CERTIFICATE OF LIABILITY INSURANCE (3)
ACORD.. CERTIFICA TE OF LIABILITY INSURANCE OPID SEI DATE (MMlDDIYY)
PALMP-2 04/09/04
PRDDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance -. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
17757 US Highway 19 N, Ste 660 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 ~~URER A:. Scottsdale Insurance CO.
INl:URER B: Progressive Insurance Company
PaLm Pavilion of Clearwater INEURER c: Fireman's Fund Insurance Co.
Ken Hamilton
10 Bay Esplanade INEURER D: National Surety Corporation
Clearwater FL 33767 Essex Insurance Comnanv
I INEURER 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 SLeJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE IlEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE POUCY NUMBER ~C;~':~~ P~~~~~~~" UMITS
LlR
GENERAL UABILITY EACH OCCURREtlCE $ 1, 000,000
f---
A X C::JMMERCIAL GENERI\L UABIUTY BCSOO07844 04/05/04 04/05/05 FIRE DAMAGE (Any one nrel $ 100, 000
1 CLAIMS MADE ~ OCCUR MED EXP (Any on~ per3on) $ EXCLUDED
X Liquor $1M/$1M PERSOIIAL .. /oDV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000, 000
-
GEN'L .AGGR=GATE UMIT APPUES PER: PRODLCTS - COMPIO' AG3 $ 2, 000, 000
I POUcv n ~:g n LOC
AurOMDBILE UABIUlY COMBINED SINGLE UMIT $ 1, 000,000
I--
B X ANY AUTO CA065726249 04/05/04 04/05/05 (Ea acdden!)
I--
All OWNED AUTOS BODILY INJURY
I-- $
SCHECULED AUTOS (Per person)
I--
Hi<ED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per aC:ldert)
-
f-- PROPERTY DAMAGE $
(Per ac:ldert)
ROE UASIUlY AUTO ONLY - EA ACCDENT $
ANY AUTO OTHER THA~ E4.ACC $
AUTO ONLY AGO $
EXCESS UABIUTY EACH OCCURREtlCE $ 2, 000, 000
C :!:J OCCUR o ClAIM:; MADE XSM974B6054 04/05/04 04/05/05 AGGREGAE $2,000,000
$
Tx D:'DUCTIBLo $
X RoTENTION $ 0 $
WORKERS COMPENSATION AND I WC STATU" 1 lOTfJ.
TORY UMITS ER
D EMPLOYERS' UABIUlY 21WECDR5490 04/01/04 04/01/05 $ 500000
E,_, E.ACH A:CIDENT
E.^" DISEASE - EA EMPLOV=E $ 500000
E ,_, DISEASE - POUCY UMIT $ 500000
OTHER
DES~IPTlON OF OPERAnONSlLOCATIONSIVEHICLES.'EXCWSIONS ADDED BY ENllORSEMENTISPECIAL 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 I y I ADDmDNAL INSURED; INSURER LErTER: CANCELLA nON
CITYO-l SHOUl.D ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE E~PIRAnON
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL -3.L DAYS WRITTEN
City of Clearwater NOTICE ro THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Barbara
25 Causeway Blvd. IMPOSE NO OBUGA110N DR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater FL 33767 REPRESENTATIVES,
AUTHO~ _ 4L- ~
I I . , V -
ACORD 25-S (7/97)
@ACORDCORPORATION 1988