CERTIFICATE OF LIABILITY INSURANCE (2)
qct-26-99 03: 13P Moore.l. & Moore Ins . 941 723 1785 P. 01
I DATE (MMIDDIVY)
&kO.RD.. CERTIFICATE OF LIABiliTY INSURANCE . - OCT2699
il-l15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGI'ITS UPON ~E; CERTIFICA1'E HOLDER. THIS
CERTIFICATE DO~S NOT AM~Ntl, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POL.ICI5.S BELOW.
THIS IS ro CERTIFY THAT THE pOLICIES OF INSURANCE L1STt:D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FO~ THE POLICY
PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMEN'f WITH RESPECT TO
WHICH TI11S CERTIF\CAH: MAY BE ISSUIOD OR MAY peRTAIN. THE INSU~ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC'T TO All
. THE TE~MS. EXCLUSIONS .AND co~.oITlO~.S OF SUC.H PO~ICIES. LIMITS SHOWN MAY HAVE BEEN ~EDUCED BY PAID CLAIMS -
IN;;:~ TyPE OF INSUM!'lCI!. POLICY NUMlill!.R ~L1CY EFFEC"!.I~ POUC;Y ElIPIRI'T1()t1 l.IMITS
G~ERAL LIABILITY 01oCE-505618 10 FEB 1 99 FEB 1 00 EACH OCCU~NCE: S
X COMMERCIAl GENERAL LIABILITY ~~E DAMAGE (Any One F,'lI). $
_.. ~ CLAIMS MArlF I~ OCCUK MEO. 8\P (Any One Pef90nl S
PRODUCER
MOORE & MOORE INSURANCE AGENCY'
601 8TH AVE. WEST
PALMETTO FL 34221-5115
PHONE; 941.722-3;l38
FAX: 941.n3-1785
COMPANIES AFFORDING COVERAGE
- -
AMERICAN S1'ATES INSURANCE CO.
. - .. .
INSURED
SILV~R DOLLAR TRAP CLUB, INC.
12601 SILVER DOLLAR DRIVE
ODESSA FL 34556
COMrANY A:
COMPANY B:
COMPANY C:
COMPANY D:
COMPANY E:
COVERAGES
A
P~NAL & Af:N INJURY ~
...
GEN~RALAGGREGATE S
-.-. .-.
F'RODUe tS.eOMPIOP AGG. 5
.. -
COMBINED SINGl!; LIMIT $
(Ell accldentl
..
BOOll Y INJURY
(I'er P9f&OIlI $
-.
BOl)ll Y INJURY 5
(F'E!( aodden\]
...
f'KOPFRTY DAMAG!; S
AUro ONLY. GA ACCIDeNT S
..
-
f--
GEN'L AGGRI:GATC LIMIT At'f'\lES PI:R:
.l POLICY I. I ~~o. n LOe
AUTOMO$llE LIABILITY
-
ANY AU TO
Al.L OWNeD AUTOS
SCHEDULED AUTOS
ItIRCD AUTOS
__ NON.OWNW AUTOS
-
GAMGE LIA8ILITY
R ANY AUTO
EXCESS LIABILITY
o OCCUR 0 CLAIMS MAOC
A
I D. EDUCfI!lIF
I Rl:rENTION S
WORKERS COMPEiN$A"I'1QN AND
EMPLOyeKS' UA~I~rrY
OTHE:R THAN
AUTO ONLY:
~.~
AGG S
01-SU-238341-10
FEB 1 99
FEB 1 00
EACH OCCUKHENCE $
AGGFtE;GATE $
. -
$
$
.. ...
$
I we STATY' I I OTI1
E.L. EACH ACCIDENT
$
E.L. OISEASE-EA I:MPLOYEE S
$
E.L. DISEASE-POLICY LIMIT
OTHER:
DESCRIPTION OF OPERA TIONSlLOCA TIONSNEHICL.ES/SPECIAL ITEMS
CERTIFICATE HOLDER IS AL.SO ADOITIO...AL INSURED AS IT PERTAINS TO: PART OF THE SOUTHEAST 1/4 OF
SECTION 19, TOWNSHIP 27 SOUTH, RANGE 17 EAST, HILLSBOROUGH COUNTY, FLORIDA
CERTIFICATE HOL.DI=R
I I ADDITIONAL IN$UREO; IN$URI!.R LETTI!.R:
CANCELLATION
1,000,000
200.000
10,000
1.000~OO~
1,000,000
1,000,000
- -~
5,000,000
5,000,000
SHOULD ANY O~ THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE
THE EXPIRATION LlATE THEREOF. THF. ISSUING COMPANY WILL ENOCAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLUtK NAMED TO TliE LEFT.
RUT ~AILURE TO LlAIL SIJCH NOTICE SHALL I"'POs!: NO OBLIGATION OR LIABILITY
O~ ANY KIND uPON THE COMPANY, ITS AGENTS OR REPRESE'NTAllVES
AUTHORIZED REPRESENTATIVE
CIT\! Of CLEARWATER
ATTN: MR. EARL. BARRETT
o {!.E~~~ rwJ 3<f!18 ~~8
~1 ntion:l II!,
Jt JRDOO=J (~~ 1999 I.:)
CITY OF Cl.EARWATEP
PUBtle WORKS AOMlt,n;;i"~,TlC:N
__,_"".__.. ,,-'n_>,.___
C-~,-Q-yyL~
1902
JAMES C. MOORE, JR.
Certificate #
A 183018