CERTIFICATE OF LIABILITY INSURANCE
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SANDBERGEN INS
7274469147
p.1
ACORD
'Ill
ERTIFICATE OF LIABILITY INSURANCE
PRODUCER < 7 27) 442 -0012 F
Sandbergen Insurance, Inc,
2121 N,E. Coachman Rd.
Clearwater, FL 33765-2616
(727)446-9147
DATE [MMlDDIYY)
05/01/2001
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BelOW.
INSURERS AFFORDING COVERAGE
Marina Restaurant
Thomas C. . Patricia Wolkowsky
25 Causeway Boulevard
Clearwater Beach, FL 33767-2064
Service Insurance COfipany
INSURER A;
ItlSURER B:
INSURER C:
INSURER D:
INSURER E;
THE POLICIES OF INSURANCE LISTED BELOW HAVE BE8'llSSUt:D TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOD INDICATED. NOlWlTHSTANDING
~Y REQUIREMENT, TERM OR CONOmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
I.AAY PERTAIN. THE INSURANCE AFFORDED BY 1HE POLICIES DESCRIB8J HEREIN IS SUBJECT TO ALl THE TERMS. EXCLUSIONS AND CONDI1lONS OF SUQ-l
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCSD BY PAID ClAIMS.
I'LT'R TYPE OF INSURANCE POUCY NUll'8ER DATE (MtNDllI'fTl DATE (MM/ODIYY) UMlls
GENERAL LIABlUTY ~"P501339 04/01/2001 04/01/2002 EACH OCCUflRENC~ S 500,000
I--
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) S 500,000
:.J CLAIMS IMDE 0 OCCUR MED EXP (Any or... """,on) S 1000/10000
-
A PERSONAL &ArN INJURY S 500,000
GENERAl AGGREGATE S 1,500,000
-
GEN"lAGGREGATE liMIT APPLIES PER: PROOUCTS.C~PAGG S 1,500,000
I POUCY n ~i n Loe
AlJT()MOBllE UABILlTY COM8li'1ED SINGLE UNIT S
I-- lEa Itddent)
mv AUIO ... - .
-
ALL OVlNED AUTOS BOOlL y I~URY
- (p",~) S
SCHEDULED "'UTOS
-
HIRED AUTOS BODILY INJURY
- (Pel ac::idenl) S
NOII-OWNEO AUTOS
-
- PROPERTY DAMAGE S
(Per Icx:idenl)
GARAGE LU>.BILITY AUTO ONLY - EAACCIDENT S
R ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG S
EXCESS lIABILITY EACH ~URRENCE $
=:J OCCUR o CLAIMS MADE , AGGREGATE $
S
==i DEDUCTIBLE S
RETENTION S .
WORKERS COMPENSATION AND TrORYLMiTS I IVar
EJo(PLOYERS' UABlUTY E.L EACH ACCIDENT S
E.L DISEASE. EA EMPLOYEE S
E.L DISEASE - POUCY LMlT $
OTHER
DESCRIPTION OF OPERATIONS/LOCA T10NSIVEHlCl.ESIEXCLUSIONS ADDED BY ENOORSEll\ENTISPECIAL PROV1Sl0~
CERTlFICATE HOLDER I X -1 ADDITIONAL INSURED; INSURER LElTER A CANCELLATION
SHOULD ANY OF ruE NJ(NE DESCRIBED POLICIES BE CANCELLEtl BEFORE TliE
EXPIRATION DATE THEREOF, T'tE ISSUING COtol'Ai'lY WILL EHDEAVOR TO MAL
City of Clearwater .JJL "'''S """''' """" '0 TIE ''''''&t''' nE ,m,
Marine. Aviation Department BUTFAlLUFlETOM41l~~~.IM ENOO IGA ORUAIlIUlY
2S Causeway Boulevard OF ANY KIND UPON THE P - Grt- S R RE ESENT S.
Clear"ater Bea~h, FL 33767 AUTliORlZED REfR ~. K. "/a..N .A ~
Steven Sandberqen ,'- oy( J'
.~~ . (lI!JT) FAX: (727)462-6957 V~ .... -1988
COVERAG S