CERTIFICATE OF LIABILITY INSURANCE (4)
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SANDBERGEN INS
7274469147
--
T>lE POLICIES OF _E LISTEn BEJ.ow HAVE BEEN ~SUED TO THe IH8I""" ....ED AaOVe FDA THE FOLlCY PEROOO "''''''''EO. NOTWmisTAND'HG
ANY REQUlRE"ENe. TERM OR CONDm", OF ANY CONnlAcr OR 0""" """"'ENr "'fH REsPECT TO ''"'"" ,",s cau'RC.". MAY BE 'SS""D OR
MAY PERTA"". THE lNSURANcE AFFORoEO BY THE POlJCJES OES"",BEO""",, ~ sua.ecr TO ALl. fHE TERMs. EXClUsr"", AND C"""mONS OF SUCI<
POlICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS.
I'l't: TYPE OF INSURANCE FOUCY NUMBER COATE (MM/DllIYY) DATe (MMID~ lIMrrs
GeNERAL LIABILITY PPS3 77 3$020 04/28/2002 04/28/2003 EACH OCCURRENCE S 500,000
f-- COMMERCIAl. GENERAL UABII.ITY FIRE DAMAGE (Any 0.1& fire) $
X 500,000
I--- tJ CLAIMS MADE CD OCCUR MED EXP (Any DIle person) S
10,000
I--- PERSONAL & ADV INJURY S
A 500,QOO
f-- GENERAl AGGREGATE S
1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS. COMPIOP AGG S 1,000,000
n POLICY n m?i n lOC
AUTOMOBILE UASrLITY COMS/NED SINGLE LIMiT $
f-- ANY AUTO (Ea aCcident)
f-- ALL OWNeD AUTOS
BOOIL Y INJURY
f-- (Per P8t'&0n) S
SCHEDULED AUTOS
f-- HIRED AUTOS
BODILY INJURY $
~ NON-OWNED AUTOS (I>"'_enl)
I--
PROPERTY DAMAGE $
(Per aCCident)
GARAGE UA8IUTY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG S
aCESS lJABlLITV EACH OCCURRENCE $
b OCCUR o CLANS MADE AGGREGATE $
$
R IDEDUCTJBLE $
RETENTION $ $
WORKERS COMPENSAnON AND I fORY lltrrs I rik....
EMPLOYERS' LIA8lUTY E.L. EACH ACCIDENT $
.
EL DISEASe. EA EMPLOYEE $
E.L. DISEAse. POLICY LIMIT $
OTHER
DESCRIPTION OF OPEAAnONSIlOCAnONSlVEHICLES/E:xCLUSIONS ADDED BY eNDORSEMEHfISPECIAL PROVISIOHS
CERTIFICATE HOLDER I X I ACDmONAL INSURED; INSURER LETTER !\ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRJBfO POUClES Be CANCELLED BEFORE THE
ElCPlRATlON DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Clearwater - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER N4MED TO THE LEFT,
BlJT FAILURe TO MAIl.. SUCH NonCE SHALL IMPOsE NO OBUGATIOH OR IJABlUTY
Marine & AViation Department OF ANr KJNDU~~E COMPANY. ITS AGENTS OR ~NTAii~ES.
2~ Causeway BOUlevard
Clearwater Beach, FL 33767 AUTHORIZED R ./IATIYE~
J f
"",",UI<U ., !/ ,"oc
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (Ml./IDoIvyi
1M OS/01/2001
PRODUCER (727) 442 - 0012 FAX (727)446-9147 ~ nI;:) . ~"".'3UI:U . ':'"
Sandbergen Insurance, Inc. ONt Y AND CONFERS NO RIGHTS UPON THE CERnFICA TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2121 N.E. Coachman Rd. AL fER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater, Fl 33765-2616 INSURERS AFFORDING COVERAGE
INSURED Pirates Pantry INSURER A: Zurich Insurance Co.
Thomas, Patricia Wolkowsky dba INSURER B:
2S Causeway BOUlevard, 14 INSURER C:
Clearwater Beach, FL 33767-2000 INSURER Do
_I INSuRER E;
p. 1
COVERAGES
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