CERTIFICATE OF LIABILITY INSURANCE (4)
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ACORDN
CERTIFICA T'-OF LIABILITY INSURJ.\ ~C~~T~~l DA~E7(;~~D;;)2
THIS CERTIFICATE IS IS~ _lD AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Real Insurors, Inc.
50~~ W. Laurel Street, Ste 214
Ta 1 FL 33607-3836
Phone: 813-288-1000 Fax:8l3-28l-24ll
INSURERS AFFORDING COVERAGE
INSURED
Bait House LLC
POBox 3025
Clearwater Beach FL 33767-8025
I
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
Western World Ins Co
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~~~~~bB9-l.}YE PJ>1-+~~~~r6'rJ:.?N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 500000
f-- ~E~~Iv1AGE (Any one fir~L!);_ 00 0 2_.____~
A X COMMERCIAL GENERAL LIABILITY NPP787l00 07/01/02 07/01/03
-.--- ___I CLAIMS MADE [iJ OCCUR
MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 500000
~
GENERAL AGGREGATE $ 500000
--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 500000
Xl nPRO- n
X POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~ (Ea accident) $
ANY AUTO
f--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
f--
HIRED AUTOS BODILY INJURY
f-- (Per accident) $
NON-OWNED AUTOS
C
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=J ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY L1MrrS I IUlH.
ER
I EMPLOYERS' LIABILITY E.l. EACH ACCIDENT $
------_... ""'--.--
E.l. DISEASE. EA EMPLOYEE $
E.l. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is Additional Insured.
Location: 46 Causeway Blvd, Slip 156, Clearwater Beach FI 33767.
S7/l8/02F.727-462-6957
CERTIFICATE HOLDER I Y [ ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CCLEAR- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Risk Management Dept -
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Marine & Aviation Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
25 Causeway
Clearwater FL 33767 REPRESENTATIVES.
I Marcia M Lewis 771- /11. ~k.
ACORD 25-S (7/97)
@ ACORD CORPORATION 1988