CERTIFICATE OF INSURANCE (3)
PRODUCER TffiS CERTlf1CATE IS ISSUED AS A MATTER OF INFORM A TION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. TInS CERTlf1CATE
Acordia SE. Central Fla Divsn DO::~o;{ AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 31666 POI 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. e
10 Pier 60 Drive
COMPANY
Clearwater FL 34630 D
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TffiS 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 CONDmONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WffiCH TffiS
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 (MMIDDIYY)
GENERAL LIABILITY GENERAL AGGREGATE ?nnnnoo
A COMM. GENERAL LIABILITY I680399K4987 2/15/96 2/15/97 PROD-COMP/OP AGG. ?nnnoon
CLAIMS MADE [X] OCCUR PERS. & ADV. INJURY 1000000
OWNER'S & CONTRACT'S PROT EACH OCCURRENCE 1000000
-
FIRE DAMAGE(One Fire) ..noon
-
MED EXP(Any one person) 5000
AUTOMOBILE LIABILITY COMBINED SINGLE
-
A ANY AUTO I680399K4987 2/15/% 2/15/97 LIMIT 1000000
-
ALL OWNED AUTOS BODILY INJURY
-
SCHEDULED AUTOS (per person) ....
"""'X" HIRED AUTOS BODILY INJURY
"""'X" NON-OWNED AUTOS (per accldent)
-
- PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
- jrI~jttttttrtrrr1rrtr~
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 X1STATUTORY LIMITS mmmmrmmmmrrritt1tttrrij}
EMPLOYERS' LIABILITY
B 021 14 1/01/97 1/01/98 EACH ACCIDENT 100000
THE PROPRIETOR! -RINCL .. :500000
PARTNERS/EXECUTIVE EXCL f- - - DISE-ASE.POLICYLIMIT- - - I....
OFFICERS ARE: DISEASE-EACH EMPL. 100000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEffiCLESISPECIAL ITEMS
THE CITY OF CLEARWATER A MUNICIPALrry IS NAMED AS
ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE.
GENERAL LIABILITY COVERAGE EXCLUDES RENTAL OPERATIONS.
'::::::.::::""""':::':'::':""::"'::"::::,:"'::;"'":""""""(":""":"::"'"/"""::'"""::"""\ttt:m:::::":::::rrt:rtt:r:tttt:::::tt::::::::r::t:tr::::t::tt::::::::m:t::::::::::::::::::::t:::":::""""':.":."":":::"..---.-":,:""':,,:r~~:;;;~:::,::t:rr,:::t,t::::::t::tr)tttttttt::::::'::":::':':::':::t:':':':'t,,':::':tttttmttt:tt)t::::::::::::::::::::':::ttrrtt't':"
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 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
-
C/O CITY ATTORNEYS 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 AZ9I;;;;&;~ ~ ?]v
.
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...................................................................................................
DATE (MMIDDIYY)
01117/97
PRODUCER TlUS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIDS CERTIFICATE
Acordia SE, Central Fla Divsn DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 31666 POLICIES BELOW
Tampa, FL 33631-3666 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
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TIDS 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 WIDCH TIDS
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 X COMM. GENERAL LIABILITY 3ANQ493 6/25/96 6/25/97 PROD-COMP/OP AGG. INrI.
~~tt~~~~r I CLAIMS MADE [j] OCCUR PERS. & ADV. INJURY lllOlUlOO
OWNER'S & CONTRACf'S PROT EACH OCCURRENCE 1000000
-
FIRE DAMAGE(One F1re) 'iIlOOO
-
MED EXP(AD1 one penon) 5000
AUTOMOBILE LIABILITY COMBINED SINGLE
- ANY AUTO LIMIT
-
ALL OWNED AUTOS BODILY INJURY
- SCHEDULED AUTOS (Per person)
-
IllRED AUTOS BODILY INJURY
- NON-OWNED AUTOS (per ac:ddent)
-
- PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
- tfrrrffr1~?rrtiiijjfm~r1jjjt~
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 ::::;:::;:::::::::::::;:;:;:;:;:;:;:;:;:;:;:::::::::::::::::::::;:;:::;:::::
EMPLOYERS' LIABILITY :;:::::;:::;:;:::;:;:;:;:;:;:;:;:;:;:;:::::::::::::::::::::::::::;:;::::::::
EACH ACCIDENT
THE PROPRIETOR! -R~~
PARTNERSIEXE€UTlVE-- - -- . -- - -" - ----- -- -- --- . -- -. DISji:AS.E-"POLlCY L~IT -- - -
OmCERS ARE: DISEASE-EACH EMPL.
OTHER
DESCRIYI10N OF OPERA TIONSILOCA TlONSlYEIDCLESISPECIAL ITEMS
RENTAL OF BEACH UMBRELLAS. CHAIRS & FOOTSTOOLS.
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS ADDITIONAL 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 WRI1TEN NOTICE TO THE CEIlTlFlCA TE HOLDER NAMED TO THE
-
C/O CITY ATIORNEYS 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.
AUTHORIZED REPRESENTATIVE ~ :r
CLEARWATER. FL 34618 ~
,
"I
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TIllS 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): 813-796-6666
Acordia SE, Central Fla Divsn TRAVELERS/CHARTER OAK FIRE
P.O. Box 3 1666
Tampa, FL 33631-3666
CODE: I SUB CODE:
AGENCY BEA22770
CUSTOMER IDN:
INSURED LOAN NUMBER I POLICY NUMBER
Alexandra of Clearwater I680399K4987
Beach, Inc. I I
10 Pier 60 Drive EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL
10/10/96 2/15/97 n TERMINATED
Clearwater FL 34630 IF CHECKED.
THIS REPLACES PRIOR EVIDENCE DATED:
I
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LOCA TIONIDESCRIPTION
10 PIER 60 DRIVE
CLEARWATER BEACH, FL 34630
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COVERAGEJPERlLSIFORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING 300000 1000
CONTENTS 100000 1000
SPECIAL FORM EXCL WIND, REPLACEMENT COST,
90% COINSURANCE
mRJiM'Amt$i::.:.:.::::::::..:::::::.....:::::::::r...:::::::::::...:::...::::.::.:::::::::::.....:.:...:::::::::::':::::::::::::::::::::::g:::t:::ffr:::::tl:::::::::::t::trrtt::::::::::::::::::f:::::ti:trr::::::::::::ttti:i:r:::::::i:)tttttt::tttttttttttttmrittfmmttttiritttttttitr:m::iii::i::ii:i:i::itm:it:itt::t:ttttmrrr
INCLUDES ENERGY EQUIPMENT COVERAGE.
-.. -- - -.------ ---'---- ----- _._-~--- ',,- ------------ -.- - - ~~.<- " -' --c- " ------ .." ._, ---- - .- - - , ----- ." -' - --.-- ,- - " -, ---- - '- --.-- - -- - -
t~Ml.o.S::::::::::::t:::::::::it:t::tmJ:tti:::ttit:::i:i:::::::::t::::tf:::t:::::i:::t:::t:::::j:ti:f::i:i:::mi:::{t:W:::::ti:l:::::1.:l::::::::I:ir:::::i:::i:i:::::::::ttttttf::::tiJ:ttf::t::ttit:::::tttiJJt:::t::t::ttitJ:ftf::::::::tft:::::::::rtJJt:tttt::::::::::i:::i:ttltm:::ttftmJ
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 INTEREST IDENTIFIED BELOW --1Q.... DAYS
WRITIEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITII THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
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NAME AND ADDRESS MORTGAGEE ADDmONAL INSURED
I-- -
CITY OF CLEARWATER A MUNICIPAL LOSS PAYEE
C/O CITY ATTORNEYS OFFICE LOANN
P.O. BOX 4748
CLEARWATER. FL 34618
AL'M~P';:AJVE ~. ~
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