CERTIFICATE OF LIABILITY INSURANCE (10)
--ACORD
TM.
CERTIFICATE OF LIABILITY INSURANCE
IDA TE (MM/DD/YYYY)
, JAN 17 05
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
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
MOORE & MOORE INSURANCE AGENCY
601 8TH AVE. WEST
PALMETTO FL 34221-5115
A ency LiC#: A183018
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
SILVER DOLLAR TRAP CLUB, INC.
12601 SILVER DOLLAR DRIVE
ODESSA FL 34556
INSURER A: Auto Owners Insurance Company
INSURER B:
INSURER C:
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.
INSR ADD.L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSR[ DATE IMMIDDNYI DATE /MM/DDNY
GENERAL LIABILITY 904612-20409507-05 , JAN 29 05 JAN 29 06 EACH OCCURRENCE $ 1,000,000
~...."'... G"'''' ,..,,,e i DAMAGE TO RENTED $ 50,000
CLAIMS MADE[~J OCCUR MED. EXP (Anyone person) $ 5,000
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 I PROJECT I LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I~ (Ea accident) $
ANY AUTO
I~
ALL OWNED AUTOS BODILY INJURY
-- (Per person) $
SCHEDULED AUTOS
I~
HIRED AUTOS BODILY INJURY
I~ $
NON-OWNED AUTOS , (Per accident)
I~ I PROPERTY DAMAGE
I~ $
I (Per accident)
GARAGE LIABILITY I
~UTO ONLY - EA ACCIDENT $
I~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: Ar.r. $
EXCESS / UMBRELLA LIABILITY I EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
1==1 DEDUCTIBLE $
. n~T~NTION $ ....._ ... ..._ ..... -- ... - -. .. - . $ '-
WORKERS COMPENSATION AND I ;rv~I>~~~;'Y':~ I I OTHER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $
tf yes, describe under EL DISEASE-POLICY LIMIT
SPECIAL PROVISIONS below I $
I OTHER: I
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
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
CITY OF CLEARWATER
ATTN MR. EARL BARRETT REAL ESTATE SERVICES MA
NAGER
POBOX 4748
CLEARWATER FL 337584748
Attention:
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
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, IT'S AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~~~
A 183018 @ACORDCORPORATION 1988
ACORD 25 (2001/08)
Certificate-# 8436