CERTIFICATE OF INSURANCE AND LETTER REGARDING INSURANCE C0MPANY
'C)'tll;j -l-l,'~ 7tHl;)
eE:RT1FI07\ ::E:~:e:F':.I,;I~B:ILITY:'INSUilA;N~I=~~ D.;~~~~
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 AFFORDE!D BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Palm Pavilion of Clearwa~er,
Inc., ~he Four Suns, Inc.
Ken Hamilton
10 Bay Esplanade I COMDPAm
Cleatwate~1 FL 34630
COVERAG~,S ,:.',., ..".:,'..:.....,. ..'. ..,..... :...'..... ,. .,<..........,. ,..,>>.':.........',;,:.;
THIS IS TO C~RTIFY THAT THE POLICIES OF INSURANCE I BeLoW HAVf 6fEN ISSUED TO THE INSUReo NAMED Move FOR THE POL.ICY PERIOD
INDICATED. NOTWITHSTANDING ANY REClUIREMENi, iERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'IVITH RESPECT TO WHICH THIS
CERTIFICATE MAY af IssUf;D OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIEs OESCRI8ED HEREIN IS SllBJECT TO ALL THE "rERMS,
eXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LlMfTS SHOWN MAY HAve afEN REDUCED BY PAID ClAIMS,
-...--....
TYPE OF INSURANCE POllCY NUMBER i POLICY IlPFECTIVE F'O~ICY eXPIRATION
I DATE (MMlDDNY) DA~ (MMlDDNYI
I
,"'. ..... . ...".. ..PANCEl.,LAtIQN"', ,. '.,:':...". :::<",:" .. ..,'... '
CI TYO-1 SHOULD ANY OF THE ABOVE DESCRIBED "OLlCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THeREOF. THe Is.sUIN~, COMPANY WI~1. ENPE~.VOR TO MAIL
2.L DAYS WltITTEN No'tlcE 'to 'tHe c ~R'tIF1cAl~ HOLDliiR NAMI;D TO THE leFT.
BUY FAILURE Yo MAIL SUCH NOTICE SHAl.L IMPOSE NO OBLIGATioN OR LlAalL1'rY
OF ANY KIND UPON THE COMPANY,ITS ACIENTS OR REPRESENTATIVIi:5,
AUTI1ORIZI;D R6PR~Ii:NT.T1VE ... .. I .L.
William Hancock W;..J-~n(A..~
.' .., ., >.......... .<'/i:'.;;;:,<,~:Aqq~pqQt~)~g~iI9N 19Ba
"'i:....':~5/ 20/ 96
..--. ..:-
-A/;ORD..
15:55
ll).\.\t.LL~ l.\,~LK:\..\
~OtlUCER . .
The Connelly Insurance Group
630 Chestnut Street
P.O. Box 2456
Clearwater FL 34617-2456
William Hancock
PhO"tNo. 813-461-6044
INSUREtJ-'-
COMPANY
A
Sco~sdale Ineul:ance Co.
FuN\>,813-442-7695
COMPANY
B
F~ogressi VI!!! Inllurance Comp.iny
I COM~ANY
CO
LTR
~NeRAL LIABILITY
A X CCMMERCW, GfONfORA~ ~JAeI~1TY
r= I eL.AIM$ MAOE [i] OCCUR
I-- OWNER'S & CONl1'lACTOR'S PROT
GENE<~"'1. AGGRfOGATfO
04/05/96
04/05/97
CPS0139253
PI'<OOJCTS' COMP/OP AGG
PERS')NAL & ADV INJURY
EACH OCCURReNce
FIRE [,AMAGE (Any Dn" filA)
Mea e iXP (My 0110 POI$Qn)
~TOMOBllE LIABILITY
B X AmAUTO CA065726241
...::.;;;..
_ ALL OWNeD AUTOS
_ SCHEOULEO AUTOs
X HIRED AUTOS
-=-
~ NON-OWNEiD AUTOS
..-
~AAoe ~IAlilILI'1'Y
~ ANY AUlO
~v
EXCESS LIABlUTY
~ UMBRELLA FORM
OTHER THAN UM8REU,A FORM
WOflKER$ COMPEN$ATloN ANtl
EMPLOYE<RS' UABIUTY
n-lE PROPRIETOR! RI~
PAR'rNERSlEXECUllYE
oFFIcERs ARe: EXCL
OTHER
A PROPERTY CPS0139253
04/05/96
04/05/97
COM81N!;iD SIN~~E LIMIT
eOtllL Y INJURY
(per p'IIliOn)
eODll y INJURy
(l"or 1l<~d4nl)
PROP iER1Y DAMAGE
AUTO ON~Y. SA ACCIOeNT
OTl-llil~ THAN AIITO ON~ Y:
SACH ACCIOENT $
A13I3FlEClATe $
EACH OCCURRENCE $
AGGREOATE $
$
I rS~fl1Mrws T l011t, :;.', ,
51. EiACH ACCIOeNT
EL O~:eA6E - PoLIcY LIMI'r
El OI.!;EASE . lOA EMPLOYEE S
04/05/96
04/05/97
aui,ldi.ng
Con~en~a
DESCRIPTION OF OPERATIONSILOCATlONSNEHIa.ESlSPEClAL "EMS
REi Buildinq #2 - 332 S. Gulfview Blvd. Cle~ater Beach FL. and
lUl.ldinQl3-330 S. Gulf'view Blvd., Clearwate~; ~~O, 000. BUilJiinq cov~ra9'(~ &
10/000. Content~. All p~~~ty cove~age ha~ed on Replacement CQ~t b.ud~.
er~ifica~eHolder is included as Additional Insured.
~~~r!fl~A't~Hq~,~$,""'.""
, "
',."','..
City of Clearwater
FAX # 462-6957
A~~n:William Held,
25 Causeway Blvd.
C!eatwate~ FL 34630
Jr.
~.,.,..'"
.., .....'
'.""."".
...'.'.'..,'.,".,..
j' ,1 ~Q""/!.....(,_T
7 ./ j \.
Ll!J VI)':, VV':
LIMITS
$2,000,000
sl,OOO,OOO
sl,OOO,OOO
$ 1,000,000
$ 50,000
$ Wil
$1,000,000
$
s
s
s
!;:;:,: ."...:....
:. :.: " . ~ " .:.; " . '.',.
""':':"':':"';'"''
" '.'.'.'.: .,..;" .~,.
,........
.: .:.::.,~ '.:.
..:.:.:.:.:.:.':'.::'::.';'.
$
$
$215,000
$15,00'
~.'.. >"
,..;J
('t"'
t
I.
{! .'~."."I'I. nf.;.:,:".':"R.'..",I:'..':m.....I..I"...:,::"II1f'..\:":....' '
... ".".., ... ...,..' ,." '.,'. ' .. .
fHi_d...,,,-, , ",.1:1t:;~,~:::::,:::",::S~k:.J~:"immil ,:
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BV THE
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Hilb Rogal. Hamilton Company
P , O. Bo x 23968
Tamp a J Fl 33623
FL
34630
-< COlPANV
I A
LEIlER Ri Co.
ance
COlPANV B
LEIlER
COlf'ANV C
LEIlER
ffi"'ANV 0
IlER
cmPANV
LEIlER E
813-289-6386
Palm Pavil ion of Clearwater
10 Bay Esp lanade
Clearwater Beach
THIS IS TO CERTIFV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOllCV PERIOD
INDICA TED, NOTWITHST ANDING ANV REOUIREMENT. TERM OR CONOITIONOF ANV CONTRACT OR OTHER OOCWENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAV BE ISSUED OR MAV PERTAIN. THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LtvtlTS SHOWNMAV HAVE BEEN REDUCED BV PAlO CLAMS.
TYPE or IlSUAAHCE
POLICY NUhIIII!R ,
POLICY El'l'ECTIVE POLICY r;xPIAAT
DATE (..../OO/YV) DATE (..../OO/YV)
LIMITS
AUTOhlOBU L1ASLITY
AI<< AUTO
ALL OWNED AUTOS
SCHEDUlED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE liABILITY
GENERAL AGGREGA IE
PROOUCTS-ClJv1P/OP AGG,
PERSONAL & ArN, INJURY
EACH OCCURRENCE
fiRE DAMAGE, (A
MED, EXPENSE (A
ClJv1BINfD SINGLE
LIMIT
.
.
.
.
.
.
.
GENERAL L1A1l LIT Y
CCMvlERCIAL GENERAL liABIliTY
nnu CLAIMS MADE 0 OCCUR,
OWNER'S & CONTRACTOR'S PROT,
BODILY INJURY
(Per person)
.
BODILY INJURY
(Per KcidenO
PROPERTY DAMAGE
EXCESS L1A1lLITY
1MB REllA FORM
OTHER THAN ltw1BREllA FORM
WORKER'S COMPENSATION
/IIIIJ
EhlPLOYERl'L1ASLITY
EACH OCCURRENCE
AGGRE6A IE
~ ~ m ~ j ~ ~ ~ ~ ~ ~ H ~ ~ ~ ~ ~ ~ ~ j ~ j~;; ~; ~; ~; ~ ~ ;wwn HHj; ~;~;~~H UH j; ~ ~ Hj HH ~ ~H? ~
A
4/01/96
,STATUTORY liMITS
4/01/97 EACH ACCIDENT
DISEASE-POliCY liMIT
DISEASE-EACH EMPLOYEE
j ~;~j~~~;~~~;~;~;j 1 ~ ~;~~ 1;~ ~ 1~ ~~1 ~;j j
12956
. 500000
. 500000
.
OTHER
DESCRIPTION C# OPEAATlONS'LOCATIONSlYEHICLESlSPEC'IAL ITEhIS
i$~~a!!f:!s+.t€}~9~RM:m:::'tm::::{::::::{::::t'ff:{lt::::ttf:'::::::::m:tmt::tt:l::tr::r:'ttf:tl::SM!~!!9!i:::r:::ff:'f:llllmrHMMHwxwrirtfrHiltrrr:::tmr:::n:::::::::M:mmtr::::t:::::rmrffM
1@ SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
-.'jo:.:
ff EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL Et-vEAVOR TO
tt MAL 30 DAVSWRITTENNOTICE TOTHECERTlFICA TE HOLDERNAMEDTOTHE
C i t Y 0 f C I 81 r wa 18 r :m:::: LEFT. BUT F AlLURE TO MAIL SUCH NO TICE SHALL MPOSE NO o BUG A TlON OR
Mar i ne Dep I rtment I:f:!ff L1ABILlTV OF.ANV KIND UPON THE COMPANV.ITS AGENTSORREPRESENT A TlVES,
Jj~i~:~;,i~{,i~;:;::;i~::OiX1~~44ril::~d~~~~ROedMO;~~:::~~'.
I
:f A~~~.III.. f:::::I!..~~ldE..:k"~J:;W"'~:!::ilit;I".::d:..I.'.':::t:!d:fIl~;iHfl.NSSd!:X:'fd:ItiE.'::::::I:I:~tlIi~ DATI! (MM/OO/YV)
tt.:~.;.:~~~.:~.:....;-=--",-.:y;.:.;.;.:.:...;.:.:.;.;..t~~~~~fi~);lj!~;:;:::;:::::::::~:::::::::!I;_~~~~~j.!t~~~~~j~i::::~jt~e~B~:~!~lig'l~l~f~t~~i:::::;:::~;:;:;~~~:::;~::~::::::::;::Rm!:~!~;~~:::::::I~~1~~~~~tl1~r:i~
THIS IS EVIDENCE THA T INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL
THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
J,
Hi Ib Rogal Be Hami I ton Company
P.O. Box 23968
Tampa, Fl 33623
Florida Windstorm U/W Assoc.
7077 Bonneval Rd. #500
One Harbert Center
Jacksonville, Florida 32216
CODe
00000000
813-289-6386
IUlI-OOOE
4/11/96
4/11/97
Palm Pavi I ion of Clearwater
10 Bay Esplanade
Clearwater Beach
FL 34630
5283
1(&'ifil~~i~ij~tr:,:I*",;;>@ltlttl:rlmt::HrK::':{ittHliM1HIWW::::::I:!,:::,:,:pt:t:lllHt@MllbILm;I':@:t:Mm:mm~te]W{'Mm:Wrilt1Mtt1WdgMM]I;;MjiMl
Loc#OO 1 BI d#OO 1 10 Bay Esp lanade
Clearwater Beach, FL 33515
Snack Bar Be Beachwear
:~~S9~~~M9:iJH:f9~M+'~!9Nt:::::::~:::::t::~t~:m:::~:~:t:):~/t::/:l:~:::t:~$:::::~t:::t::::~:~/tt~:::::::::::~:~::;:t~tt::::~:~::):::t:):::':t~~~:~:~/::))~~:~:~~~:t~:::::,::~::::~/t::~tm::::~:~::t~:~:~~~tt:/:t:t~t~:~~:~:::~t::::::mt:m:m::::::::):~:~:r::):m::m:~:::::l::t~tf)):::~:t::rf:t::m::::
COVERAGE!PERLSlfORNS AMOUNT OF INSURANCE DEDUCTIBU!
Building
Windstorm Coverage
275,000
1,000
tS~~P!:'l.jP~i!P~~::t::::~J:t:~t~:))~:::::,:t:t(tt~:::r:t:rm@r~(fir:::tt::ttftt:t::::::::t:::::::::tit::rt:::::::::::tt::t:::rr:tt:tr:::ttttt:rrr::r:::~~tr:::tt:::::r))rr:tirrr)::~:r~::::t:::tr::t:I:::::trt~:~:::t::H:tt::::t:t:~~:r:tt,r:::t:~:~
,.."N"".'..'tHE"POUc:'i'is'SiJBjE"(~t'tO.tHE'.PREMiCMs:'j:"(jFMS.:'i.NiYRiJLES'iN.'EFFECt'.FOO.E.ACH'POCiCY.PERi6tf'SHOti:ti".,""',.,""""'"
THE POLICY BE TERv1INA TED, THE CO'v1PANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW ~o tfllYs
WRITTEN NOTICE, AND WILL SEND NOTlFICA TlON OF ANY CHANGES TO THE POLICY THA T WOULD AFFECT THA T
INTEREST,IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REOUlRED BY LA W,
'~:~:nilf!:;G~~J~l:::,,,"LI;:1@tdMMEgiMM:ktEllliliit:t@mPfftI:mt!~=ffiSIl!~~mMm;llimm$:}/Mm@Er:@m:m@tMm;mmm:fiiMl&/I&Wrm:lbtr::m
MOOTOACEE
D AOOITlONAl INSl.flED
City of Clearwater
Ma r i ne Dep t D (OTtf:R)
25 Causeway Boulevard TOFCOt.lP~V,'
Cluwater FL 34630 ./)J, J O'..k~'~,;.,~/I~.r"-
~" I, 1 '""V' ~~, 0 11947
:tAPp~P'4Z:1~l'Ur~rmmmrmrrr:::r:rmmmrrrr~rrtmrrr:~r)rtrt:::tt~rr~irt:::::::::ttt:::t@~:~~mm:~rr~::~~trr:rrtm::"rtl~:::r::::lm:r:::t:rH::::::t:::rt::~!g\P.PrRltP.P:~~~:~AtI.Pf{:J:'..':r~~~:
I
:lill A~~~~III" ~~:EIIIt:~:.:'::;,::.::":<:*I:~"::;';'::"::,":' '":":::ti:~,!I!!D:fIi~#:1?:1:..ISlflli,t:.:~..:::: '. ':
:';'::~'::::::'e;~:::C::llCl:::':;CC:~j::>>;~~::::;:;<~:::::.:::~BL~ '*j:::rt:~ . .... .::-=;j~.:ei.RjJjll~!l~li~:~:::~H~!i::~::~~*"D ..r:r...:$ R
THS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSLeD,IS IN FORCE. AND CONVEYS ALL
THE RIGHTS AND PRIVILEGES AFFORDED lJ'.lDER THE POLICY,
Hi Ib Rogal ac Ham! I ton Company AETNA FLOOD
P.O.Box 23968
Tampa, FL 33623
J
00IIl!
813-289-6386
IUB-OClDE
Howard G. Hamilton
Four Suns, et al
10 Bay Esplanade
Clearwater Beach
FL 34630
7/20/95
E1003207881
LOCAT~iPTioH ' "'-"~L";~#001 Bld#001 33'2 S. Gul f~'ie'; BI';;':'"W"W '"mm__ wm, ,-~--~~,~ ^- ~w,~__
Clelrwlter. Fl 33515
Mer c an t i I e
:iSR!Wl~9iJt!A!M~I!gM::::i:t::::::::i::littt:iHlliltM~MMtiiMttit:ttlllttft:':ir::::ri1mtmtr@tt::t::t::t:Jtt:r:iJ:m:t:t:m:::::itlit?itt:tmMg:mitMttttmtMlttllltlMMtmM
OO~AGE'PERLI'fOR" AhIOUNT 01' INSURAHOI! DEDUOTIlLI!
Bui Iding
Flood Coverage
166,400
750
.;
THE POLICY BE TERMINATED. THE CQ'v1PANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW ~n rI,ys
WRITTEN NOTICE. AND WILL SEND NOTlFICA TlON OF ANY CHANGES TO THE POLICY THA T WOULD AFFECT THA T
INTEREST. IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REOUIRED BY LAW.
:tHi:&i~~=jy;*",<<,*<,::;:MI::Mt::@%Mit:t@tW:it:WmllM':'t::mHJt::':;i~!::w'ii.!ft?IM:M:::IMt:"tmmll{ttttt:"W:':}tfitttt:MMiliMtH:::@@:i::mMmMHmm
toOllOAOEE
o AOOITIONAlINSUlED
LOSS p~~ 0 (OII-ER)
ORIZED~~ OOMPMlY" / c,
tVu '7"'"" c;f-Ci/--tr-
_ 0 11947
:\A~A~P:::~t:UI.U:f::::::f::::ff:\i:i::i:::f'\f:::::i:'if:ffi:f:ff::'::::::\::::i:i::i::ili::f::f:::f:::::::f:\:::\(::::f=:i::::::,\rr:i::::f:f:::::::::f:::::::f::f::::::::::::\:f:::\:::::::':f::::'i:i:::::':if:\'f::':f::::f::::::::::i:::::i~:*~A~P::~(;.:Rt9~~;:t/.A:Nan.f:f
City of Clearwlter
Marine Dept
25 Causeway Blvd
Clelrwlter FL 34630
.,-
u.
j
rwater
,
o
>
.....
o
Harbormaster
May 15, 1996
CLEARWATER MARINA
25 CAUSEWAY BLVD.
CLEARWATER, FLORIDA 34630
TElEPHONE (813) 462-6954
Mr. Ken Hamilton
Palm Pavilion of Clearwater, Inc.
The Four Suns, Inc.
10 Bay Esplanade
Clearwater, FL 34630
RECEIVED
MAY 1 6 1996
Dear Ken:
CITY CLERK DEPT,
A month ago you asked my office to call The Connelly
Group for an updated copy of your Certificate of
Insurance. Several messages have been left with the
company, with no response to date.
Insurance
Liability
insurance
Attached is a memo from the City of Clearwater Risk Manager noting
the additional coverage that is required by your Lease Agreement.
Your prompt attention in getting the required insurance
documentation is appreciated.
Please call me at 462-6954 if you have any questions.
WCH/wch
cc: Elizabeth M. Deptula, City Manager
Leo W. Schrader, Risk Manager
Susan Stephenson, Documents and Records Supervisor
G>
'EqlK11 Employment and AffirmatIve Action Employer'
~,
,
CITV OF C'I F,A.P~A/^TE8
,
APR 10 1996
S.
at.-"
-=.
HARbUIiIIlIJ1v I Ltlu vrt-ICE
CITY OF CLEARWATER
INTEROFFICE CORRESPONDENCE SHEET
TO:
Susan Stephenson
Documents and Records Supervisor
City Clerk's Office
FROM:
Leo W. Schrader, Risk
SUBJECT:
Certificate of Insurance
Contract dated
-V Lease dated
~ Special Event A pli at
--- Miscellaneous Activity
=== Unknown Activity dated
This office has received the attached Certificate of Insurance Form presumably
for the document identified above.
1.
This Certificate of Insurance is in compliance with the insurance
requirements contained in the contract identified above.
This Certificate of Insurance is not in compliance with the insurance
requirements in the contract identified above for the following
reasons(s) :
2.
3.
The General Liability ___ limitS/Business Auto Liability limits
shown are less than the required amounts.
The type of General Liability policy provided is a "claims made
4- policy when the contract called for an "occurrence" policy.
worke.r's Compensation Insurance coverage is not provided.
Flood Insurance coverage is not provided.
Plate Glass Insurance Coverage is not provided.
~ Boiler and Machinery Insurance coverage is not provided.
Business Automobile insurance coverage is not provided.
The City has not been provided a copy of the policy(s).
The City is not shown as an additional insured.
The Notice of Cancellation is for a shorter period than required.
The policy deductible shown is not provided for by the contract
X ~~.,._a'-i.~~tt~.
This cer~ift~~ mayor may not be in compliance with a City
contract, but this office cannot offer an opinion because neither the
contract nor the purpose of the Certificate of Insurance can be
identified. _
,.
'm4l?//VI!.. tIC'" Department (If no department is
shown, it is because no department can be identified.)
cc:
,.
.~
ACORD..
CERTIFIC
E OF LIABILITY' lNSU: 'NCq~~2":: '., CA~~=
THIS CERTlFICA ... ISSUED AS A J.Q1'TER OF INFORMATION
ON1.Y AND CONFERS NO RIGHTS U1'ON ntE CERTIFicATE
HOLDER. THIS CERTIFICATE DOES ~OT AMEND. EXTEND OR
ALTER THE COVERAGI! AFFORDED BY THE POUCIES BELOW.
COMPANIES AFFOR)JNG COVERAG!
MtOOUCIIJt
Th. Conn.lly Inauranee Group
630 Che.tnut street
P.o. Box 2456
Clearwater rL 34617-2456
fax No,
COMPA1lY
A SeotsdaJ.. Insurs.noe Co.
CCMPANV
e
Palm Pavilion of Clearwater,
Inc., The Four Suns, Inc.
Ken Hamilton
10 Bay Esplanade
Clearwater, FL 34630
COWIAA'Y
C
COMPANV
D
COVERAGES:':':'/::::::::, "'.. .,:::,~:;:;:>:::: :::::;:;:;:.;:;;.::,::,,:...:..
"'THiS'iSTocei'RTIFY THAT THE POUCIES OF INSURANCE US TED BELOW HAVE BEEN ISSUED TO THE INSURED N.AMED A8<IVE'FORTHE PO.Liev r'eFi.1oO
INDlCATI:D, NOlWITH~TA/IIDlNG ANY ReQUIREMENT. TERM OR CONOITION OF NoN CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THI:; INSURANCe Af'FOFlOeO BY THe pOLICIES OESCRJeEO HEREIN IS SU!JECT TO ALL THE TERMS.
EXClUSIONS AND CONOITlONS OF SUCH POUCIES.lMTS SHOWN MAY HAVE 8EEN REDUCED BY PAlO Ct.At.1S.
POUCY EFFECTIVE POLICY EXPIRATION "
YYPE OF INSUFlANCE POLICY NUMBiiR DATE (MMlDDlVY) 0.0.11: (MMlDDlVY) lIMIT$
GENERAl UABIUTY GliNliRI.l AGGR~GA~
00
Lift
A X eoMl.1ERCI"L GEseR"L LI"SllLnv CPS0139253
...;;;~;~ CLAJMS MAce [!J DCC'JR
OVYNER'S & eot-.'TR"CTOR'S PROT
AUYOMoelLE LIA$ILITY
AN'i AUTO
ALL OWNED AlJTOS
SCl-lEOUU<D AlJTOS
HlRliCl ,t.IJTOS ~~~~~
NON-OWNEO AUTOS
GARAGE UABILI'N APR 0 9 19 6
AN'iAUTO
EXCESS UABIUTY
L/MIIRElLA FORM
OTHliR lHAN UMBReLl.A FORN
WOftKliR5 OOMPrNSATION AND
D1Pl.OVI!RS' LIA9lUTY
TliE PROPfllE'l'01CI INCL
'AATNERSlEXECUTtVE
OFFICERS ARE: EXCL
OlliE"
A PROPERTY cPS0139253
04/05/96
04/05/97
poqOCl.k:T$. COW'IOP AOO
s2,000,OOO
'1,000,000
s 1,000,000
$1,000,000
s 5.0,000
Nil
P~SOt;'\L & ADV!N.IURV
I EAC1 0 :;CVMEI-'CE
i FlRE DAOoIAGE (Ar,y _liIe)
; Mal lOX" (Anyone person)
COMBit'!:O SINGle UMrr $
, 60DllV HJ\JRY
i ;po, per..en)
r-
1800lL Y .wRY
po.r '" dltntl
I PROPEI:TY [).I.I~E
!
s
s
,
: AUTO O~V. EAACCtOENT S
i OnlER""'HAN "'J:O ONL '\":
EACH ACCIDENT $
AGGREGA11! ,
~ OeevARENCi I
AGG"lE'M'l'!
.
$
:tV
El. EAC-. f,CCIOENT I
a. ellSEA$E. POLICY l.IMIT I
El ClSEASE . EA EMPLOYEE S
04/05/96
04/05/97
3uildinq
Contents
137,500
25,000
~CRIPt10N OF OPERATlONSIlOCATIONSNEHICLESlSPECIAL ITEM$
RE: Sui1din9 *2 - 332 S. Gulfview Blvd., C1~arwater Beach, FL.
cEimFICA TE'HOl..Or:R:
......,.~...-..;.......;........;.-:....... ;". ........'......;,..... '.
.:;...;..,.:.:.:",...,.;.
CITY'O-l
::';;;;'~:~~N.'l~5.q~~Y;~,':n::~;::(':,;;;';.;:??/:.;'. :,;;:~:~:;;;;r;~",:;'::':: ;:,:::' :;:;'~:.:;:~';::;:-'::...,.
SHOUlD AI<< OF TliE ABOVE PE$CRIB~ p:lUel~~ BIl CANeI<UZO BEfORE THe
EXPIRATION DATE THEREOF, THE 1$$VlHo .;QMPANY WILL ENDEAVOR TO MAl.
~ DAYS WRITTEN NOTIce TO TliE CE UIFlCA'TE HoLDI<R NAMED TO TKE LEfT.
BUT FAILURE TO MAil SUCH NonCE SHALL IMPOSE NO OBLIGATION OR L1ABIUTY
of At('( KIND UPON T1-II; COMPANY,ITS AGUoITS OR REPRESENTAnYIii$.
AIITHORIV<D REPRaENTATMl .
Willi~.JI~n~>~~~Lv.4U~~ .
. '..,.,',. '..,. ..".."". .. .@~C9IU? CORPORAT:JON198S
city of Clearwater
FAX fI 462-6957
Catherine
25 Causeway Blvd.
Clearwater FL 34630
AcbR625~sl1i9!j)"" '