CERTIFICATE OF INSURANCE FOR RENTAL OF BEACH UMBRELLAS CHAIRS AND FOOTSTOOLS (2)
::~~~ ...
PRODUCER TillS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RlGlrrS UPON THE CERTIFICATE HOLDER. TillS CERTIFICATE
Acordia SE, Central Fla Divsn DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 31666 POLICIES BEWW.
Tampa, FL 33631-3666 COMPANIES AFFORDING COVERAGE
COMPANY
A TRAVELERS/CHARTER OAK
INSURED COMPANY
B FLA RESTAURANT OWNERS
Alexandra of Clearwater
COMPANY
Beach, Inc. C
10 Pier 60 Drive
COMPANY
Clearwater FL 34630 D
:::::~~i.:::::::::::::::::::::::::::::::::::::::::I:::::::::::::::::'::I:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::m::::::::::::::::::::I::::::I::::::::::::::::::::::::::::::::::::::::::::::I::::::::::::II::::::::::::::::::::::::::::::::::::::::::::::::::::::1:::::::::::II::::::I:1:::I:::::::::::::::1111::::::::::::1:::::::::::::::::::::::::I:1::::::1::I:::::::::::::::::=:::I:I:::::t::::1:::::::::::::::::I:::::1::::=
TillS 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 WInCH TillS
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP.
LTR LIMITS
DATE (MMIDD/YY) DATE (MMIDD/YY)
GENERAL LIABILITY GENERAL AGGREGATE 2000000
A COMM. GENERAL LIABILITY I680399K4987 2/15/96 2/15/97 PROD-COMP/OP AGG. '2000000
CLAIMS MADE [1[] OCCUR PERS. & ADV. INJURY l00()()/)()
OWNER'S & CONTRACT'S PROT EACH OCCURRENCE 1000000
I--
FIRE DAMAGE(One Fire) ..nonn
I--
MED EXP(Any on. p....on) 5000
AUTOMOBILE LIABILITY COMBINED SINGLE
I--
A ANY AUTO I680399K4987 2/15/96 2/15/97 LIMIT 1000000
I--
ALL OWNED AUTOS BODILY INJURY
I--
SCHEDULED AUTOS (Per person)
nr HIRED AUTOS BODILY INJURY
"""'X' NON-OWNED AUTOS (P.r ac:ddent)
-
'-- PROPERTY DAMAGE
" ,.,
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
f-- iliiiti\tiii?iiii?iiif~i~J~~JJi~?iJtj
ANY AUTO OTHER THAN AUTO ONLY:
-
EACH ACCIDENT
-
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE 1000000
A ~~BRELLA FORM CUP506W418 2/15/96 2/15/97 AGGREGATE 1000000
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND X I STATUTORY LIMITS i~i~1;tttt;iJ!;~1rti;i;li~iiiiiJiiii!{rf
EMPLOYERS' LIABILITY
B 021 14 1/01/97 1/01/98 EACH ACCIDENT 100000
THE PROPRIETOR! R:~~ 500000
PARTNERSlE-XECUTlVE .... - -- DlSEASE.POLICYLIMIT --
OFFICERS ARE: DISEASE-EACH EMPL. 100000
OTHER
DESCRIPTION OF OPERATlONSILOCA TIONSNEillCLESfSPECIAL ITEMS
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS
ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE.
GENERAL LIABILITY COVERAGE EXCLUDES RENTAL OPERATIONS.
:'f:.:::...........::...::..:....:.."Oii'kliol1ndlt::::::::::::tt@rtf'tHl1t=f::::,::::,::::::::t:::::::::::::::=::tr:::::::::::tt==:::::t::::::t::::1,:::::::::::::=:r':::.:...::..:...:.:::.........:,:...:==~,~K~::::::::::::::::l::,r::r:::::::t::::tttrrr:::::rr:rr::::r:t::::t::t:::rrrr::::::::rr:::::::::::::::,r:::::::::::ttt:::::rr:,rr::::r:::n:::::,:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER A MUNICIPAL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENnEA VOR TO
MAIL 30 DAYS WRllTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
-
C/O CITY AITORNEYS OFFICE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
P.O. BOX 4748 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
CLEARWATER, FL 34618 A?YI;;;;&;;VE ~ >>u
'/ .
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.........
PRODUCER TIllS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TillS CERTIFICATE
Acordia SE, Central PIa Divsn DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 31666 POLICIES BELOW
Tampa, FL 3363 1-3666 COMPANIES AFFORDING COVERAGE
COMPANY
A ESSEX INSURANCE CO
INSURED COMPANY
Alexandra of Clearwater Beach, B
COMPANY
Inc. dba Pier 60 Concessions C
10 Pier 60 Drive
COMPANY
Clearwater Bch FL 34630 D
:::::ijmMijM::::::::::::::::::::::::r:::t::::tttt::::::::::::ttttt:::I::::::::::::::::::r::::::::::::rI::r:::::::tt::tt:::::r::::::::::::::::::::::::::::::::::::::::::::::rrr:::::::::::::::t::::::t:::::::::::::r:tt:rrr::::r::r::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::r:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::t::::::::::::::::::::::t:::::::::
TillS 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 WillCH TillS
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP.
LTR LIMITS
DATE (MMIDDIYY) DATE (MMIDDIYY)
GENERAL LIABILITY GENERAL AGGREGATE 1000000
A . COMM. GENERAL LIABILITY 3ANQ493 6/25/96 6/25/97 PROD-COMP/OP AGG. TNCT
CLAIMS MADE [K] OCCUR PERS. & ADV. INJURY 1000000
OWNER'S & CONTRACT'S PROT EACH OCCURRENCE 1000000
-
FIRE DAMAGE(One Fire) <:lVlnn
-
MED EXP(Aoy ooe person) 5000
AUTOMOBILE LIABILITY COMBINED SINGLE
-
ANY AUTO LIMIT
-
ALL OWNED AUTOS BODILY INJURY
-
SCHEDULED AUTOS (Per person)
- lURED AUTOS
- BODILY INJURY
NON-OWNED AUTOS (per accldeot)
-
- PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
- ......................................
ANY AUTO OTHER THAN AUTO ONLY: :.:.:.:.:.:.:.:.:.:.;.:.;.:.;.:.:.;.;.;.:.;.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.
......................................
- :::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::
EACH ACCIDENT
-
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE
=1~BRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND I STATUTORY LIMITS r)rrtr)rmmrt@ttf\rIi~
EMPWYERS' LIABILITY
-R~~~ EACH ACCIDENT
THE PROPRIETOR!
PARTNERSIEXE€UTIVE-- -- - - ---- -- .- - '- DISJ;:Mll!:-POLICY L1MIT .- - -- ___n___'_______
OFFICERS ARE: DISEASE-EACH EMPL.
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSlYEillCLESISPECIAL ITEMS
RENTAL OF BEACH UMBRELLAS. CHAIRS & FOOTSTOOLS.
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS ADDmONAL INSURED
AS RESPECTS GENERAL LIABILITY COVERAGE.
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 30 DAYS WIU1TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
-
C/O CITY ATIORNEYS OFFICE LEn, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
P.O. BOX 4748 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~ :r
CLEARWATER, FL 34618 ~
,
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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 I PHONE COMPANY
(AlC, No, Ext): 8 1 3-796-6666
Acordia SE, Central Fla Divsn TRAVELERS/CHARTER OAK FIRE
P.O. Box 3 1 666
Tampa, FL 3363 1 -3666
CODE: I SUB CODE:
~g~g~ER ID#: BEA22770
INSURED LOAN NUMBER 1 POllCY NUMBER
Alexandra of Clearwater I680399K4987
Beach, Inc.
10 Pier 60 Drive EFFECTIVE DATE I EXPIRATION DATE I CONTINUED UNTIL
10/10/96 2/1 5/97 n TERMINATED
Clearwater FL 34630 IF CHECKED.
TIllS REPLACES PRIOR EVIDENCE DATED:
I
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LOCA TIONIDESCRIPTION
10 PIER 60 DRIVE
CLEARWATER BEACH , FL 34630
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COVERAGEIPERlLSIFORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING 300000 1000
CONTENTS 100000 1000
SPECIAL FORM EXCL WIND, REPLACEMENT COST,
90 % COINSURANCE
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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 ADDmONAL INTERESI' IDENTIFIED BELOW ....2Q... DAYS
WRI'ITEN 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 ADDITIONAL INSURED
- -
CITY OF CLEARWATER A MUNICIPAL LOSS PAYEE
C/O CITY ATIORNEYS OFFICE LOAN'
P.O. BOX 4748
CLEARWATER, FL 346 1 8
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