CERTIFICATE OF INSURANCE FOR RENTAL OF BEACH UMBRELLAS CHAIRS AND FOOTSTOOLS (3)
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TIllS IS EVIDENCE TIlAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER I PHONE
CAlC, No, Ext): 813-796-6666
COMPANY
Acordia SE. Central Fla Divsn
P.O. Box 31666
Tampa, FL 33631-3666
TRAVELERS INDEMNITY CO
CODE:
AGENCY
CUSTOMER IDN: BEA22770
INSURED
Alexandra of Clearwater Beach
Inc dba Pier 60 Concessions
10 Pier 60 Drive
Clearwater FL 34630
I SUB CODE:
LOAN NUMBER
EFFECTIVE DATE
2/15/97
I
I POLICY NUMBER
I680399K4987
EXPIRATION DATE I CONTINUED UNTIL
2/15/98 r---'1 TERMINATED
I I IF CHECKED.
TillS REPLACES PRIOR EVIDENCE DATED:
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LOCA TIONIDESCRIPTION
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10 PIER 60 DRIVE
CLEARWATER BEACH. FL 34630
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COVERAGEIPERILSIFORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING
CONTENTS
SPECIAL FORM EXCLUDING WIND.
REPLACEMENT COST, 90% COINSURANCE
300000
50000
1000
1000
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INCLUDES ENERGY EQUIPMENT COVERAGE
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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 --..l2- DAYS
WRI'ITEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY TIlAT WOULD AFFECT TIlAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
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NAME AND ADDRESS
MORTGAGEE
ADDITIONAL INSURED
CITY OF CLEARWATER, A MUNICI-
PALITY. % CITY ATIY'S OFFICE
P.O. BOX 4748
CLEARWATER, FL 34618
-
-
LOSS PAYEE
LOANN
AUTH~~D.. REPRES~TATIVE /"") ... n
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DATE (MMIDDIYY)
03/10/97
Acordia SE, Central Fla Divsn
P.O. Box 31666
Tampa, FL 33631-3666
TillS CERTlFlCA TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGIITS UPON THE CERTlFlCA TE HOLDER. TillS CERTIFlCA TE
DOES NOT AMEND, EXTEND OR ALTER TIlE COVERAGE AFFORDED BY THE
POLICIES BELOW.
PRODUCER
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY
A TRAVELERS INDEMNITY CO
COMPANY
Alexandra of Clearwater Beach
Inc dba Pier 60 Concessions
10 Pier 60 Drive
B
FLA RESTAURANT OPERATORS
COMPANY
c
Clearwater
FL 34630
COMPANY
D
TillS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIlE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WillCH TillS
CERTIFlCA TE MAYBE 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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF. POLICY EXP.
DATE (MMIDDIYY) DATE (MMIDDIYY)
LIMITS
A
COMM. GENERAL LIABILITY
CLAIMS MADE [X] OCCUR
OWNER'S & CONTRACT'S PROT
I680399K4987
2/15/97
2/15/98
GENERAL AGGREGATE
PROD-COMP/OP AGG.
PERS. & ADV. INJURY
EACH OCCURRENCE
FlRE DAMAGE(One Fire)
MED EXP(Any one person)
5000
GENERAL LIABILITY
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X illRED AUTOS
X NON-OWNED AUTOS
I680399K4987
2/15/97
2/15/98
COMBINED SINGLE
LIMIT
1000000
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY -EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EXCESS LIABILITY
A X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
CUP506W418
2/15/97
2/15/98
EACH OCCURRENCE
AGGREGATE
1000000
1000000
X STATUTORY LIMITS
B
02114
1/01/97
1/01/98
EACH ACCIDENT
100000
500000
100000
THE PROPRIETOR!
n' PARTNERslIixECUrIVE
OFFICERS ARE:
-INCL-
EXCL
.. ..
DISEASE-POLICY LIMIT
DISEASE-EACH EMPL.
OTHER
DESCRIPTION OF OPERA TIONSILOCA TIONSNEffiCLES/SPECIAL ITEMS
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS
ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE.
GENERAL LIABILITY COVERAGE EXCLUDES RENTAL OPERATIONS.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, TIlE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITIEN NOTICE TO TIlE CERTlFlCA TE HOLDER NAMED TO THE
LEFI', BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON TIlE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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CITY OF CLEARWATER, A MUNICI-
PALITY, % CITY A'ITY'S OFFICE
P.O. BOX 4748
CLEARWATER. FL 34618
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