CERTIFICATE OF INSURANCE (15)
FEB-24-2003 15:18
FROM-Acardia Team XS
727 791 5428
T-513 P.OOI/002 F-186
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ACaRDIA EAST - TAMPA BAY
P.o. Box 31666
Tampa, FL 33631-3666
727-796-6666
CERTIFICATE OF LIABILITY INSURAfjCE DATI;o';/~:~
nlls CERTIFICATE IS fSSUED AS A MATTeR OF INFORMAnO~
ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICATl
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND Of
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURHl
Alexandra of Clearwater Beach,
Inc. dba Pier 60 Concessions
POBox 3337
Clearwater FL 33767
IN$URSl A:
INSURER B.
IN5UFtER C:
IN5UIlEFt D:
lNSUf\I;lle,
INSURERS AFFORDING COVERAGE
ASSOCIATED INDEMNITY CORP
COVERAGES
THE POLICIES OF INSURANCE USTB> BELOW HAVE BeEN ISSUED TO THE INSUI'ED NAMED ABOVE FOR THE POUCY PEFlIOD INDICATED. NOTWmtSTANDINI
ANY RIiQU1~MENT. TeRM OR CONDITION OF ANY CONTRACT OR OTHER COCUMENT WITH RESPECT TO WHICH THIS CEfITlFICATE MAY BE ISSUED 0
MAY PERTAIN. THE INSURANCE AF'OFIDED BY THE POLICiES DESCRI81i!O HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OFSUCI
POLICIES. AGGReGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ TVPI1 OF IN$l,IRANCE POLIGY I\IUMBEI'I I'OI.II;:Y EFFECT1VE POUCY EXPIRANN UMITS
A ~ElW. LIABILITY BIND483999 2115/03 2/1 5/04 BACH OCCUfIfliNCI; $ 1000000
X COMMI;RCIAL GIiNliFlAL UABILriV' I'll'll! DAMAGE lAny _ f1ra) $ 100000
, CLAIMS MACE W OCCUFt MID EXP IAIW one pw$Dn1 $ 5000
pEFlSONAL 10 ADV INJUFtV S 1000000
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GENERAl. AGGREOATE $ .2000000
t--
n'~ AGGREn UMIT APn PER: PRODUCT5 - eOMPIOP AGG , 200000[]
POLICY ~~ LOC
AUTOMOBILE UABIUTV COMIIINEO SINGLE LIMIT $
t-- lea 8cclllerltl
t-- AtlYAUTO
f--- AU. OWNID AUTOS BOCILY IN.JURY $
SCHlitJULED AUTOS 1f'9r peqanl
I--
t-- HIFtI!D AUTOS 1lI0DIL V INJURY
IP.,. ilCddllntl .
1Il0N.oWNliC AUTOS
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.......... PROPERTY !;lAMAGE .
IPm accideml
RARAGELIABlUTV AUTO OIllL Y . EA ACCID1i!II1' $
ANY AUTO OTHlifI THAN EA ACe $
AUTO ONLY: AGG $
I!XCDS L1AB1I.ITY EACH ocCl,llUlENCE $
~ OCCUR 0 CLAIMS MADE AOOREGATE .
$
~ ol!!~CTIBLE $
RUENTION $ .
woRKlRS COMPENSATION ANI.1 1..YJ..r.v~~I.~ I I~-
EMPLOYERS' UAIIlUTY LL EACH ACCIOliNT .
E.L DISEASE - 'iii" IiNIPLOYEE .
E.l. C15'1i1"S~ - POLICY LIMIT $
OTHiA
t1EScRlmON OF OPERATlONS/LOCATlONSJV$-IICLESJEXCWSIONS ADD1iP (IV ENDORSIiMISJ\/T/SPECIAL PROVISIONS
RENTAL OF BEACH UMBRELl.AS. CHAIRS &. FOOTSTOOLS.
THE CITY OF CLEAAWAiER A MUNICIPALITY IS NAMED AS ADDITIONAL INSURED
AS RESPECTS Gi:NERAl. LIABILITY COVERAGE.
CERTIFICATE HOLDER I I ADDITlONAL INSUREO: Jl\/eURER LETT1iI: CANCELLATION
CITY OF CLEARWATER I$HOULD ANY Of THt!! ABOVE DESCRIEII!D JICIUCIES Ii CANCBJ.m BEFORE THE EXPIIUl
DATE THEREOf'. THE ISSUING IN$l.lFtER WIll ENtIliAvOR TO MAIL ~ DAYS WRT
25 CAUSEWAY BLVD. NOTICE TO THE CI!R'I'lFICATE HOI,bSt NAMED TO THE LEFT. IllIT FAIWRE TO 00 SO 6-
CLEARWATER, FL33767 IIlllPOSI! NO OIlUGAT1ON OR UAIlII.ITY 0.. ANY KIND UPON TMI! INSUREA. ITS AGENT
REPfWI~T1fes. ^ A
I (--7L-[ ~M~,
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ACORD 25.6 C7/97)
46- 38
IS ACORD CORPORATION'
j.o-03g-0D
FEB-24-2003 15:19
FROM-Acardia Team XS
727 791 5428
T-513 P.002/002 F-186
~
y
.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED. the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsementls).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of InslJrance on the re'lerse side of this form does not constitute a contract between
thlll issuing insurerlsl. authorized representative or producer. and the certificate holder, nor does it
i1tffirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S 17/971