CERTIFICATE OF INSURANCE (4)
~-~-~-~-~-~-~-~_:_~-~----~-~----~-~-~-~-~-~~-~---------------~_::_~--~---------------..-----~~~~~-~:~~-~~~~~~~~~~~~~.._~~~:~~~~~
iPRODUCER 111 I THIS CERTIFICATE IS ISSUED AS A MATT~C~ INFORMATION ONLY AND CJNFERS NO :
IBurke-Lehman Ins. Inc. RIGHTS UPON THE CERTIFICATE 1JLDER. !hiS CERTIFIChTE DOES NOT AMEND. :
12173 NE Coachman Rd. EXTEND OR ALTER THE COvERAGE AFFDRDED BY THE POLICIES BELOW. . j
i Cleat'water. FIot'ida 34625 i --------------------------------------------------------------------------------------:
i' I COMPAt.IES AFFORDING COVERAGE i
1--------------------------------------------- i ---------------------------------------------------- ---------.------------- --..--- ------- j
: INSURED I COMPANY LETTER A: SEIBELS BRUCE INSURANCE
ICarpen~er Enterprises Inc. i COMPANY LETTER B:
iDBA Marina Gifts & Souvenirs I COMPANY LETTER C:
175 Causeway Blvo. j COMPANY LETTER D:
I Clearwater', FI 34630 i COMPANY LETTER E:
i j I
i= COVERA6ES ====================================================================================================================i
i THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSJED TO THE INSURED NAMED ABOVE FOR THE POLICY
j PERIOD INDICATED~ NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT O~ OTHER DOCUMENT WiTH RESPECT
! TO WHICH THIS CEHTIFICATE MAY BE ISSUED OR MAY PEHTAINl THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS
-!!illBJtCr.:fG-p.LLTbE-IERMSf-EXCLUSWNS,ANPG.QNQUI9NS Ot'_ SUCH POLICIES.
1-------------------------------------------------.::-:.--..;:..------:;=---.::-..;::~..;~.....;..~~~-. ' ----~~-- -_"''''C', ---::':-::=--.::--=--::---
ICO I TYPE OF INSURANCE POlICY NUMBER 1 POlICY IPOLICY EXPIR-i ALL LIMITS IN THOUSANDS
ILTRi I EFFECT, DATE! PT:ON DATE !
i , i j MM/DD/YYYY i MM/DD/YYYY I I
1---1----------------------------------1---------------------------I----------~-I-------------I----------------------------------:
I[A3iGENERAL LIABILITY I BINDER I 3/14/1989! 3/14/1990 iGENERAL AGGREGATE I $ 1,000 :
I i [XJCOMMERCIAL GENERAL LIABILITY i New policy number is i j iPRODUCTS-COMP/OPS I
Iii being issued. This is the Iii AGGREGATE I $ 1,000
I lEX] [ ]claims made [XJoccurrence i renewal of SMP4747223. i 1 jPERS. & ADVERTISING I
1 I i A t'evised certificate 1 1 INJURY i $
I I[ J OWNERS & CONTRACTORS PROTECTI VE I will be sent wheYI new I I I i
I I I policy number is assigrled i I lEACH OCCURRENCE i $
I 1m Bi'oad Form PD 1 1 1 IFIRE DAMAGE (ANY ONE
I i I I i FIRE) j $ 50
I [ J I 1 1 iMEDICAL EXPENSE (ANY
I I 1 I lONE PERSON) i $ j
: ___1___________________________________1______________-------------1------------ j ------------- i --------------------.-- i ----------..- j
i [ J I AUTOMOBILE LIABILITY 1 i i CSL j $
![ J ANY AUTO I I 1 BOD IL Y INJURY I
i [ ] ALL OWNED AUTOS i i i (PER PERSON) I $
j [ J SCHEDULED AUTOS 1 I 1 BODILY INJURY I
IE J HIRED AUTOS (PER ACCIDENT) I $
1 [ J NON-OWNED AUTOS I
IE J GARAGE LIABILITY IPROPERTY DAMAGE ; $
I i [ J I Iii i i
J---i----------------------------------I---------------------------1------------1-------------1----------------------------------j
j[ j lEXCESS LIABILITY 1 i i 1 EACH OCCURRENCE AGGREGATE !
I I [ j i i i
i 1 [ j OTHER THAN UMBRELLA FORM 1 1 i I $ $
j---I----------------------------------I---------------------------j------------;-------------I----------------------------------j
LUJ_ . dJIOHKER5~C~.ENSAJJIJ!IL_____.l_ ,,' , Iii STATUTORY I
i I AND j -.- --r-- I . r-r- - ~-uttK6HHCfriftffiH----- n +
I I EMPLOYERS' LIABILITY j 1 i i $ WISEASE-POi.ICY UMlTi i
I I I 1 1 I $ (DISEASE-EACH EMPLOY.) j
1---1----------------------------------1---------------------------j------------j-------------i-----------------------------------1
1 [ j I OTHER I i I I
1 i 1 i 1
I I Iii
) Iii ; I
1--------------------------------------------------------------------------------------------------------------------------------1
IDESCRIPTIONS OF OPERATIONS/LOCATIONS/VEHICLESiRESTRICTIONS/SPECIAL ITEMS I
~"""'" I
I " I
I j
CERTIF ~ - R ============================ CANCELLATION =================================================================1
i 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I
i City ClerK I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL i
j Clearwatei' City Hall I 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
j P.O. Box 4748 I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL-
! Clearwater,Fl 34618 I ITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. !
I 1------------------------------------------------------------------------------'--1
l_______________________________________________l_:~~:~~-~~--------------------l
ACORD 25-S (11/85) ACORD is a registered trademark of ACORD Corporatio~
0/3- /6
C E R T I F I CAT E 0 FIN S U R1I N C E 11- ISSUE DATE (MM/DD/YYYY): 3/02/1989
----------------------------------------------------------------------------------------------------------------------------------
1 PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
IBurke-Lehman Insurance 1 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
12173 NE Coachman Rd. i EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1
1 Clearwater, Florida 34&25 1-----------------------------------------------------------------------------------1
1 I COMPANIES AFFORDING COVERAGE I
1--------------------------------------------1-----------------------------------------------------------------------------------1
1 INSURED 1 COMPANY LETTER A: SEIBELS BRUCE INSURANCE 1
lCarpenter Erlterprise5 Inc. 1 COJIIPANY LETTER B: i
IDBA Marina Gifts & Souvenirs 1 COMPANY LETTER C: i
175 Causeway Blvd. 1 CQIl1PANY LETTER D: 1
I Clearwater, FI 34630 1 COMPANY LETTER E: I
1 I I
1= COVERAGES =====================================--=====================--========================================================1
1 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY i
1 PERIOD INDICATED, NOTWITHSTANDING ANY REOOlREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT I
1 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI~L THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS I
1 SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS Ul" SUCH POlICIES. 1
1--------------------------------------------------------------------------------------------------------------------------------1
ICO 1 TYPE OF INSURANCE 1 POLICY NUMBER 1 POLICY IPOLICY EXPIR-i ALL LIMITS IN THOUSANDS I
ILTRI I I EFFECT. DATE 1 ATION DATE I I
I 1 1 I MM/DD/YYYY I MM/DD/YVYV 1 i
1---1----------------------------------1---------------------------1------------)-------------1----------------------------------1
1 [AJ I GENERAL LIABILITY 1 CB07477068 1 3/14/1989 1 3/14/1990 IGENERAL AGGREGATE i $ 1,000 1
I 1 [XJCOMMERCIAL GENERAL LIABILITY 1 1 1 IPRODUCTS-DOMP/OPS I
1 I 1 1 1 1 AGGREGATE 1 $ 1,000
1 I [Xl [ Jclaims made moccurrence I 1 I IPERS. & ADVERTISING I
I 1 I 1 1 I INJURY I $
1 I [ JOWNERS & CONTRACTORS PROTECTIVE I I 1 1 1
ill I I 1 EACH OCCURRENCE I $
I 1 [Xl Broad Form PD ill IFlRE DAMAGE (ANY ONE 1
I I I 1 1 1 FIRE) I $ 50
1 I[ J 1 1 I IMEDICAL EXPENSE (ANY i
I I 1 Iii ONE PERSON) I $ I
1---1----------------------------------1---------------------------1------------1-------------1----------------------1-----------1
I[ J 1 AUTOMOBILE LIABILITY I 1 1 I CSL i $ I
i 1 [ J ANY AUTO I I I IBODILY INJURY I I
1 1 [ J ALL OWNED AUTOS 1 1 1 I (PER PERSON) I $ I
1 1 [ J SCHEDULED AUTOS 1 I I lBODILY INJURY I I
I I [ J HIRED AUTOS I 1 1 1 (PER ACCIDENT) I $ I
I 1 [ J NON-OWNED AUTOS 1 1 I I i I
I I [ J GARAGE LIABILITY 1 I I IPROPERTY DAMAGE 1 $ I
i I [ J I I I I I I
1___1__________________________________1______________________-----1------------1-------------1----------------------------------1
I [ J 1 EXCESS LIABILITY 1 1 1 1 EACH OCCURRENCE AGGREGATE 1
I I[] I 1 I 1 1
1 I [ J OTHER THAN UMBRELLA FORM 1 I I 1 $ $ I
,j-".,.,. i---:".,..,.~.,..,."'_::_:="'_::.,.=-_==_-=_-=.,,~,:--_:_-J=--=__:::==_===___:_:::_:::_---__::..:'-==-_: L__-.:-------__-__I-------------I-----....----------------------------1
I[ ] I WORKERS' COMPENSATION 1 I ~--- -1----l'STIlTUTIlRY ..,--------------)------
1 1 AND I 1 1 I $ (EACH ACCIDENT) 1
I I EMPLOYERS' LIABILITY ill 1 $ !DISEASE-POLICY LlMITlI
I 1 1 1 I 1 $ !DISEASE-EACH EMPLOY.) i
1---1----------------------------------1---------------------------1------------1-------------1----------------------------------I
1 [ ] I OTHER 1 1 1 1 1
I I i I I I i
1 I 1 I I 1 I
1 1 1 1 I I I
1--------------------------------------------------------------------------------------------------------------------------------I
IDESCRIPTIONS OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS I
1 I
1 I
~ICATE HOLDER ======----========== 1 ~I~ - OF THE -ABO~~=DE~R~BED-~IC~~~=B~=rn~~~~~D-BEFORE=~~======== I
I City Clerk 1 EXPlRATI~ DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I
1 Clearwater City Hall 1 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFTL i
1 P. O. Box 4748 I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABI - I
I Clearwater,Fl 34618 1 ITY OF IW{ KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. I
1 1--------------------------------------------------------------------------------j
l_______________________________________________~~~~~~~_~:RE~~~~~ _~~~/~~~_________!
ACORD 25-5 (11/85) ACORD is a registered trademark of ACORD Corporation
C-,C.'I {{:wit f}'1c;t~ 3/30/~1