CERTIFICATE OF LIABILITY INSURANCE (5)
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CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
MOORE & MOORE INSURANCE AGENCY
601 8TH AVE. WEST
PALMETTO FL 34221-5115
PHONE: 941-722-3238
FAX: 941-723-1785
DATE (MM/DDIYY)
DEC 19 01
THIS CERTIFICATE IS ISSUED 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.
Agency Lic#: A183018
COMPANIES AFFORDING COVERAGE
INSURED
SILVER DOLLAR TRAP CLUB, INC.
12601 SILVER DOLLAR DRIVE
ODESSA FL 34556
COMPANY A: Auto Owners Insurance Company
COMPANY B:
COMPANY C:
COMPANY D:
COMPANY E:
THIS IS TO CERTIFY THAT 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.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
904612-20409507 -02 JAN 29 02 JAN 29 03 EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any One Fire) $ 50,000
MED. EXP (Any One Person) $ . 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 1,000,000
PRODUCTS-COMP/OP AGG. $ 1,000,000
I'~;: TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE 0 OCCUR
A
-
-
GEN'L AGGREGATE LIMIT APPLIES PER:
h POLICY n PROJECT n LOC
AUTOMOBILE LIABILITY
-
-
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CITY OF CLEARWATE~
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PROPERTY DAMAGE
COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO
-
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
-
BODILY INJURY
(Per person)
-
-
GARAGE LIABILITY
R ANY AUTO
EXCESS LIABILITY
=:J OCCUR 0 CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY:
EACH OCCURRENCE
AGGREGATE
I WC STATU- I I OTHER
E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
OTHER:
EA ACC
AGG
$
$
$
$
$
$
$
$
$
$
$
$ c._ - - - -'
$
$
$
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED AS
IT PERTAINS TO: PART OF THE SOUTHEAST 1/4 OF SECTION 19, TOWNSHIP 27 SOUTH, RANGE 17 EAST, HILLSBOROUGH COUNTY,
FLORIDA
CERTIFICATE HOLDER
I I ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, IT,'S AGENTS OR REPRESENTATIVES.
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CITY OF CLEARWATER
ATTN MR. EARL BARRETT REAL ESTATE SERVICES MA
NAGER
POBOX 4748
CLEARWATER FL 33758-4748
Attention:
AUTHORIZED REPRESENTATIVE
ACORD 2-5 S(7J9?) -_
Certificate# ",.4440
Jl:ImesJ::J~/lQor.El,_ Jr.
A 183018
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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- --Gertificateft4440