CERTIFICATES OF INSURANCE (3)
I
I
CERTIFICATE OF INSURANCE 07/21/98
T-p~UrrUCER--------------------------------------------T--TRTS-CERTTFTC~TE-TS-TSSUErr-~S-~-ft~TTER-QF-TRFURR~TTOR-UR[Y-~Rrr-----------T
; Real Insurors, Inc. : CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE ;
: : DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE :
; 5005 W. Laurel Street, Ste 214: POLICIES BHOII. :
: T ama FL : -- ---------- - -------- -------- --- -------- -- -- - --- - - - -- -- --------- -- - ---- --- -:
: 3360~-3836 : COMPANIES AFFORDING COVERAGE :
: PHONE813-2B8-1000: :
~-----------------------------------------------------:---------------------------------------------------------------------------:
: INSURED : CO"'PANY LETTER A American States Ins. Co. :
~ :---------------------------------------------------------------------------;
: : CO"PANY LETTER B ;
: Bai t House : -- ---- ------- ----- ---- ----- ------------- - -- -- -- -- -- ----- ----- -- ---- - -- -- -- -:
: POBox 3025 : CO"PANY LETTER C :
: Clearwater Beach, FL : _n_nnn___n__nnn_________u____________n___________________nn_n_:
: 34630 : CO"PANY LETTER D :
: :------------------------------------------------------------~--------------:
: : CO"PANY LETTER E :
;> COVERAGES (:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELON HAVE BEEN ISSUED TO THE INSURED NA"ED ABOVE FOR THE POLICY :
1 n:~~~DT~~~I~~~~~ ~l€~~~N~I~s~~N~ ~~N~R R~~~I=~iNiT.W~~~I ~~\~O~A~~~l~~H~~s~~~~~N~E~n~~~S~~IEI,~ TO -.l-
: ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POlIC ES. LI"ITS SHIMI ftAV HAVE BEER REDUCED BV PAID CLAIMS. :
~--------------------------------------------------------------------------------~------------------------------------------------~
: CO: TYPE OF INSURANCE : POLICY NU"BER : POLICY EFF : POLICY EXP : LI"ITS :
: L TR : : : DA TE : DATE : :
:---:-------------------------------~---------------------------~---------------:--------------:----------------------------------~
: : GENERAL LIABILITY: : :GENERAL AGGREGATE : 300000:
~ ~ : : :-------------------~--------------~
: A: [)O CO""ERCIAL GEN LIABILITY : 01CDE136796 : 09/06/97 09/06/99:PROD-COMP/OP AGG. : 300000:
:: : ------------------:--------------:
[ ] CLAIMS !'lADE [)(] OCC. : :PERS. ~ ADV, INJURY: 300000:
: :-------------------;--------------;
: [ I OWNERS'S ~ CONTRACTOR'S I :EACH OCCURRENCE : 300000:
: PROTECTIVE :-------------------.:--------------:
: :FI RE DA"AGE: :
: [ ] : (ANY ONE FIRE) : 50000 :
: ~ -~----------------:--------------:
: [ ] :"ED. EXPENSE: :
, : ,: (ANY ONE PERSON) : 5000 :
:---:-------------------------------,---------------------------:---------------1--------------:-------------------:--------------~
: : AUTOMOBILE LIAB : :: :CO!'lB. SINGLE LIMIT: :
: ~ ~ ~;: -------------------: --------------~
; :r] ANY AUTO: :: BODIl Y INJURY: :
: : [ ] All ONNED AUTOS : :: (pER PERSON): :
: : [ ] SCHEDULED AUTOS : :: -------------------: _____u_______:
: :r] HIRED AUTOS: : :BODIlY INJURY: :
: : [ ] NON-OWNED AUTOS : :: (PER ACCIDENT): :
: :r] GARAGE lIABILITY : : ~-------------------~---..----------:
: : [ ] : ,:: PROPERTY DAI'IAGE: :
:---:-------------------------------:---------------------------;---------------:--------------:-------------------:--------------:
::E-XCESS~l-lAB1LITyc: :-: lHCItOCCUlffiENCE:~ -:
: :r J U"BRElLA FOR": :: :-------------------;--------------:
: ; [ ] OTHER THAN UMBRH LA FOR" : ::: AGGREGA TE : :
;---;-----------.--------------------:---------------------------~---------------;--------------:-------------------:--------------;
: : : ::: :STATUTORY LI"ITS: :
: : WORKERS' COMP : :: lEACH ACCIDENT: :
: : AND: ::: DISEASE-POL. LI"IT I :
: : EMPLOYERS' L lAB: :: :DISEASE-EACH E"P. : :
:---~------------------------------~:---------------------------;---------_.._---;--------------~-------------------~--------------:
: : OTHER : ::: :
I I I I I' I
I I I I I I I
I I I I I I I
I I I I I I I
:---------------------------------------------------------------------------------------------------------------------------------;
: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAl ITEMS :
The City of Clearwater is Additional Insured. :
I
,
46 Causeway Blvd, Slip 156, Clearwater Beach, Fl 33515 :
,
,
) CERTIFICATE HOLDER (:::::::::::::::::::::::::::::::) CANCELLATION (:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- :
Ci ty of Clearwater : PIRATION DATE THEREOF THE ISSUING COMPANY WIll ENDEAVOR TO MIL 10 ;
Cather ine, Faxed 462-6957 : DAYS lIRITTEN NOTICE Tb THE CERTIFICATE HOLDER NA"ED TO THE LEFT, BUT :
25 Causeway Bl vd : FAILURE TO "All SUCH NOTICE SHAll I"POSE NO OBLIGATION OR LIABILITY OF :
Clearwater, FL : ANY rIND UPON THE CO"PANY, ITS AGENTS OR REPRESENTATIVES. :
:34e;3() :---------------------------------------------------------------------------:
_ACORD 25-S (7190)___________________________________~::::::~E~~:::-::~________ _____________________________________'
" l
I.
~~~~l~~~1[J;.-tJJ:--I-~:it!~~~~-Ji_.._---------i--TRrs1DERTrFrC~Tt-r;-rggOErr.~S-A-RArTEI.DF.rRFDR~ATrD'-~R~~'~~~!.~~---T
: R~.l Insurors, Inc. : COKFERS NJ RISHTS U~ON THE CERTIFICATE HOLUR. THIS CHTlFICm l
i : 00E3 ~]T 4~:ND, EXTEND OR ALTER THE COvtRA8E AFFORDED !Y THE ~
! 5005 N. Laul"el St. -Su~t& 214 : POLICIES BElOll, :
i ~~~!.3:~6 ;---u------cOMPANi"i:-s--AFFoRi).iNauCOVEAA6E-.'...-nm----:
: PHOPlEB13-28B-l000 :. I
I---....._------~...._--------~-..._--------....._----:____P......._____.._.________....___________....~__________~.._.___________:
: mum : ClJ"PAlIY lETTER A American States Ins_ Co. :
~ :..._---------.._--------.....~-------_......~._------~~~-_._~---------.~._.:
: CO":JMIT lETTER B :
;.~~----------_.-.;-------~.._---------......________w..--~-------r..._.~_ _'
; COIIPA.-T LETTER C - i
1---------..--------......-------"'.----------......--------.....----------l
I CO"PAIY lEnER D :
:..----------..".------."..--------..,....--------.....---------.......---1
j COllPA.' lETTER E I
\ COVERAbES '--------.,.,----------.-.....-.----.--..........~------..----------."...-----------.......________.....___------,..1
I' THIS IS TO-CERTIFY-THAT-PDLI:IES-OF t~SUq^NCE-lIS1ED BElOW-H^VE-BEEN'jssuED-To-1HE'jNsURED-NAftED-ABOVE-FOR-THE-POLiCy----- I
: PERIOD INDICATED. NOT~ITHST~NDINS AMY REQUIREIIENT TERII O? CONDITION OF ~NY CONTR~CT OR OTHER ~NT Mlr~ RES~ECT TO
: WHICH THIS CERTIFI~ATE MAY BE ISSVCD O~ IIAY PERTAlftl THE :HSURANCE AFFCRDED B~ THE POLICIES DESCRIBED HEREl~ IS SUBJECT TO
; All TE~r EXCl~SIONS, AnD COND[TIONS OF SUCH POLle ES. ll"llS SHOWN KA~ HAVE BEEN REDucED BY PAID ClAI~. ,
i--------..---------......---------......--------........~----------....-------......---------r~....~_______-.--...------------.--l
: co: TYPE DF I!ISURA~CE POL!C~ NUlIBEP. POlICY HI' : POlICY E1P : LI~lTS :
IlTR: , UTE : DAlE : :
~...:---------....------------.-----I----......--------------..-:..-------......:-------...._.~:---------~--...____________.__.._6:
: : SENERAL LIABILITY: :SENER~L A6SRE,,,TE I 300000:
; ~ I ~ :---.......__________: _..____________~
: A:DO C~II!E~WL BEN LIABIlITY 01CDEl367'9G I 09/06/'96: 09/06/'97:PROD-CO~PJ~? ASS, : 300000:
; ; : : t ________________.w:___________...:
: I [ ) :tAll'1S mE IX 1 Dec. : 09/06/97: Q9/06/98:~ER5. ~ ~DY. INJuRy I 300000:
; 1 : ~ 1___...______________: ......________...~
\ : [ ) ~IIM~~S' S ~ CONTRACTOR'S ::: EACH OCCURRENCE : 300000 I
: : PROTECTIVE :: l-------.---........: ....__m....':
: I : : : mE DAl'IA6E: : ,
I I [ ] ; (ANY ONE mE) :i0000 I
, I : ________.,..._____ _____..,.."._:
I It] IIIED. EXPENSE :
l : , 'I I:m DNE PERSDn; 5000 I
:---:----.........-----------........---~-------.........-----------~--~....-~------I_-__----------:........---------__. ...~----------l
: : AUTOMOBILE LIAB : : :mB, SINGLE l:IIH : :
1 : I ! 1.._..______..._........,__________.......
: : [ I AllY AUTO: : 80m Y INJURY I :
:i [ 1 AlL ll'IlttED AUTns : ; [PER PERSON) :
: : ( 1 SCHEDUlED AUlDS : : -m......'_m____l___.......____1
: :r 1 HIRE! AUTOS ~ :BODIlY INJURY I
: : r 1 ~ON.Olll1ED AUTOS : : (PER ACCIDnlll I \
: :l 1 1i^US~ LlAB1LlH : :...._____m._....':..___m_____.:
: r 1: : PROPERTY DA"AIiE :
:---,--.....~-----------...-.....-----l---------------------------,---...-~-------,.....-.-------l--.......~---------~.....---------1
: : EXCESS LIABILITY I : :mll OCCURRENCE: I
: : r J UIIBRHLA m~: : : ..___________......: ____________..:
: :r) OTHE~ lHAN UIIBRHlA FORM I : : ~GliRE6ATE : :
---l---.....~------------.-----_.--:-------------.".......~----~------~.......~--:------...~~.....:-----------.......-1-----------.--:
I : ;!; :STATUTOfiV urns: l
: WORKERS' COt1P I : :mH ACCIIlEtn I :
: AND: : : DlSEAEE 'POL. LIl'lT : I
: EMPLOVERS' LIAS l : :mEASE-EACH EP'P, : :
....:___________W...4___________.___;.._.._______________.......:...________.... ---------r....:.._____________P.._.~____________~:
I OTHER; ::
I. ,
I I .
I I ,
1. I
I.._..._------------..-..----~-----------.-.._._..~._-_______________......._________......_._____________~_______________________~
: DESCRIPTIO~ OF OPERATION5/l0CATIO~S/VE~It~ESJSPECIAl ITE"S ~
I The City of Clearwa~~r is Addit!o~l In5urRd. I
I I
I 46 Causeway Blvd, Slip 1~, Cl.~rw~~&r B&ach, Fl 33515 l
I I
, I
l, CERTIFICATE HOLDER (:::::::=========.....::::::;;::) CANCELL~~ION (.:.~.;;=::===::::...........;=:==========.......a.a=========:
: : SHOULD ~NY Of TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E~. :
: City of Claaywa~Qr' : P!RA-;:Oll DATE THEREOF 1l1E l55UINE COMPAN'1 IIIll ENDE"'JUR TO Mm 10 I
: Cather ins, FiU<vd 462-6957 ~ DAYS UiEHM NOlICE T6 lHE CEmFIC~TE IIlLDER NAMED TO THE LEFT, BUT I
: 2:5 CauSlNay Blvd ; fAILURE TO ""ll SUCH ~OTlCE S~AlL II1POSE NO OBLlBATlON fiR LaBILITY O~ :
Clearwater, FL : m mm UPON lH~ CO~PANY, liS AGENTS OR REPRESENTATlVrs. :
, 34';30 : .._________________u.. .--- _n_ ---.----.......---------------~......... "'-1
i_A''"' l>-S "190)___________________________________:_:::::::~~-------__......__________i
100 'd IjH18,~18:13l S~O~i1SN[ lY3~ 60:Z1 rJ1HllL6,Ol-1nr
Ba! t House
POBox 302~
Cle_r'water BeaCh, FL
:34630
.
,
CERTIFICATE OF TNSURANCE . 09/12/94
T-PROnDCER----------------~---------------------------T--TRIS-CERTlrICATE-IS-ISSDEn-AS-A-RATTER-Or-IRrDRRATIOR-OR[Y-ARn-----------T
1 ReC\J. Insu'I'oof'5;, Inc. 1 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE 1
I 1 DOES HOT AMEHD, EXTEHD OR ALTER THE COVERAGE AFFORDED BY THE 1
1 1 '700 N. W E~ f:. t 5; tlC> 'f'f~ II J. v cI . ttl 03 1 POLICIES BELOIt I
: ~~ ~ 6 b 7 ~ 3 ~ ~ 'J : -----------C-OJ1~~ANi-I:!3--A-FFOR-DIN-(3--------------------i-~-f;~-'
i-~~~-~~:::::-:~:---------------------------i~~~~~~0i~~~~~~~~~~~~~!:~~~~~~~~~~~~~-~~~~~jil])
I B C\ i tHo U !S f? 0 , I COMPAHY LETTER B SEe 1 4 19.9.4 'I-
I <: / 0 C I f? a Of' W c.'" t e Of' C 1 t Y 1'1 a of' 1 n a 1--------------------__________________________________ -- -- -- _____1
I "tE, Clea'f'wateof' Blvd. ,Slip 156 1 COMPAHY LETTER C I
1 C Ie a "(' w ate Of' Be c.'" c h F L 1----------------------_____________________________________________________1
I 34630 ' I COMPAHY LETTER D . 1
I :-CO"PANY-LETTER-E---------------------------------~1t~-~----I\rt1fi-1iI~
I) COVERAGES (====================================================================================================================1
I THIS IS TO CERTIFY THAT POLICIES OF IHSURAHCE LISTED BELOW HAVE BEEH ISSUED TO THE IHSURED HAMED ABOVE FOR THE POLICY I
: ~~E~DT~~~I~~~~~FIC~~~W~~~S~~H~~~~E~H~RR~~I~~:~~I~iT~~~ ~~s~~~~E~I~~F~D~~YB~O~~~A~~L~~j~~H~S~~~N~E~~I~ ~~S~~~1E~~ TO :
I ALL TER"S, EXCLUSIONS, AND CONDITIONS OF SUCH POLIC ES. LIftITS SHOUN ftAY HAVE BEEN REDUCED BY PAID CLAIMS. ,
J----------------------------------------_____________-----------------------------------------~------------______________________1
1 COI TYPE OF INSURANCE 1 POLICY HlmBER I POLICY EFF , POLICY EXP 1 LI"ITS 1
IURI I I DATE 1 DATE 1 1
---1------------------------------- --------------------------- --------------- ______________1__________________________________,
I GENERAL L I AB I L I TY IGENERAl AGGREGATE I 300000 I
I 1___________________1______________1
~~ID(] CO""ERCIAL GEN LIABILITY 01ccll.3()'7962 09/06/94 09/06/95IPROD-CO"P/OP AGG, 1 300000 1
1 I --------__________1______________1
I [] CLAIMS "ADE IX] OCC, IPERS. & ADV. INJURYI 300000 I
I ,___________________1______________,
I[ ] OWNERS'S & CONTRACTOR'S lEACH OCCURRENCE 1 300000 I
I PROTECTIVE 1___________________1______________,
I IFlRE DAftAGE 1 I
I[ ] I(ANY OHE FIRE) I 50000 1
I I -----_____________1______________1
I[ ] I"ED, EXPENSE 1 1
I I (ANY ONE PERSON) I 5000 I
1---'-------------------------------1---------------------------1-------________1______________,___________________,______________1
, 1 AUTDI'10BlLE LlAB I 1 1 ICOMB. SINGLE L1"IT I I
1 I I I' 1___________________1______________,
I ,[] ANY AUTO , " IBODIlY INJURY 1 1
I I [] ALL OWNED AUTOS 1 '" (PER PERSON), J
I I [ ] SCHEDULED AUTOS 1 I 1 1___________________1______________1
1 I [ ] HIRED AUTOS I 1 I I BODR Y INJURY I 1
I I [ ] NOH-OWNED AUTOS 1 1 1 I (PER ACCIDENT> I I
I I[] GARAGE LIABILITY 1 1 I ,-------------------1--------------(
1 I [ ] I I I 'PROPERTY DAftAGE 1 1
1---1-------------------------------1-------------______________1_______________1______________1___________________1______________1
I 1 EXCESS LIABILITY 1 1 1 lEACH OCCURRENCE 1 I
I I [ ] U"BRELLA FOR" I I 1 ,___________________1______________1
I I [ ] OTHER THAN U"BRElLA FOR" I I I I AGGREGATE I 1
'---1-------------------------------1---------------------------1---------------1--------------1-------------------1--------------1
1 I I 1 1 I 'STATUTORY LI"ITS I ,
I 1 WOI;:KERS' COI'1P , 1 I 'EACH ACCIDENT 1 I
I I AND I I 1 IDISEASE-POL. LI"IT I 1
1 , EI'1PLOYEI:::S' LIAB I 1 1 IDISEASE-EACH E"P, I I
'---1-------------------------------1---------------------------1--------------_1______________1____________-_____________________1
, 1 DTHEF"< I I I' I
I I I '" 1
I I J I 1 I I
1-----------------------------------------------------------------------------------------------------------______________________1
1 DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITE"S 1
, flAITSALES I
: The City of Clearwater is included as an additional insured, :
I I
I) CERTIFICATE HOLDER (===============================) CANCELLATION (============================================================1
I = SHOUlD ANY OF THE ABOVE DESCRIBED POLICIES BE CAHCELLED BEFORE THE EX- I
1 C:i. t y 0 f C lea Of' w C\ t e Of' = PIRATION DATE THEREOF THE ISSUING CO"PAHY WILL ENDEAVOR TO "AIL 10 I
I Ihsk IrlanC\gement dept. = DAYS WRITTEN NOTICE Tb THE CERTIFICATE HOLDER HAftED TO THE LEFT, BUT I
I P.O. If 0 x .l+ 7 1+ 8 = FAILURE TO MIL SUCH NOTICE SHAll I"POSE NO OBLIGATION OR LIABILITY OF I
I Clea'f'waeof', FL = ANY KIHD UPON THE CW.PANY, ITS AGENTS OR REPRESENTATIVES. 1
I :34618 =------------------------------------------~-----------_____________________1
I A C h' Faxed 462-6957 = AUTHOR ED REPRES~:ZE - J
I ttn: at erlne, =. I
'_ACORD 25-S (7/90)_______________________________________ _ ' ~~-_---------~-----------------~~---~---I
AUG, - 24' 95 rTHU) 1 i: 44
REAL I NSlj~ORS
, 'r; 'ft" .,, \~;' V' t7 ~'? n,
au~.lJ.;;...'fMiJJ
TEL:81328f411
p, 001
I""ERTIFICATE np INSURANCE
l-"llRnU1JCmr-:--~J.:'
Rea1 lnsurors, Inc.
5005 w. l~urel St.-Suite
Tampa, FL
33607-3836
PBOHE813-288-1000
---------~---~---------------~~---------------------~ ---------------------------~--------------------._-------------------------
I~SUREO COMPANY LBTTBR A American States Ins . Co.
8 1995 08/024/95 '
mcERTIJ'rcnnnSB'UEo AS A HATTElfOF1JlFOlliTIlfII-orn;rA1H -~
LCQKi~~ RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
IJm .AMEND, BUENO OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW,
-------------.-_____~-~______________________M______~__________________a___
COMPANIES AFFORDING COVERAGE
COMPANY LETTER B
---------------------------._----~~~---------------~-~---~._---------------
COMPANy LETTER ~
_u~_._________________________~_______________________________________~~___
COHPAN1 LETTER [)
--_._---------------------~~~~---~---------------~-----~----------------~--
COMPAHY LETrRR E
> COVERAGES <====~~~~=======~======~~~~~~====~======~~~~~==~;:========~~==:~~~~====~=;~;;:======:=~~~====;=;;:;========:~~===
THIS IS TO CERrIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED HAKED ABOVE FOR THB POLIcy
PERIOD IHDICATED. NOTWITHSTANDING ANY RBQUIRKKKHT TBRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMBNT WITH R8SPEC~ TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI'! THB InSURANCE AFFORDBD BY THE POLICIEs DESCRIBED HERRIN IS SUBJECT TO
ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLIC ES. LIIITS SHOll lAY BAVI BIBB IIDUCRD at PAID CLAIIS,
________4____~-_____________~_______________________________~_.___________________~____________________~_~~______________~_______
co TYPE OF INSURANCE POLICY NUKBER POLICY ErF POLICr EXP LIMITS
LTR DATE DATE
Bait House
c/o Clearwater City ~ina
4~ Clearwater Blvd.~S11p 156
~learwater Beach, FL
34630
--------------------~---.----------------------------------------------~--~
--- --------------------~---------- -------~--------------~--~- --------------~ -------------- ---~----------------._------------
GENERAL LIABILITY
A [Jq COMIIERCIAL GRN LIABILITY 01CD1367963
[ ) CLAIM'S MADE [X ] oce.
[ J OWNBRS'S & CONTRACTOR'S
PROTECTIVE
GENERAL AGGREGATE 300000
------------------- ------~-------
09/06/95 09/06/96 PROD-COKP/OP AGG, 300000
------------------ -----.--------
PERS. & ADV, INJURY 300000
----------~~------- --------~-----
BACH OCCORRENCE 300000
---------~--------- --~-----------
FIll DAXAG E
(ANY ONE FIRB) 50000
-._--------------- ------------..
liED, EXPENSE
(ANY OWE PERSOll) 5000
--- ------~~-----------~--~~------- ----------------.---------- ~-------------- -------------- ------------------- --------------
AUTOKOB.lLE LIAB COMB, SINGLE LIlHT
------------------- --------------
BODILY INJURY
(PER PBRSON)
--~---------------- -------~------
BODILY INJURY
(PIlR ACCIDENT)
-~----------~------ --------------
PROPERTY DANACB
[ ]
I ]
ANY AITTO
ALL Oll"NED AUTOS
SCHEDULED AUTOS
HIRED AUIOS
NOH-OWNED AUTOS
GARAGE LIABILIfV
--- -------------.----------------- -----~--------------------~ ------------~-- -------------- -----------n_______ _LL_._________
EXCESs LIABILITY EACH OCCURRENCE
[ J ~~~~L~~A~O~~BRELLA FORM iGGREGATE..~--~---- --_.~-------_.
--- -----.~-~---------~----------~- ------------.-------------- --.------------ -------------- -------------~.___. ___L~~________
ISTATUTORY LIKITS
WORKERs' COifi' lACa ACCIDENT
~ DISEASt-POL, LIMIT
EMPLOYERS' LIAB DISEASE. EACH EMP.
--- -~---------~-~---------~------- ----------------~-------~-- -------~--~---- -------------- ------_._-------._..._.._~--------
OTHER
-----------------~----------~-----------~-~------------------------------------------~._----------~----_._-----------------------
DESCRIPTIO,N OF OPERATIOHS/LOCA'llOHS/VEHI~LBS/~PECIAL ITEMS
The C1ty of Clearwater 1S ~ncluded as an Additional Insur~d.
= SHOULD ANy OF tHE ABOVE DeSCRIBED POLICIES BE CANCELLED BEFORB THR EX-
= PIRATION DATE THEREOF THB ISSUING COMPANY WILL EHDEAVOR TO HAIL 10
~ DAYS WRITTEN NOTICE T6 THE CERTIFICATE HOLDBR NAKED TO THE LEFT BUT
= fAILURE TO IIAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIlITY OF
~ANr KIND UPON THE COKPANY, ITS AGEHTS OR REPRESENTATIVES,
~-._._---~--._---------------------------------------------------~----------
: AUTHOJUZED REP~
----..._---
I
SEP, -12' 94IMON) 09: 41 REAL I NSURORS
1
TEL:872 0817
i
p, 001
CERTIFICATE OF INSURANCE 09/12/94
T-PRODOCER---------------------------------------------T--TRrs-tERTIFICATE-rs-rSSOEIIAS-A-"ATTER-DF-IRFDRAATIDRIDRCY-AAn-----------j
I Re~l 1n5OI.\'('0'('5, Inc. I CONFERS NO RIGHTS UPON THE CERTIFIGATE HOLDER. THIS CERTIFICATE I
I I DOES NOT AIlEND, EXTEND OR At TER THE COVERAGE AFFORDED BY THE I
I 1700 N. Westsho're :Blvd. #103 I POLICIES BELOW. I
: j3 6 g 7'~ 3 ~~ /~ l----------COI11:~AN I E~S--AF FOR DING CO VE RA GE------------:
I PHOHEB 13-877-9149 I I
1-----------------------------------------------------1---------------------------------------------------------------------------1
I INSUREl> 1 ClmPAHY lETTER A AmeT'i C'<i\ n S-ea 'te s 1115. Co. I
I J -----------------------------------~------,--------------------------,
I Bai t House I CO"PAHY LETTER B I
I c/o C 1 ea 'rw~ te.r- C i 'by Ma.r i na 1------------ ----------------------------------------------1
I .(t 6 ClEO a r w ~ t e r B 1 v d . , S 1 i P 1 56 I COHPAHY LEiTE(( C J
1 C 1 e.> a r \A,I ate'r Be a c h, F L 1------------------------------------------------------------------------1
, 34630 I CO"PAHY LETTER D I
I ,---------------------------------------------------------------------------1
I I COftPAHY LEITER E 1
I) COVERAGES (;:;:;~==~~~~~~~~~~===~;;:~~~~~~=~=====~~==============;-----------;;===;;;=~~~====~~~~~~l
I THIS IS TO CERTIFY nUll POLICIES OF INSURANCE LISTED BELOII HAVE BEEN ISSUED TO THE INSURED HA"ED AOOVE FDft THE POLlCY I
: ~~~DT~~~I~~~FIC:~~~A~~~N~~~~E~H~RR~~~I~~~~hlT~ ~~I~F~D~B~~~~A~~l~~I~~~~S~~~~~~~~ ~~S~~~~E~~ TO :
I All TER"S, EXCLUSIONS, AMD CONDITIOHS OF SUCH POlIC ES. LIftITS SHOWN NAY HAU[ BEEN REDUCED JT PAID CLAIMS. I
1------------------------------ -------------------------------------------------------------------------------1
I CO I TYPE: OF IHSURAHCE I POlICY HUftBER I POLICY EFF I POLICY EXP I LI"ITS I
ILTRI I I DATE I DATE 1 I
---I-------~~---------------------- ---------------------------1--------------- --------------1 ------------------------1
I GENERAL LI ABI L I TY f IGENERAL AGGREGATE I 300000 1
1 I 1 1 ------------1
AI[x] COMERCIAL G€H LIABILITY 01 cd 136. 79b2 I 09/06./94 09/0b/95IPROl)-CO"P/OP AGQ, I 300000 I
I I I -------- 1------ I
I [] CUlIK9 KADE IX J oce, I IPERS. & AD\). INJURY I 300000 I
I J I---~------------I ~~--------I
I[ ] OWNERS'S & CONTRACTOR'S I ItACH OCCURREHCE 1 300000 I
I PROTECTIVE I J --------I---------~---I
I I IFIRE DA"AGE I I
J[ J I I HIHY OHE FIRt) I 50000 I
I I I ------------------1--------------1
I[ ] J In8l. EXPENSE I I
I I I (ANY ONE PERSON) I 5000 I
1---1------------------ I---------------~---------I---------------I--------------I-------------------1--------------1
I 1 AUTOMO(lILF- LIAB I I I Icorm. SIHGLE LI"IT I J
I I I I I 1-----------------.1-----------1
1 I[ J AMY AUTO 1 I I IBODILY iNJuRY I 1
I I [ J ALL OWNED AUTOS I I I I (PER PERSON) I I
I I [ J SCHEDULED AUTOS 1 I I 1-------------1-------------1
I ,[ J HIRED AUTOS I I" lJODIl Y INJURY I I
I I [ J HON-OWNED AUTOS I I I I (PER ACCIDENT> I I
1 I [ J GARAGE LIABILITY I I I 1-------------------1----------1
I I[ J I I' IPROPERTY DMAGE 1 I
l---I-------------------------------I--~~---------------------I---------------1--------------1-------------------1--------------1
I J ~XCESS LIABILITY I I 1 IEAl"Ji OCCURRENCE I I
I 1 [ J UIUlRf1.l.A FORft I I I 1-----------------1-----------1
I J [ ] OTHER THAN UPIBRELLA FOR" I I I IAGGREGi)Tt I I
1---1-------------------------------1------ ------1---------------1--------------1-------------------1--------------1
I I I 1 I I ISTATUTlmY lIKITSI I
I , WOI~KF.:RS' CO,,,,:, I J I lEACH ACCIDEHT I I
I I AND I I 1 JDIst:ASE-POl. LInIT I 1
I I EMPLOYERS' LIAB I I 1 (DISEASE-EACH EJ!P. I I
1---1-------------------------------1---------------------------1---------------1--------------1----------------------------------1
( I OTHER I I I I I
I I I I I I I
I I 1 1 I' I
1----------- ------------------------------------------------------~-- --------------------------------------1
I DESCR1PTION OF OPERATJOHSILOCATIONSIVEHIClES/SPECllll lTEftS I
r BAIT SALES I
I The CitY'.of Clearwater is included as an additional insured. I
I I
I) CERTIFICATE HOLDER (;;-----~~~~~-===--------- ) CAHtEllATJOij (~--------~~~=----------~~~~~=====;;;_____~~~~===I
I ~ SHOULD ANY OF THE ABQVE DESCRIBED POLICIES BE CAHCElLED BEFORf THE EX- I
lei ty 0 f C 1 e a .r IN C\ t: e.,... = PIRATlOH DATE THEREOtb THE ISSUING COKPAHY WILL EHDmJOR TO "AIL 1 0 I
I Risk 1'1<lln~geme)'lt; dept. ; DAYS IIRIll91 NOTICE T THE ~TIFICATE HOUER HAltED TO THE LEFT, BUT I
I P.o. II 0 X 4748 ; FAILURE TO MIL SUCH MOTICE SHALl llIPOSE HO OBlJGATJOH OR LIABILITY OF I
, C 1 ear \A,I a e r , F L = ANY KIND UPON THE ctmPAHY, ITS AlifHTS OR REPRESENTATIVES. I
I 34618 ~---------------------------------------------------------------------------I
I Attn: Catherine, Faxed 462-6957 ~ AUTHOR ED REPRESEHTATI E )
C71 n _____1