CERTIFICATE OF LIABILITY INSURANCE (6)
~~.-~,-~- ~~;~~M ~ANU~~HGEN
INS
INC
P.Ol
DATE (MMlDOlYVVYI
04/07/2004
THI Rn Te I UED RMA
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTeND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
727 446 9147
~'ORQM
R UCER (727)442-0012
5andbergen Insurance, Inc,
2121 N.E, Coachman Rd,
Clearwater, FL 33765-2616
CERTIFICATE OF LIABILITY INSURANCE
(727)446-9147
~D Marina Restaurant
Thoma5 & Patr1ca Wolkowsky
2!) Causeway Bool evard
Clearwater Beach, FL 33767-2064
INSURERS AFFORDING COVERAGE
INSURERA: 'Service :Insurance ~ny
INSURI'R B:
INSURER C:
INSURER 0:
INSURER E:
NAIC.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED fO THE INSURED NAMED ABOVE FOR THE POliCY PE~IOD INDICATE:O. NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT~ RESPECT TO WHICH THIS CERTIFICATE MAY ElE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POliCIES DESCRIBED ~EREIN IS SUBJECT TO ALL TtiE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGMEGATE LlMlfS SHOWN MAY HAVE SEEN REDUCED BY PAlO CLAIMS,
lTR NSR TYPE OF IN5URANCE pouev NUM~ DAtE IMINDD/'fY'- DATI! IMM.ODlYY'\ LlMI1S
GENERAL LlA8ILITY SMP~01339 04/01/2004 04/01/200~ EACH OCCURRENCE S 500,OO(]
.- .
X COMMERCIAL GENERAL LIABILITY PREMISES IE;, ~Mencel S 5DO,C!~
-' h CLAIMS MADE [!J OCCUR
NED EXP IAnr one per!lOf11 S 1.00(
A X PERSONAL & ADV INJURY $ 500.00C
.-
GENERAL AGGREGATE $ 1.500.00Cl
~_.,
GEN'L AGGKEGA TE LIMIT APPllF.S PER: PRODUCTS.COUP~PAGG $ 1,~~
-, POLICY n ~ n LOC
AUTOMOBILE UABIUTV COMBINED S'NGl.E LIMIT
I-- $
ANY AuTO (Ell aa:ident)
1-,'-
ALL OWNEO AUTOS BOOIL Y INJURY
>-- S
SCtlF.DULEO AUTOS ~r perSDn)
>-- -
HI~"D AUTOS 8ODll. Y INJURY
>-- S
NON.(jWNED AUTOS (Per accldenll
f--
f-- PROP5RTY DAMAGE S
iper accIclent)
GARAGE UABlLI'N AUTO ONLY. EA ACCIOEHT S
~ ANY AUTO EA I\CC $ --
OTHER THAN
AIJTO ONLY: AGO S
EXCESSlUMBRELLA L1A8lUTV EACH OCClJRRENCE S
=:J OCCUR o CLAIMS MADE "'GGREGATE S
$
R DEDUCTleLE S
RETGNTION S S "'-
WORKERS COMPENSATION AND I TORYLIMllS 1M.
EMPLOYEAS' LIABILITY .
ANY PROPRIETORlPARTNEAiF.XECUTIVE E.L, EACH Accloem S
OFrJCERlMEMI}I;R EXCLUOED7 E,L. OISEASE . EA EMPlOYEE S
w~. dfil'ribe ul'\der "
S 'C IAL PJ<<)VISIONS below e,L, DlSEASF. . POLICY LIMIT $
OTHER SMPSOB39 04/01/2004 04/01/200S $500,000 Each Claim
A iquor Liability $500,000 Aggregate
OESCRlPllON OF OPEIlATlONS I LOCATlOIofS I VEHICLES I EXCLUSIONS ADDED BY ENDORSt;MENT I SPECIAL I'ROWilON5
CERTIFICATE HOLDER
City of CleaMNater
Marine & Aviation Department
2S Causeway Boulevard
Clearwater Beach. FL 13767
CANCELLAnON
SHOULD ANY OF T11E ABOW DI!SCRlBED POUCIES IE CAt/CELLED BEFORE THE
I!XPlltA1l0N DATE THEReOF. THI! ISSUING INSURER WILL ENOEAIII)R TO MAIL
~ DAYS WRITTEN NonCE TO THI! CI!Rlll'ICATE HOLDER N
8\JT FAlLURI! TO MAIL SUCH NO ALL IMI'Q
OF AlIlY KIND UPON AOENT
AUllIORIZEO REPR
~CORD 25 (2001108) FAX: (727)462-6957
nON 1988