CERTIFICATE OF LIABILITY INSURANCE (6)
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID N~ DATE (MM/DD/YYYY)
NHCLL-1 03/10/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Alliance Insurance Brokers HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
7600 N, 16th St" Suite 201 AlTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phoenix AZ 85020-4447
Phone: 602-996-7600 Fax: 602 -494 -1175 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: Gulf Underwriters Insurance CO
INSURER B: Hartford Insurance Group
Silver Dollar Trap Club, Inc, INSURER C:
12801 Silver Dollar Drive INSURER 0:
Odessa FL 34556
INSURER E:
COVERAGES
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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~';-~1ri~J.f,w;E P8k!fEY(~':b~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY GU0435697 12/31/02 12/31/0_3 !:'~~~"-':. ;Xf ,,,::,, I cu e} $ 59,000 .
PREMISES Ea occurence
, I' ClA1MS MADE [!J OCCUR I. . -~--,.--- 'C'._ - ---- ., - -
'. --, MED EXP (Anyone person) $5,000
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $ None
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO " (Ea accident)
- ill ~ m ~n\YJ a~ ,ill
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- I 3 2JTIij (Per accident) $
NON-OWNED AUTOS
-
- --.J PROPERTY DAMAGE $
.It:lY m ('I ~,\P~::,;r:: ., (Per accident)
GARAGE LIABILITY rUt3111 WOnKS AD"',,;',iS iJ11~1J'I1If'A/ AUTO ONLY - EA ACCIDENT $
=j ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS(UMBRELLA LIABILITY EACH OCCURRENCE $6,000,000
A =:J OCCUR D CLAIMS MADE CGL0494785 12/31/02 12/31/03 AGGREGATE $
$
~ DEDUCTIBLE $
X RETENTION $0 $
WORKERS COMPENSATION AND X IT8~i~I~Ws I IO~~-
B EMPLOYERS' LIABILITY 21WEGD6020 03l10/()2 03 /:1. 0 /()3 $5,000,0.00
AN.Y.EROPRIETOR/PARTNER/EXECUTlVE E.L. EACH ACCIDENT
" "- '. .-- _.- ' ,. ".
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $ 5,000,000
~~~~I~tS~~~v~~?6~s below E.L. DISEASE - POLICY LIMIT $5,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is named as 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
CANCELLATION
CITY OF CLEARWATER
Attn: Mr, Earl Barrett Real
Estate Service Manager
P,O, Box 4748
Clearwater FL 33758-4748
CITYOCW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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, ITS AGENTS OR
ACORD 25 (2001/08)
Nanc
._----._~,
@ACORDCORPORATION 1988