORDED BY THE
B13-461-3704 COMPANIES AFFORDING COVERAGE
POBOX 2B56
CLEARWATER
FL 34617
COMPANY A
LETTER
GEN ACCIDENT INS CO
INSURED
COMPANY B
LETTER
MARINA RESTAURANT
25 CAUSEWAY BV
CLEARWATER FL 34630
f~~~~NY C
COMPANY D
LETTER
f~~~NY E
....~____~__________.....__...u_........._......'.....,c,...,.._....'''.. "..,.."..'..'............H'.'...'.,~,~,.......~,..'...."._...' ..,....''''.."...-..
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.
,
i
i
ICO
bR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
.. ...
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROTo
CPP0B3992606
4/01/96
4/01/97 GENERAL AGGREGATE
PRODUCTS.COMP/OP AGG.
PERSONAL & ADV. INJURY
S300, 000
il<J Q)(2), 0 0 0
$
.AUTO:::~:;~ABlLiTY.'.._...-_..__._---_._.-.---_.-.._..-..---..",........---. .-.-.-.......--. ..........".,
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED, AUTOS
NON.OWNED AUTOS
EACH OCCURRENCE il<J00, 000
FIRE DAMAGE (Anyone tire) a-s0, 000
....",....~.E~:.:::~~.~~~.(~y.o~e .~~~L..~~..0~~L., '
COMBINED SINGLE
LIMIT
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
GARAGE LIABILITY
i ", PROPERTY DAMAGE
~,~:~:~::::-.__._--_._-------_.__._-_._-_........:::~:~;"",,. ...
~ OTH.:~.2:.':'.~~.~~~'::':~~.~.. ,,' _...._,,,.....,..,..__ "",,,n . .._..._......_...."..._......"._.~_.._.__...._..,,' .,." ""'" .... ""...,,.....__ ...."". .,.. ,.....__...".. ,..,....., ,'.. ..... ." ,....
,I. . .""WORKER'S COMPENSATION STATUTORY LIMITS
L"""" AND" EAGHACClOlONT $
, · 0'"'" ~"=------_.._-_.--tH-!H-wi:~~;:,,'_:.._-
l fEB 2 2 19~6
-------.-...-.-,..'''"'..,.........."..--.---......-..".-....,,...-..--.,...--.......-----."...--..........".--". ' ... .,...."... ...' ..."...,....."....,., .,............."
DESCRIPTION OF OPERA TIONS/LOCA TlONS/VEHICLES/SPECIAL ITEMS
$
$
$
ADDITIONAL INSURED - CITY OF CLEARWATER
RISK MAr:.tGEMENT
CSRTI-=ICATE HOLDER
.-CANCELLATToN...........-...-.......... ................."...,..-.......-..-""..'''''...... ,,,......,,,,,,..,..,,.,,.,,. ." ..."'...,, '...",
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
i EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
:al' MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
r-' CITY OF CLEARWATER LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
i A TTN LEO W SCHRODER - RISK MGR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
; ~L~A:~~T~~48 FL 3461B 'A~'l74" .....
I ACORD '~J7,!'L..._.____________ __ _. __:=~.d__~~=:~=t.~r_.____~~~.".~c-"."".~..~o~(~
,)
AtDttIUt.,. CERTIFICATE OF INSURANCE
.. ,';:~"':\":'''''~~>'IJ.t::';M~,i_~;k~".-;::'.':, ,. -, .
I
ISSUE DATE (MM/DDIYY)
PRODUCER
LANCASTER INS INC
813-461-3704
POBOX 2B56
CLEARWATER FL 34617
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
COMPANY A
LETTER
GEN ACCIDENT INS CO
INSURED
COMPANY B
LETTER
t1ARINA RESTA1..IRAHT
25 CAUSEWAY BV'
CLEARWATER FL 34630
COMPANY C
LETTER
COMPANY D
LETTER
~~~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
TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DDIYY)
LIMITS
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROTo
CPP0B3992606
.. 4/01/96,
. i
4/01/97. GENERAL AGGREGATE
PRODUCTS.COMP/OP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone tire)
MED. EXPENSE (Anyone person)
'300,000
'300,000
$
'300,000
~0, 000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
COMBINED SINGLE $
LIMIT
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
EACH OCCURRENCE $
AGGREGATE $
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY LIMITS
EACH ACCIDENT
$
$
$
OTHER
fEB 2 2 1YIJ6
DESCRIPTION OF OPERA TIONS/LOCA TlONSNEHICLES/SPEClAL ITEMS
ADDITIONAL INSURED - CITY OF CLEARWATER
RISK MAt:.t. GEftlrNT
CER!1ACA TE!:t~LDER
CANCELLATION
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.
AU~~~Ee~~ /2d'L___. /~ /'
CITY OF CLEARWATER
ATTN LEO W SCHRODER-RISK MGR
POBOX 4748
CLEARWATER FL 34518
. ,- ,,->'-
PRODUCER
LANCASTER INS INC
813-461-3704
POBOX 2B56
CLEARWATER FL 34617
CODE SUB.CODE
37-2541
INSURED
MARINA RESTAURANT
25 CAUSEWAY BV
CLEARWATER FL 34630
\ i::O~:~ERAL ACCIDENT I BiN~E:;O~B0_3 F
~I'F~etIV~ ..... I:xl'll1A TloN
,d~'il94\ i:; , ., irK I :: ;-; i ~Ai'/94 Ix
K 1 b~~~l~~E:EW ~~~V~~J~Mb~~o~OVER~p; ~~~~~~~M~~
DEsCRiPTioN OF OPERATioNSNEHICLESIPROPERT'f (InCiuding Lociiiion)
TIME
\'2.01 M~
NllON
FIRE 25 CAUSEWAY BV
HIRED & NON OWNED
LIMITS
COVERAGES .'". .' .~. ","':7"~:"':'.'''., "'~n":::;"o.',rot,~~., ,..:",'7_:;ji':~."
TYPE OF INSURANCE \ COVERAOEIFORMS
PROPERTY CAUSESOFLOSS .... .......... ........ Content";''::Repiecement Cost
BASIC li"JBROAD!]SPEC. Earnings
GENERAL LIABILITY
X lCOMMERCI.AL GENERAL LIABILITY
'1 J CLAIMS MADE L K ] OCCUR
OWNER'S & CONTRACTOR'S PROTo
RETRO DATE FOR CLAIMS MADE:
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
x
X NON.OWNED AUTOS
GARAGE LIABILITY
AMOUNT
DEDUCTIBLE
COINSUR.
75,000 250
16,000
80
GENERAL AGGREGATE !,300, 000
PRODUCTS - COMP/OP AGG. t;3 0 0, 000
PERSONAL & ADV. INJURY $
EACH OCCURRENCE
~00,000
:150, 000
FIRE DAMAGE (Anyone fire)
MED. EXPENSE (Anyone person)
COMBINED SINGLE LIMIT ~00, 000
BODILY INJURY (Per person) $
BODILY INJURY (Per accldenl) $
PROPERTY DAMAGE $
MEDICAL PAYMENTS $
PERSONAL INJURY PROTo $
UNINSURED MOTORIST
$
ACTUAL CASH VALUE
STATED AMOUNT $
OTHER
EACH OCCURRENCE $
AGGREGATE $
SELF.INSURED RE TENTlON $
STATUTORY LIMITS
EACH ACCIDENT 1$
DISEASE,POLlCY LIMIT \ :
DISEASE.EACH EMPLOYEE
AUTO PHYSICAL DAMAGE DEDUCTIBLE I ALL VEHICLES SCHEDULED VEHICLES
\ COLLISION:
OTHER THAN COL: ...
EXCESS LIABILITY ,
1 UMBRELLA FORM
, OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE:
WORKER'S COMPENSATION
AND
EMPLOYER'S LIABILITY
I
SPECIAL CONDITIONS/OTHER COVERAGES
INCLUDES SCHEDULED GLASS COVERAGE
PENDING RECEIPT OF RENEWAL FROM THE
1::" ~\~{><~:-~~::;'1..'
~ .:.J ~;;;:;~::
'1 LOAN *
1 AUTHORIZED REPRESENTATIVE tfl ,
,~e?'L ~ -/'~~
"..._._'"'__....n....~~~1;P_E.~~,~~-~~~~~~~~......" ..... -.' .,
"",.!/.l., ..' .'. ...,... eACORD CORPORATION 1990
"N:,,::/.y,:~I\.. }. i. :~:,-'i~~~,i,,'.M~!";;:l":'
BECEI'ED .
APR 0 5 1994
NAME & ADDRESS
CITY CLEU DEPT.
ACORD 7S.S
ADDITIONAL INSURED
'"
........
.........
',-
~
AF'R 04'94 0'3: 13 LAJ1CASTEF: RHODE~:; H1SURRNCE, mc.
I
POLlCY NUMBER: cpp 083$826-03
P.2.2
I
COMMERCIAL.G.EN~RAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-STATE OR POLITICAL
SUBDIVISIONS-PERMITS RELATING TO PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
State or Political Subdivision:
SCHEDULE
City of Clearwater
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to
include as an insured any state or political subdivision
shown in the Schedule, subject to the following addi-
tional provision;
This insurance applies only with respect to the follow.
ing hazards for which the state or political subdivision
has issued a permit in connection with premises you
own, rent, or control and to which this Insurance
applies:
1. The existence, maintenance, repair, construc-
tion. erection, or removal of advertising signs.
awnings, canopies, cellar entrances, COGlI holes,
driveways, manholes, marquees, hoistaway
openings. sidewalk vaults, street bannerS,or
decorations and similar exposures: or
2. The construction, erection, or removal of ele-
vators; or
3. The ownership, mainter'lance, or use of any ele-
vators covered by this insuranCe.
CG 20 13 11 85
Copyright. Insurance ~ervices Office, Inc., 1984
o
,
~ ',\. APR 04 '94 ~9: 13 LRr'lCASTER RHODES U'ISURAr-..JCE, HlC.
t
F'.1.2
I
r:AC:::; I ('I I i....E CO I.)E.:H Si"IL~L::'r
.,.... ;".., ","',"'"
/....'1"., )1::;'
(::;::'n a. 1,
1 r-jS.l~
T'i. tilt::: 9 j Z~~~ A. :/j.
t,a.Ji1IBE(.i Qt:. SHE.:=:-:-S I;,JC~_UDING COVER SHEt=:-r 2
-r:J F:-';':X i'LE1iBCR L;.i'.:,~::""i:'-:)::.i'/
COMPANY CITY OF CLEARWATSR
ATTENTION CATHSRINE
F HO\tl?;Ci'lE ~"i:";CHES
LANCASTER INSUnAr~CE, INC. 813-4bl-3704
F J':.~): B,~ ~.~ ,,,,,.it l.r ::. .....::~~~~~.:.; ~3
RS MARIN~ ~ESTQURANT
CATHERINE, AT~ACHE8 is A COpy DF THE ENDORSEMENT SHOWING THE
CITY OF CLEARWRTER AS AN ~DDITIONAL INSURED.
IF '/OU LOO:< C);'" 'n::=: P:P.3HT j--j;;ND SIDE DF Tl':i:~ Bn~:DEP1 PBOUE T:-!E
SIGNATURE-YOU WI_L SEE TH~ BLOCK IS CHECKED SHOWING ADDIT10NAL
I :'~~~~~jn~~G"
WE WILL SEND YOW A COpy O~ THE ~ENEWAL AS SOON AS IT IS
R~C~lVfl) F~OM GENERA~_ ACCID2NT !NSURA~CE cOr~PAN\{~