CERTIFICATE OF LIABILITY INSURANCE (6)
_~.cORD...
CERTIFICATE OF LIABiliTY INSURANC~i~:2~ DA;~~~~'!o~
THIS CERTIACATE IS ISSUED AS A MATTER Or: IN~ORMATION
ONL.Y AND CONfERS NO RIGHTS UPON nle CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEIIID, EXTEND OR
ALTER THE COVERAGE AFFORoeo BY THE POUCIES BELOW.
PROtlUCER
Real ~nsurorg. inc.
5005 W. Laurel S~~eet, Ste 209
Tampa FL 33607-3836
Phone;813-288-~000 Fax:813-281-24~~
-iN'SUREtl
INSURERS AFFORDING COVERAGE
Wesa.~n World :J:ns Co
Bg~~A~9ton ~ns Co
Bait House LLC
POBOx 3025
Clearwater Beaeh FL 33767-8025
INSURIn A:
INSURER B:
INSURER c:
INSURCR 0:
INSURER Ii:
COVERAGES
nil::: POl.IClliS OF INSURANCE LISTED BELOW HAVE HEi:N ISSUe) TO THJ:: INSURCD NAM[;Il AOO~ FOR THli POl.ICY PERIOD INDICATED. NO'fWi'rHS"ANDINC
ANY Rl:QUIR!:MEN'T. TI:RM OR CONcmON OF ANY CONTRACT OR OTHF,R POCUMENT WITH RESf'ECT TO WHICH THIS CERTII'ICATI: MAY BC ISSUCD OR
MAY PERTAIN, THE INSURANCE AfFOROED BY THJ:: POUCll:S DI:SCRlBCD liGREIN IS SUDJF.CTTO Al.l. THE TERMS, EXCLUSIONS AND CONornONS 01' SUCH
POLICIES, ACCREGATE LIMITS SHOWN MAY HAVE DEEN REDUCEO DY PAID CI.AIMS.
l~f~ .'.\._'- ~wrM;;;~~ I ~i-+~~?N
TYPG OF INSURANCI; POLICY NUMBER ~IMITS
GJ::NERAL LIABILITY 6ACH OceUI'l~EI'lCE :& 500000
1- "..-
A X COMMCRCIAL GENEAAL LIA[]ILlTY NPP837086-RSNEWAL 07/0~/04 07/01/05 FIRE DAL4AGF.IAnll ~no:: tlr~1 $ 50000
-,.... .. . I CLAIMS MADC [!] OCCUR
MEn EXP (/\ny ene P~"'I;If1) S 5000
PER$ONAl. & AOV INJURY $ 500000
GF.NCRAI, AGGREGATE $ 500000
GEf'J'1. AGGREGATE LIMIT APPLIES ..lOR: PRODUCTS - COM PlOP AOC $500000
Xl PO~'CY n ~8i nLOC ----- ............
AUTOMOBILE LlADlLITY COMBINCD SlNGlC L1Mrr
- ~
ANY AUTO lea ~ecid.~11
-
ALL OWN CD AUTOS RODIL Y INJURY
.- S
SCI'IEDULED AUTOS lPilr per,;onJ
-
I-lIRI;P At,lTOS BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
- ....
PMOPERTY OAMACJ:: S
[Per acclcIenl)
GARAGE LIABILITY AUrO ONLY - EA ACCIDENT :&
==j ANY AUTO ...........- ..,...... .. .~
OnlER TNAN EA ACC $
AUTO ONI. Y; AOe $
EXCESS LIABILITY EACH OCCURRENCE: $
~ OCCUR o CLAIMS MADE AGGREGATE :&
$
=J DGDI,lCTIDLE $
: RETENTION $ $
. WORKERS COMPENSATION AND I TO....RY'UMrrS I IUEit
eMPI.O~RS' ~IABILITY e,1.. EACH ACCIDENT $
E.I.. DISEASE - EA EMPLOyEE $
F..l., DISEASE - POI.ICY LIMIT $
OTHER
,
B Liquor Lial:lility I S03BOO1798-REHBWAL 07/0]./04 07/0]./05 Li:Q:Lie $500,000
Aaa~etTate $500,000
t1ESCRIPTION OF DPEIlATlDr.lSlLOCATlONSIVEHICLE.SIEXCLUSlONS ADD20 BY ENOORSEMErtf/$f'UOIAL ~OVl:ilOIQ
C:l.ty of clearwater is Adclltional :tnsured.
Loeatior.u 46 Causeway Blvcl. Slip ~S6, C1earwater Beach Fl 33767.
1'.727-462-6957 ATTN: CATIIERiNE
CERTIFICATE HOLDER I y I ADDmONAL INSURED: INSURER LETTER: _~ CANCELLA110N
CCLBAlt- 9HOOLD ANY OF THE ABOVE DESCRIBED I'OLlClES BE CANCRLI!D Dl!FORE Till! I!XPIRATION
City of Clea.rwater DATE THEREOF, THE ISSUING IN$URI!R W1LI.I:!NDI!AVOIt TO MAIl. .J.L DAYS WAITl'EN
lilisk Management Dept NOTIC!: TO THE CERTIFICATE flOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
M'ar:lnt!l &: )\.v:l.at:l.on Dept IMPose NO OlilLlGATIOJII OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
2S Causeway
clea~atel:' J'L 33767 REPRI;SENTATlVE$,
AUTHORlZliD ~I;PRl;S"NTATlVE ~~
I Marc:i.a M Lawi$ '71/ .hi.
ACORD 25.S (7/97)
@ACORD CORPORATION 1988
600/l00 "d
ll170l808l8(X\J.:l)
svlo...lnsuI le~CJ
60:17l (3nl)17002-82-Nnr
IMPORTANT
If the certiflClilte holdor Is an ADDITIONAL INSURED, the pollcyOes) must be endorsed. A statement
on this certlficam does not confer rights 10 the cortlflcate holder in lieu of such ondo~emont(s}.
If SUBROGATION IS WAIVeO, subject to the terms and conditions of the polley, certJln poliCies may
requiro an endorsement. A Slatement on this cortlficate does not confer rights to the certlflcate
holdcr In lieu of such endor.s9ment(s).
DISCLAIMl;R
The Certificate of Insurance on the revorse side of this form does not constitute a COntract between
Ihe issuing insuror(&}. authorl%ed reprO$$nlatlllc or produCQr, and tho eertificato holder. nor does it
affirmallvely or nogatively amend. extend Or altar the covorage afforded by tho poliCies Ilsled thereon.
ACORD 25-8 (7197)
600/300 'd
llV0L808l8(X\J.:I)
s..,Io..lnsuI 1ea~
00:17l (~nl)17006-66-Nnr