CERTIFICATE OF INSURANCE (16)
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE lMMIDDfYYI
02/19J04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
ACaRDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
INSURERS AFFORDING COVERAGE
ASSOCIA TED INDEMNITY CORP
ESSEX INSURANCE CO
Alexandra of Clearwater Beach,
Inc. dba Pier 60 Concessions
POBox 3337
Clearwater FL 33,767
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAMlJING
ANY REQUIREMENT. TERM OR CONDITION aF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
'l":: TYPE OF INSURANCE POUCY NUMBER r:i,*TMe:r~~ Pg~.fl EXPIRATION UMITS
A GENERAL LlABtUTY BIND513140 2/16/04 2/15/05 EACH OCCURRENCE . 10110000
~MERCIAL GENERAL UABIUTY FIRE DAMAGE IAny one fire! $ 100000
I CLAIMS MADE W OCCUR MoD EXP (Anyone person) $ 5000
I PERSONAL & ADV IIIWURY $ 11l1l0onO
~
- GENERAL AGGREGATE . 2000000
~'LAGGRn LIMIT APn PER: PRODUCTS - COMPIO? AGO $ 2000000
, POUCY .~~~.;. LOC
~OMOBILE LIABlLfTY COMBINED SINGLE LIMIT .
I i ANY AUTO lea accident'
B ,~owoo, ,un" BDOIL Y INJURY
! SCHEDULED AUTOS (p., person) $
! HIRED AUTOS BODILY INJURY .
rl OO~W,,"~OO (Per accident)
PI10PERTY DAMAGE $
(Per accident}
~RAGE LlAIllUTY AUTO ONl.. Y - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC .
AUTO ONl.. Y: AGG $
EXCESS LIABIlITY EACH DCCURRENC= .
U OCCUR D CLAIMS MADE AGGREGATE $
t
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC STAT!tS I IOJ,r'
EMPLOYERS' UABILlTY E.L. EACH ACCIDENT .
E.L. DISEASE. EA EMPLOVEE .
E.L. DISEASE - POLICY LIMIT $
B OTHER BIND513146 2/15/04 2/1 5/05
BI.PD,LAE PER OCC GENERAL L1AB. $1.00a.Ooo GENERAL AGGREGATE
$500 DEDUCTIBLE $1 000000 EACH OCCURRENCE
DESCRl'TION OF OPERATlONS/LOCATlONSNEHICLESIEXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
RE: 10 PIER 60 DRIVE. CLEARWATER BEACH. FL 33767
RENTAL OF BEACH UMBRELLAS. CHAIRS 11& FOOTSTOOLS.
THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS ADDITIONAL INSURED
AS RESPECTS GENERAL LIABILITY COVERAGE, FAX 462.6957
CERTIFICATE HOLDER I I ADDmONAL Il'ISUAED: "SURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED IIEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL -2Q.. DAYS WMTn:M
25 CAUSEWAY BLVD. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 sa SHALL
CLEARWATER, FL 33767 IMPOSE NO OBUOATION OR LIABILITY OF ANY KIND UPON THE INSUREI1, ITS AGENTS OR
REPAES~TJ1ES. ^ /\
I AUTHc;r::::t~.rJiJ,-.
ACORD 25~S (7/97)
46. 38
@lACORD CORPORATION 1988
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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 endorsement's).
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 Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer'sl, authorized representative or producer, and the certificate holder, nor does it
affinnatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
ACORD 25-S 17/97)
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