CERTIFICATE OF INSURANCE (5)
PRODUCER
Acordia SE, Central Fla Divsn
P.O. Box 31666
Tampa, FL 33631-3666
TInS CERTIFlCA TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON TIlE CERTIFlCA TE HOLDER. TInS CERTIFlCA TE
DOES NOT AMEND, EXTEND OR ALTER TIlE COVERAGE AFFORDED BY TIlE
POLICIES BELOW.
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
COMPANY
D
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Clearwater
FL
34630
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TInS IS TO CERTIFY THAT TIlE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIlE INSURED NAMED ABOVE FOR TIlE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTIlER DOCUMENT WITH RESPECT TO WInCH TInS
CERTIFlCATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TIlE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIlE 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
A COMM. GEl'iERAL LIABILITY I680399K4987 2/15/97 2/15/98 PROD-COMP/OP AGG.
CLAIMS MADE [K] OCCUR PERS. & ADV.INJURY
OWNER'S & CONTRACT'S PROT EACH OCCURRENCE
f--
FlRE DAMAGE(One Fire)
f--
MED EXP(Any one person)
AUTOMOBILE LIABILITY COMBINED SINGLE
f--
A ANY AUTO I680399K4987 2/15/97 2/15/98 LIMIT
f--
ALL OWNED AUTOS BODILY INJURY
f--
SCIlEDULED AUTOS (Per person)
f--
X InRED AUTOS BODILY INJURY
f--
X NON-OWNED AUTOS (per accident)
f--
f-- PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
f--
ANY AUTO OTIlER THAN AUTO ONLY:
f--
EACH ACCIDENT
f--
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE
A M~BRELLA FORM CUP506W418 2/15/97 2/15/98 AGGREGATE
OTIlER THAN UMBRELLA FORM
WORKERS COMPENSATION AND X I STATUTORY LIMITS
EMPLOYERS' LIABILITY
B 02114 1/01/97 1/01/98 EACH ACCIDENT
~- !1IE"l'l\C)PRIETOBl ~--- RINCL~ .. ~ - DISEASE-POLICY LIMIT
PARTNERSIEXECUTIVE
OFFlCERS ARE: EXCL DISEASE-EACH EMPL.
OTIlER
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1 ()()O()()()
1 ()()()()()O
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5000
1000000
1000000
1000000
100000
500000
100000
DESCRIPTION OF OPERA TIONSILOCA TIONS/VEInCLES/SPECIAL ITEMS
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS
ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE.
GENERAL LIABILITY COVERAGE EXCLUDES RENTAL OPERATIONS.
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SHOULD ANY OF TIlE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIlE
EXPIRATION DATE TIlEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRllTEN NOTICE TO TIlE CERTlFlCA TE HOLDER NAMED TO TIlE
LEFf, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON TIlE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AY~'/&~J ~
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CITY OF CLEARWATER, A MUNICI-
PALITY, % CITY ATTY'S OFFICE
P.O. BOX 4748
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
(A/C, No, En): 8 1 3-796-6666
Acordia SE, Central Fla Divsn TRAVELERS INDEMNITY CO
P.O. Box 3 I 666
Tampa, FL 3363 1 -3666
CODE: I SUB CODE:
AGENCY
CUSTOMER 10#: BEA22770
INSURED LOAN NUMBER I POLICY NUMBER
Alexandra of Clearwater Beach I680399K4987
Inc dba Pier 60 Concessions
10 Pier 60 Drive EFFECTIVE DATE I EXPIRATION DATE I CONTINUED UNTIL
2/ 1 5/97 2/ 15/98 n TERMINATED
Clearwater FL 34630 IF CHECKED.
TIDS REPLACES PRIOR EVIOENCE DATED:
I
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LOCA TIONIDESCRIPTION
10 PIER 60 DRIVE
CLEARWATER BEACH, FL 34630
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COVERAGEIPERILSIFORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING 300000 1 000
CONTENTS 50000 1 000
SPECIAL FORM EXCLUDING 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 ADDITIONAL INTEREST IDENTIFIED BELOW --1Q.. 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 ADDITIONAL INSURED
CITY OF CLEARWATER. A MUNICI- - ~
LOSS PAYEE
P ALITY. % CITY ATTY' S OFFICE LOAN#
P. 0 BOX 4748
CLEARWATER, FL 346 1 8
AUTH~DREPRESEJI!TATIVE ."'} L. " /~-
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