CERTIFICATE OF LIABILITY INSURANCE (2)
ACORD", CERTIFICATE OF LIABILITY INSURANCE;AL~:~~ T~ DATE (MM/DDIYY)
-.",---- 04/04/03
PRQDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
630 Chestnut Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Scottsdale Insurance Co.
INSURER B: Progressive Insurance ComDanv
Palm Pavilion of Clearwater INSURER C: Fireman's Fund Insurance Co.
Ken Hamilton
10 Bay Esplanade INSURER 0: Hartford Ins. Co. of the S.E.
Clearwater FL 33767
I INSURER E:
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE POLICY NUMBER b~~If~~b~~E POLlC:~1 EXPI'rJ.:.?N LIMITS
LTR DATE MMlDD
GENERAL LIABILITY EACH OCCURRENCE $ 1.,000,000
I--
A X COMMERCIAL GENERAL LIABILITY TBD 04/05/03 04/05/04 FIRE DAMAGE (Anyone fire)' $ 100,000
: CLAIMS MADE ~ OCCUR' MED EXP (Anyone person) $ EXCLUDED
X Liquor $1M/$1M PERSONAL & ADV INJURY $1.,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
h ,nPRO- n EmD Ben. 1.,000,000
POLICY JECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.,000,000
B ~ ANY AUTO CA065726248 04/05/03 04/05/04 (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
I--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $2,000,000
C ~OCCUR D CLAIMS MADE TBD 04/05/03 04/05/04 AGGREGATE $2,000,000
$
~ DEDUCTIBLE" $
X RETENTION $0 $
WORKERS COMPENSATION AND , I TORY L1MrrS I [OTFf-
ER
D EMPLOYERS' LIABILITY 21.WECDR5490 O~/Ol/O3 01/01/04 $ 500000
EL, EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $ 500000
E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
,
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Building #2 - 332 S. Gulfview Blvd., Clearwater Beach, FL and
Building #3 - 330 S. Gulfview Blvd., Clearwater. Certificate Holder is
included as Additional Insured.
CERTIFICATE HOLDER [ Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...JJL.. DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
25 Causeway Blvd.
Clearwater FL 33767 REPRESENTATIVES,
AUTH~UC&.- /Jt- /..
I I . r V -v-r --
ACORD 25-5 (7/97)
@ACORDCORPORATION 1988