CERTIFICATE OF LIABILITY INSURANCE
ACORD~ CERTIFICATE OF i.lABILITY INSURANCE. DATE6~~/~~~Y)
flROaut.'ER -. THIS CE~TIFICATE IS ISSUED AS A M..TER OF INFORMATION ONLY
MOORE & MOORE INSURANCE AGENCY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
601 8TH AVE. WEST CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
PALMETTO FL 34221-5115 AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
INSURED COMPANY A: AMERICAN STATES INSURANCE CO.
SILVER DOLLAR GOLF & TRAP, INC. COMPANY B:
17000 PATTERSON ROAD COMPANY C:
ODESSA FL 33556
COMPANY D:
I COMPANY E:
COVERAGES
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.
I~;~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 01-CC-635794-8 NOV 19 98 NOV 19 99 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fire) $ 200,000
I CLAIMS MADE 0 OCCUR MED. EXP (Any One Person) $ 10,000
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000
II POLICY n ~:;>~ nLOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~ $
ANY AUTO (Ea accident)
~
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
BINCL $
R DEDUCTIBLE EXCL $
RETENTION $ $
-
WORKERS COMPENSATION AND I WC STATU- I 10TH
EMPLOYERS' LIABILITY
E.L EACH ACCIDENT $
E.L DISEASE-EA EMPLOYEE $
EL DISEASE-POLICY LIMIT $
OTHER:
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
CITY OF CLEARWATER ...,:....:'7"'".;-;- ~ It -;:::;1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
ATTN: MR. EARL BARRETt .:' \rr ~ ~ ~ ~, / r 1 f 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
POBOX 4748 ..---------.., t ; : BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CLEARWATER FL 34618-4748 i '" . ; OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
~~. ,.. t I II i AUTHORIZED REPRESENTATIVE ~c-m~
\ I
Attention: , "." .-.. i
'ACOR025-S m9")~" '" ... .~ .... '-', -, -"--._--- Cerlificate #- 7 4-~H
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