CERTIFICATE OF LIABILITY INSURANCE (7)
Date: 4/23/2003 12:09 PM
Sender's Fax 10: 727-449-1267
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ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 K6/ DATE (MM/DD/YV)
PICKL-1 04/23/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Starcrest ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 6090 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax: 727-449-1267 INSURERS AFFORDING COVERAGE
INSURED INSURER A THE TRAVELERS INSURANCE CO
INSURER B
Pickles Plus Too
Kim INSURER c:
320 Cleveland Street II,SURER D
Clearwater FL 33755
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 ISSUEDOR
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 ~~~kC~~~~;~~E Pg;~~~~~~~~/g~~N LIMITS
LTR
GENERAL LIABILITY EACH OCCLRRENCE $ 1000000
- 03/23/03 03/23/04
A ~ COMMERCIAL GENERAL UABILlTY I6804638A922-COF FIRE DAMAGE (Anyone fire) $ 100000
P CLAJMS MADE [!J OCCUR MED EXP (Anyone person) $ 10000
-
PERSOw.L:l. ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 2000000
-
GEN'l AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2000000
Xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
t-- $
ANY AUTO (Ea accident)
f--
ALL OWNED AUTOS BODILY INJLFY
f-- $
SCHEDULED AUTOS (rer pCr:Jon)
f--
HIRED AUTOS SODIL Y INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accidenl)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
AUTO OI"JL Y: AGG $
EXCSSS LIABILITY EACH OCCU:~I=lENCE $
t=J OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
I we STATU- I IOTH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILITY
EL EACH ACCIDENT $
EL DISEASE. EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPEClAL PROVISIONS
Restaurant * Family Style
FAX: 727-562-4825
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER A CANCELLATION
CITCLEA SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ OAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: DEBBIE REID
100 SOUTH MYRTLE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33756 REPRESEN!NIYES,
I AUTHOj/yt:;:2!
ACORD 25-5 (7/97)
<9 ACORD CORPORATION 1988