CERTIFICATES OF LIABILITY INSURANCE
At".ltl.~
DATE (MIMlDIYY)
07/WOO
THIS CERTIRCATE IS ISSUb..- AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOlDER. THIS CERTIRCATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POliCIES BELOW.
INSURERS AFFORDING COVERAGE
NorIIern Ins Co of NY
ZenIlh
~SURER A;
~SURER B:
~SURER c:
~SURER 0:
~SURER E:
PRODUCER
ALLEY REHBAUM . CAPES
ASSURANCE, INC.
P. O. BOX 4820
ClEARWATER FL 33758
INSURED
Mama ..
C8rpentlr' EntBrprtses Inc DBA
25 Causeway BIW.
Clearwater Beam FL 33781
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NO'TWITHSTANDING
AN( REQUIREMENT, TERM OR CONDITION OF AN( CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUClES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS, EXClUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS. ~
~iR TYPE OF INSUR.6HCE POlICY NUMBER IC rv ~W ION lIMITS
A GENERAL llABl.lTY PAS031650139 07/25/00 07/25/01 EACH OCCURRENCE $ 1,000,000
'--
X COMMERClAL GENERAL llABl.lTY FIRE DAMAGE (My one fire) $ 1,000,000
I cw.1S MADE [!] OCCUR MED EXP (My one pelSon) $ 10,000
PERSONAL & /lDV INJURY $ 1,000,000
- 2,000,000
GENERAL AGGREGATE $
- 2,000,000
GENt AGGREGATE LIMIT APPliES PER: PROOUCTS . COMPIOP AGG $
I POlICY n ~8i nLOC
~OM08Il.E LIABLITY - COMlltlED stIGlE lIMIT $
NlY AUTO (Ea ~enQ
-
- ALL Q'MojED AUTOS BOOl Y INJURY
SQiEDlA.ED AUTOS (Per pelSOlI) $
-
HIRED ,AUTOS BOOl Y INJURY
- $
NON-OWNED AUTOS (Per ~enQ
~
PROPERTY DAMAGE $
(Per ~enQ
GARAGE llABll.lTY AUTO ONLY. EA ACC()ENT $
==1 NlY AUTO 01llER lllNl EA N:;C $
AUTO ONLY: AGG $
EXCESS llABl.lTY EACH OCCURRENCE $
=:J OCCUR D CLAIMS MADE AGGREGATE $
$
==1 ~EDUCTaE $
RETENTION $ $
WORKERS COMPENSATION NlD X I we S"ATU- I 10~-
B EMf'LOYERS llABllTY 35197 07/25/00 07/25/01 100,000
El. EACH ACC()ENT $
E.L. DISEASE. EA EMf'LOYEE $ 500,000
E.L. DISEASE. POlICY lIMIT $ 100,000
01llER
DESCRIPTION OF Of'ERATIONSIlOCATIONS^lEHIClESlEXa.USlONS ADOED BY ENDORSEMENTISPEClAL PROVISIONS
Certificate Holder i. Add'l Insured for General Liability only
Cancellation Notice for Workers Camp is 30 Days
CER1lFICATE HOlDER I I ADOITIONAL INSURED; ~SURER lETTER: CANCEUAllON
SHOU,D NlY Of lllE N!I:NE DESCRIBED POlICIES BE CNlCaLED WORE lllE EXPIRATION
Harbomtaster DATE lllEREOf, lllE ~G INSURER WU ENDEAVOR TO MAl. 10 DAYS WRmEN
-
City of Clearwater NOTICE TO lllE CERTIFICATE HOlDER NAMED TO lllE LEFT, BUT FAlLURE TO DO so SHALL
25 Causeway Blvd. IMPOSE NO Oll.IGATION OR llABll.lTY OF NlY KIND UPON lllE INSURER, ITS AGENTS OR
Clearwater FL 33787
REPRESENTATrvES.
AUTHORIZED REPRE1-r!i ~ ,
I ,,,,JAr! . iA Cfr
ACORD 25-S (7/97) V e ACORD CORPORATION 1988
&UA
A.~.tltlts CERTIFICA TE.IJF LIABILITY INSURANaii I DATE (M1MlOIYV)
07116199
PRODUCER THIS CERTIFICATE IS ISSUbJ AS A MATTER OF INFORMATION
ALLEY REHBAUM & CAPES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ASSURANCE, INC. HOlDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. BOX 4620 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CLEARWATER Fl 33758
INSURERS AFFORDING COVERAGE
INSURED INSURER A: Northern Ins Co of NY
MarIna GIftI INSURER B: ZenIth
~nter ~ 100 DBA INSURERC:
25 IUsewt B . INSURER 0:
Clearwater ach Fl 33767
I INSURER E:
COVERAGES
THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLlCY PERIOD INDICATED. NOTWITHSTANDING
Am REOUIREMENT, TERM OR CONDITION OF Am CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUaES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS. ~~
lI'tf TYPE OF INSURANCE POlICY NUMBER LIMITS
A GENERAL LIABILITY PAS031650139 07/25/99 07/25/00 EACH OCCURRENCE $ 1 , 000 , 000
--
X COMMERCIAL GENERAL LIABILITY . , FIRE DAMAGE (Any one fil8) $ 50,000
1 CLAIMS MADE [!] OCCUR loIED EXP (Any one peqon) $ 10,000
PERSONAL & ADV I~URY $ 1,000,000
. GENERAL AGGREGATE $ 2,000,000
~t AGGRE~r~~APPUES PER: PROOUCTS . COMPIOP AGG $ 2,000,000
POUCY JECT n LOC
~OMOBILE LIABILITY COloIlllNED S1NGLE LIMIT $
ANY AUTO lEa accidenl)
I-
~ ALL OWNED AUTOS BODtl. Y INJURY
SCHEDULED AUTOS (Per pel1OIl) .
-
- HIRED AUTOS BODtl. Y ItWRY
NON-OWNED AUTOS (Per accidanl) $
-
- PROPERTY DAMAGE $
(Per accidanl)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
==i ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
5SS LIABILITY EACH OCCURRENCE .
OCCUR o CLAIMS MADE AGGREGATE .
.
==i' DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION AND X~I 10JIt
B EMPLOYERS' LIABILITY 35197 07/25/99 07/25/00
E.L EACH ACCIDENT . 100,000
E.L DISEASE - EA EMPLOYEE $ 500,000
E.L DISEASE . POLICY LIMIT $ 100,000
OTHER
DESCRIPTION OF OPERATIONSlLOCATKlNSlVEHICLESiEXCLUSlONS ADOED BY ENDORSEloIENTISPEcw. PROVISIONS
Certificate Holder is Add'l Insured for General liability only
Cancellation Notice for Workers Comp is 30 Days
r;FRTIAr.ATE HOLDER I I ADDITIONAl. ~EO; INSURER LETIER: I.&~
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
Harbonnaster DATE THEREOF, THE ISSUING INSURER W1U. ENDEAVOR TO MAIL 10 DAYS WRITTEN
-
CIty of Clearwater NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
25 Causeway Blvd. IMPOSE NO 00lIGA TION OR UA8lUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater Fl 33767
REPRESENTATIVES.
AUTHORIZED REPRESENTA)n~
I . ~ "*"""1 /J./O ./A_/~
ACORD 25-S (7/97) (7" AtaAD COlfPORATION 1988
(...
'A.~..III.~
;,7:\(e ow:
DATE (MM/DDIYY)
07/16198
THIS CERTIFICATE IS ISSUED AS A MAmR OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
AllEY REHBAUM & CAPES
ASSURANCE, INC.
P. O. BOX 4620
CLEARWATER FL 33758
COMPANY
A
Northern Ins Co of NY
INSURED
Marina' Gifts
Carpenter Enterprises 100 DBA
25 Causeway Blvd.
Clearwater Beach Fl 33767
COMPANY
B
Zenith
COMPANY
C
COMPANY
o
etl'fflFY THAT THE POLICIES OF INSURANtE liSTED BELOW HAVE BEENI~SUEDtbTHE 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
LlR
TYPE OF INSURANCE
POLICY NUMBER
POUCY EFFECTIVE
DATE (MMlDDIYY)
07/25/98
POUCY EXPIRATION
DATE (MM/DDIYY)
07/25/99
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
PAS031650139
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
2,000,000
2,000,000
1,000,000
1,000,000
50,000
10,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELlA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLQ'(ERS' llAElIllD'
35197
-07/25/98
07125199-
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
GARAGE LIABILITY
ANY AUTO
B THE PROPRIETORI
PARTNERs/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
DESCRIPTION OF OPERATlONSlLOCATIONSNEHICLEs/SPECIAL ITEMS
Cert i f icate Holder is Add' I Insured for General Liabi I i ty only
Cancellation Notice for Workers Camp is 30 Days
1 Sin.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Harbonnaster
City of Clearwater
25 Causeway Blvd.
Clearwater
FL
33767
EXPIRATIDN DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRmEN 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.
AUTHORIZED REPRESENTATIVE
nX1J'U., ~
, ,:: -I.; ,),' "4' '. ..
. ,.' .f, ,-<,; ,.fi' ,,:'.~ .
'ii- ",'
" . ,",,~".;''' '.
: '., .~
A.~4.111.@ .
DATE (MM/DDIYY)
12/04197
THIS CERTIFICATE IS ISSUED AS A MATTER 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
PRODUCER
ALLEY REHBAUM & CAPES
ASSURANCE, INC.
P. O. BOX 4620
CLEARWATER FL 33758
COMPANY
A
Assurance Company
Marina Gifts
Carpenter Enterprises 100 DBA
25 Causeway Blvd.
Clearwater Beach Fl 33630
COMPANY
B
RISCORP
INSURED
COMPANY
C
COMPANY
D
: ::'ilki'i';,t,Ai:iiiL'\:'; ;;3,,::\;::;,;':., ,:::;;i:~!I:~: ;n~t:':,'!: ':: , ", '.., ;i ,.", ;", ':;:i, ':~~:;p ;::','~"{:";
.' 'r/OO"'fHE"~bLW'I~~'offNSU~~C~: Lt~tE6"a~E8~~~BE~N IsSUED TO THE'INSUFlEb'NA~ED ABOVE'i=OR"THE '~otr6Y"PERI6D
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 TYPE OF INSURANCE POlICY NUMBER POlICY EFFECTIVE POUCY EXPIRATION LIMITS
LTR DAlE (MMlDDIYY) DAlE (MMlDDIYY)
A GENERAL LIABILITY PAS031650139 07/25/97 07/25/98 GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2,000,000
CLAIMS MADE o OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PRDT EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
(Per accident) $
NON.OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO DNL Y:
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND Ta.
-EMf>LOYERS'tb\BtI:ff'l'-' - -.---- __0-'--------
B 35197 07/25/97 07/25/98 EL EACH ACCIDENT $
THE PROPRIETOR! INCL EL DISEASE - POLICY LIMIT $
PARTNERs/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONs/LOCATIONSlVEHICLESlSPECIAL ITEMS
Certificate Holder is Add'l Insured for General Liability only
Cancellation Notice for Workers Comp is 30 Days
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFDRE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRmEN 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 AGE~S OR REPRESE~ATIVES.
_IIEP "",'TNE t\;~
Hartlonnaster
City of Clearwater
25 Causeway Blvd.
Clearwater
FL
337ff1