CERTIFICATE OF INSURANCE FOR RENTAL OF BEACH UMBRELLAS CHAIRS AND FOOTSTOOLS (8)
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER PHONE 813-796-6666 COMPANY
Acordia SE, Central Fla Divsn
P.O. Box 31666
Tampa, FL 33631-3666
Interstate Fire & Casualty
SUB CODE:
BEA22770
Alexandra of Clearwater Beach
Inc. dba Pier 60 Concessions
1 0 Pier 60 Drive
Clearwater FL 33767-
EFFECTIVE DATE
2/15/98
POLICY NUMBER
051022717
EXPIRATION DATE
2/15/99
CONTINUED UNTIL
TERMINATED IF CHECKED
LOAN NUMBER
THIS REPLACES PRIOR EVIDENCE DATED:
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LOCATION/DESCRIPTION
10 PIER 60 DRIVE
CLEARWATER BEACH, FL 33767
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COVERAGE/PERILSIFORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
BUILDING
CONTENTS
SPECIAL FORM EXCLUDING WIND
REPLACEMENT COST
300000
71450
2500
2500
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THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
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NAME AND ADDRESS MORTGAGEE ADOITIONAL INSURED
CITY OF CLEARWATER, A MUNICI-
PALITY, % CITY ATTY'S OFFICE
P. O. BOX 4748
....~
LOSS PAYEE
LOAN #
813-796-6666 THIS CERTIFICATE I ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS C~TIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COV RAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Acordia SE, Central Fla Divsn
P.O. Box 31666
Tampa, FL 33631-3666
COMPANY
A
ESSEX INSURANCE CO
INSURED
COMPANY
D
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THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Alexandra of Clearwater Beach,
Inc. dba Pier 60 Concessions
1 0 Pier 60 Drive
Clearwater Bch FL 33767
COMPANY
B
COMPANY
C
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE CMMIDDNYl DATE CMMIDONYI
LIMITS
A GENERAL LIABILITY BIND290676
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0 OCCUR
OWNER'S & CONTRACTOR'S PROT
2/1 5/98
2/15/99
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE IAny one fire)
MED EXP (Anyone person)
1000000
INCLUDED
1000000
1000000
50000
5000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREO AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
IPer accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY
UM8RELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILlTY-
EACH OCCURRENCE
AGGREGATE
$
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
EL DISEASE - POLICY LIMIT
EL OISEASE - EA EMPLOYEE
DESCRIPTION OF OPERATlONSILOCATIONSNEHICLESISPECIAL ITEMS
RENTAL OF BEACH UMBRELLAS, CHAIRS & FOOTSTOOLS.
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS ADDITIONAL INSURED
AS RESPECTS GENERAL LIABILITY COVERAGE.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER A MUNICIPAL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
C/O CITY ATTORNEYS OFFICE ---1Q.. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
P.O. BOX 4748 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION DR LIABILITY
CLEARWATER FL 33758 OF KIND UPON AGENTS OR REPRESENTATIVES.
, AUTH IZ a:ENTA, 7f /1
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