CERTIFICATE OF LIABILITY INSURANCE (7)
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Barrett, Earl
From:
Sent:
To:
Subject:
Barrett, Earl
Monday, February 23, 2004 8:35 AM
Stephenson, Susan
insurance certificate
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FEB 23 2004
Susan -
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
Under copy of this message I will forward a copy of an additional insurance certificate I received that relates to the City
lease with Silver Dollar Trap Club. This certificate insures the interests of Encore Communities in the trap club and its
assets, The certificate is effective for coverages shown from 12/31/03 through 12/31/04, The City is additionally insured as
to Encore's interests as well as the interests of Silver Dollar Trap Club, Inc, whose certificate I sent to you earlier. That
certificate is effective 1/29/04 - 1/29/05,
1
02-20-'04 14:05 FROM-
T-756 P02/02 U-987
ACQRDm
CERTIFICATE OF LIABILITY INSURANCE
OPID N
NHCLL-1 02 20 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
PRODUCER
Alliance Insurance Brokers
7600 N. 16th St., Suite 201
Phoenix AZ 85020-4447
Phone:602-996-7600 Fax:602-494-1175
INSURERS AFFORDING COVERAGE
:NAIC#
INSURED
INSURER A:
Gulf Underwriters Insurance Co
NHC Management Company LLC
Encore Communities LLC
6991 E, Camelback # B310
scottsdale AZ 85251
INSURER B
INSURER C
Hartford Insurance Group
INSURER D:
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,
,.
POLICY NUMBER 'tii~E iMMlDDlYti)-
L TR INSRCi TYPE OF INSURANCE
LGENERAl LIABILITY
A xn '~~= ,.~.?MMERCIAL GENE7. ~L~IA.B...ILlTY
~_, _I CLAIMS MADE l.~_, OCCUR
1___
~EN'LAGGRE~~E L;Mr;.A'P~~~~PER
i 'l POLICY -I ~~gT I' : LOC
I
~~TOMOBILE LIABILITY
i ANY AUTO
GU0435697
12/31/03
DATE MMlDDNY . LIMITS
[ EACH OCCURRENCE ! $ 1, Q.<>.(),,-OOO __
'illIMI'.GETOREN I CU
12/31/04 i PREMISES (Ea occurence) L!.~QL()OO___
: MEo.EJS~(AnYOne"",-so-")J~.O() , ,., _
: PERSONAL & ADV INJU~~,_L$.1..LQQ~00o._,
:9ENERAL AGGREGAT~---1!..No~~ ..... ..___
PRODUCTS - COMPIOP AGG ! $ 2,000 , 000
"
A
BA5302051
12/31/03
12/31/04
COMBINED SINGLE LIMIT
lEa accident)
$ 1,000,000
[.-----
~_ ALL OWNED AUTOS
I.}C. SCHEDULED AUTOS
,X HIRED AUTOS
tl X- NON-OWNED AUTOS
1,-
~- ---~-------~---
!
BODILY INJURY
(Per person)
BODILY INJU RY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
~ ANY AUTO
~ESSfUMBRELLA LIABILITY
A I I OCCUR [] CLAIMS MADE CGL0495035
h DEDUCTIBLE
~'j RETENTION $ 0
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B ANY PROPRIETORIPARTNERfEXECUTIVE 21 WEGD6020
OFFICERfMEMBER EXCLUDED?
It yes, deSCribe under
SPECIAL PROVISIONS below
OTHER
i AUTO ONLY, EA ACCIDENT : $
.--------------- - -.------ -.-.. .,- .... ..---------
i OTHER THAN
AUTO ONLY:
EAACC. $
12/31/03
! EACH OCCURRENCE
12/31/04 ! AGGREGATE
AGG! $
._J~~OOO , O_~~.
, $ 5,000,000
03/10/03
I ! $
j------------.-...----1-
, : $
:$
IU~~'.
$ 500000
.-
Tb'i/t.:~I~'t I
03/10/04 I E.L. EACH ACCIDENT
i E.L. DISEASE, EA EMPLOYE~ $ 500000
i E.L. DISEASE - POLICY LIMIT i $ 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as additional insured as it pertains
part of the southeast 1/4 of section 19, township 27 south, range
Hillsborough County, Florida
.
n 1 ,-l.;...-~_. :
pY
j~ a~ 2 0 2004
,
: '
I ,,, ./
\
CITY OF CLEARWATER
,;....;^n...c'
CERTIFICATE HOLDER
CANCEllATION
CITYOCW
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 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
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
CITY OF CLEARWATER
Attn: Mr. Earl Barrett Real
Estate Service MA Nager
P.O. Box 4748
Clearwater FL 33768-4748
Gu L. Labelle
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ACORD 25 (2001108)
@ACORDCORPORATION 1988