CERTIFICATE OF LIABILITY INSURANCE (3)
Apr' 03 02 09: 15a
SANDBERGEN INS
7274469147
p. 1
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE IMMlDDIYY)
111 04/03/2002
PRODUCER (727)442-0012 FAX (727)44' 9147 1"'::; "'CKlIr-I~AII: I~ A MATtER OF
S~ndbergen Insur~nce, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
2121 '-I.E. COachman Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater, Fl 33765-2616 INSURERS AFFORDING COVERAGE
INSURED Marina Restaurant INSURER A: Service Insurance Company
Tholl~s & Patr-icia Wolkowsky INSURER s:
25 Causeway Bouevard INSURER c:
Clear-water Be~ch, FL 33767 INSURER 0:
I INSURER E:
COVERAGES
THE POLICIES OF I\JSURANCE 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 AFFOROED 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.
'~ TYPE OF INSURANCE POUCY HUUBER DATE (MWoorrir DATE (MMiDDIYYJ UMITS
GENERAL LIABILITY I5MPS01339 04/01/2002 04/01/2003 EACH OCCURRENCE S 500.000
I---
X COMMERCIAL GENERAL LlAllrLITY FIRE DAMAGE (Anyone lire) $ SOO,OOO
- ~ CLAIMS MADE 0 OCCUR
MED EXP !Anyone person) S 1.000
I-..- PERSONAL & ADV IllJlJRY
A S 500,000
GEl'lERAL AGGREGATE $ l,SOO,OOO
GEN'L AGGREGATE LII\IIIT APPLIES PER: PRODUCTS. COMPIOP AGG $ 1,500,000
I POLICY n ~~ r4-lOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f...- lEa accident) S
ANY AUTO
-
ALL OWNED AUTOS B-:>Dll Y INJURY $
I.- (Per person)
SCHEDULED AUlOS
I...-
HIRED AUTOS aoDIl Y IN.lJRY
I-- (Per accident) $
NON.QWNED AUTOS
-
PROPERTY DAMAGE $
(Per aCCider.\l
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
RANY AUTO OrnER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABIUTY EACH OCCURRENCE $
=:J OCCUR o CLAIMS MADE AGGREGATE S
$
R IDEDUCTIBlE $
RETENTION $ S
WORKERS COMPENSATION AND I TORY LIMITS I ~
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
E.L DISEASE. EA EMPLOYEE $
EL DISEASe - POLICY LIMIT $
OTHER
DESCRIPTION OF Ol'ERATIONSlLOCATlOHSlVEHlCLESlEXCWSJONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER I X I ADDJ110HAL INSURED; INSURER lETTER A CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEll POLICIES BE CAllCELLEO BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIU EN~R TO MAIL
City of Clear-water -'JL ""'''' ""'"" """" ro F""'''' "'.Jl"" :;i' ro n.. '"",
Marine & Aviation Department BUT FAILURE TO MAIL s~~c '~OBU I OR LIABILITY
25 Causeway Boulevard OF ANY KIND UPON THE C i>,vl AGE PRES T ..
Clearwater Beach. FL 33767 AUTHcrRIZEO REPRESENTAr ~ Uh~
Steven SlIIndberge
'1m", FAX; 462 6957 111llll