CERTIFICATE OF LIABILITY INSURANCE (8)
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CERTIFICATE OF LIABILITY INSURANCE
PAGE eJ2
DATE (MM/DDIYY)
JAN 23 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON TH~ CERTIFICATE
HOLDeR, THIS CeRTIFICATE DOES NOT AMEND, EXTEND OR
ALTER 'THE COVERAGE AFFORDED BY THE POLICIES BELOW,
PRODUCER
MOORE & MOORE INSURANCE AGENCY
801 8TH AVE. WEST
~ALMETTO FL 34221-5116
PHONE: 941-722-3238
FAX: 941-723-1785
A enc LiC#: A183018
INSURERS AFFORDING COVERAGE
IIIAIC#
INSURED
SILVER DOLLAR TRAP CLUB, INC.
12601 SilVER DOLLAR DRIVE
ODESSA FL 34556
INSURER A: Auto Owners Insurance Campan
INSURER B:
INSURER C:
INSURER D:
INSURIOR E:
COVERAGES
THI: POLICIES OF INSURANCE L1Sil:o BELOW HAVe elEEN ISSUED TO THE INSURED NAMI:D ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY ~EQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATI: MAY BE ISSlIED OR
MAY PERTAIN, THe INSURANCE AFFORDI:D 9Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E);CLUSIONS ANO CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAJMS,
INS 'NPE OF INSURANCI: poucy NUMBER ~~~~ P~~;:,::'~~ LIMITS
~T~
GENIORAL LIABILITY 904612-20409507-04 JAN 29 04 JAN 29 05 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~e TO ReNTED S 50,000
I CLAIMS MADE I~ OCCUR MED, r=XP (Any One PersQn) :& 5,000
A PERSONAL 8. ADV INJURy $ 1,000,000
- GENERAL AGGREGATE $ 1,000,000
'GE;.,'L AGGREGATE LIMIT APPLIES PI:R: PRODUCTS-COMP/OP AGG, S; 1,000,000
I POLICY n ....n..""T n I Or'
AUTOMOBILE LIABILITY COMBINED SINGle LIMIT
- fEa accid..nl) $
ANY AUTO
- ALL OWNED AUTOS 800lL Y INJURY
- (Per pereon) $
I--- SCHEDULED AUTOS
HIRED AUTOS 800lL Y INJURY
r-- (Per acadent) $
NoN-OWNED AUTOS
t--
- PROPERTY DAMAGe $
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=J ANY AUTO OTI-lER THAN EA ACC $
AUTO ONLY: AGG S
=~~t3SI UMBERELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
S
~ DI:DUCTI9LE $
RETENTION $ :Ii
WO~KERS COMPENSATION AND I we STATU- I lOTHER
I TO"V I MITS
I:MPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EJlECUTIVE
OPP'CERlMoMeER El(eLUQ~~l E.l. DISEASE-EAEMPLOYEE $
Ir ye:s. describe und.t E,l. OISEASE.POLICY LIMIT
SPECIAL PROVISIONS .01_ S
OTHER:
--... ~...^'.~u~,,_. .. ,
,...., IC (jiJ r? n l\r1 I,' j"'''', i
DESCRIPTION OF OPl:RATIOIIIS/lOCATIONNEHIClES/EXCLUSIONS AOOEO ENDORSEMENTI SPEC lfJ ..!d.. J1 ~~ ~H'111
CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED AS IT PERTAINS TO: PART OF THE SOUTHEJ T- OF SECTION 19, TOWN1. "Mf7
SOUTH, RANGE 17 EAST, HILLSBOROUGH COUNTY, FLORIDA Jl Jl\N 2 6 2:ifl! J LJ
'---CiTY.OF Cl[M~.^7~'IER
CERTIFICATE HOLOER I I ADDITIONAL INSURED; IN6URER LETTER: CANCELLA TION :J..~,':'-L . " ':"~...
SHOULD ANY OF THE ABOVE D!::SCRIBED POLICIES BE CANCELLED BEFORE '('HE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WilL ENDEAVOR TO MAIL 10
CITY OF CLEARWATER DAYS WRITTEN NOTICE: TO THE CERTIFICATE HOLDER NAMED TO THE: LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLlGA.TION OR LIABILITY OF ANY KI/IID UPON THE
ATTN MR. EARL BARRETT REAL ESTATE SERVICES MA INSURER, ITS AGENTS 01'1 FlEPRESENTArIVES.
NAGER AUTJ.lORIZED REPRESI:NT,o,lWE
POBOX 4748 ~~~
CLEARWATER FL 33758.4748
Attention:
ACORD ~5 (:l001/0B)
Certificate # 7113
James C. Moore, Jr.
A 183018