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CERTIFICATE OF INSURANCE (17) , From:ACORDIA TA DEPT 727 799 5117 02/22/2005 12:27 #274 P.002/006 lilf'Aii'iijii.:"":"':':':':<':' :::::~.:.;.;.:.:-:.:.:.:.;.:.:.:.:.:.:.~.;.:.;.;.:+:.,:.;.:~.;,:.;.:,:.:.;.~;,;: "" '111111:;~:"':::::':h 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 ~~ON~ Ezt: 727-796-6666 "', ti!llflllfir"D~~~'~~~'OO~YYi '." COMPANY Acordia Southeast, Inc. PO Box 31666 Tampa, FL 33631-3666 LLOYD'S OF LONDON CODE: AGENCY CUSTOMER 10 #: INSURED SUB CODE, ALE99722 El'FECTlVE DATE 2/15/05 EXPlRATlOI\I DATE 2115/06 CONTINUED UNTIL TERMINATED IF CHECKED Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions POBox 3337 Clearwater FL 33767- LOAN NUMBER POUCY NUMBER M 11016 ::mlQm;.'1.t!t~_n.mM~:!~f#WMiifimWl1WXtt[lfl@Nt@!1!#IMMtfMtdW$1t1$m@t1@l!lnijHmWttmmnt!itt.f#I.:tN$~t,m1M\MnM!iim~tmXt!J~m::::::WWiW::i THIS REPlACES PRIOR EVIDENCE DATED: 2/21/05 lOCATION/DESCRIPTION 10 PIER 60 DRIVE Oearwater Beach FL 33767 Build;n~ 1 COVERAGE/PElULS/FORNS AMOUNT OF INSURANCE 250,000 50,000 ~50, 000 DEOUCTIBLE BUILDING - BUILDING 1 REPLACEMENT COST BUSINESS PERSONAL PROPERTY ACTUAL CASH VALUE BUSINESS INCOME WITH EXTRA EXPENSE SPECIAL FORM. EXCLUDING WINDSTORM & HAIL/FLOOD EARTHQUAKE AND THEFT WINDSTORM POLICY #ICS09661 02428200 XL SPECIALTY INS,CO. 3/2D/05-06.REPLACMENT COST OEOUCTIBLES:NAMEO HURRICANE 1 ALL OTHER W/H BLOG #1 $12,500 $7,500 CONTENTS #1 $ 2,500 $1,500 BUS INC/EE $ 7,500 $4,500 ~,ooo 1,000 SAME LIMITS AS ABOVE !iftf..MIm~#.il!ij.ijlm!.i9.1if._Hml.@liHtMttl:%f~!M~~i.N}']ttf:MUjMMi\j}1~nmw.5M!lMmWWlniiWMf&mfidiMm1;tm~kWilf1Um@!!;:~gM!iI.Mll!Ii}!@lH@m!i:~ 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 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POUCY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. CITY OF CLEARWATER 25 CAUSEWAY BLVD. CLEARWATER, FL 33767 MORTGAGeE LOSS PAYEE LOAN' X ADDITlONAL INSURED NAME AND ADDRESS ~~ ! From:ACORDlA TA DEPT 727 799 5117 02/22/2005 12:28 #274 P.003/006 ACORDTM CERTIFICAtE OF LIABILITY INSURANCE DATE jMMIODIYYI 02/21/05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIACATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER Acordia Southeast, Inc. P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 INSURERS AFFORDING COVERAGE INSURED INSURER A: INSURER B: INSURER c: : INSURER 0: INSURER E: ASSOCIATED INDEMNITY CORP ESSEX INSURANCE CO Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions POBox 3337 Clearwater FL 33767 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONOITION OF 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. '~~ POUCY NUMBeR POUCY EFFECTIVE POUCY EXPIRATION UMJTS TYPE OF INSURANCE A ~ERAl UABIUTY MZX80839252 2/1 5/05 211 5/06 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE IAny OM firel $ 100000 I CLAIMS MADE TlJ OCCUR MED EXP IAnV one personl $ 5000 PERSONAL & ADV INJURY $ 10')0000 - GENERAL AGGREGATE $ 2000000 --- GEWL AG:iREGATE LIMIT APPLIES PER: PROOUCTS - COMPIOP AGG $ 2000000 n POLICY n ~~RT n laC ~TDMOBILE UABIUTY COMBINED SINGlE L1I\1.IT $ ANY AUTO lEe .~~klentl - - ALL OWNED AUTOS BODilY INJURY $ _. SCHEDULED AUTOS (Per personl --: HIRED AUTOS 800fl Y INJURY $ _ NON-DWNED AUTOS IPer accident) I PROPERTY DAMAGE $ (Per eoodentl RRAGE UABlUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS L1ABIUTY EACH OCCURRENCE $ [~l OCCUR 0 CLAIMS MADE AGGREGATE $ $ R ~EDUCTlBLE $ RETENTION $ $ WORKERS COMPENSATION AND I ~~vs;r f.!.~s I TOTH' ER EMPLOYERS' UABIUTY E.L. :ACH ACCIDENT $ E.L. DISEASE. EA EMPLOYEE $ E.L DISEASE. POLICY LIMIT $ B OTHER 3CC5970 2/1 5/05 2/15106 BJ,PD,LAE PER DCC GENERAL LIAS. $1,000,000 GENERAL AGGREGATE $500.DEDUCTIBLE $1 000 000 EACH OCCURRENCE DESCRIPTION OF DPERATIONSILOCATlDNSNEHIClESIEXCWSIONS ADDEO BY BIIDORSEMENTISPECIAl PROVISIONS RE: 10 PIER 60 DRIVE, CLEARWATER BEACH, Fl 33767 RENTAL OF BEACH UMBRELLAS, CHAIRS & FOOTSTOOLS. THE CITY OF CLEARWATER A MUNICIPALITY IS NAMED AS ADDITlONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE. FAX 462-6957 CERTIFICA TE HOLDER I X I ADDITIONAl INSURED; INSURER LETTER: CANCELLATION CITY OF CLEARWATER SHOULD IWY OF THE ABOVE DESCRIBED POUCIES BE CANCELlED BEfORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WilL ENDEAVOR TO MAIL ~ DAYS WRITTEN 25 CAUSEWAY BLVD. NOTice TO THE CERTIFlCATi! HOLDER NAMED TO THE lEFT, BUT FAIWRE TO DO SO SHALL CLEARWATER, FL 33767 IMPose NO OBUGATION OR UABIUTY OF ANY KINO UPCN THE INSURER, ITS AGENTS OR REPRESEItlU. TIllES. ^ i"I I AUr~ ACORD 25-S (7/971 46- 36 @l ACORD CORPORATION 1988 .. From:ACORDIA TA DEPT 727 799 5117 02/22/2005 12:29 #274 P.005/006 A CORDru ~ CERT'IFICAi'"E OF LIABILITY INSURANCE DATE IMM.-DDIYY} 02/21/05 THIS CmTIFICATE 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 Acordia Southeast, Inc. P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 INSURERS AFFORDING COVERAGE INSURED INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: ESSEX INSURANCE CO Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions POBox 3337 Clearwater FL 33767 COVERAGES 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 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. INSR TYPE OF INSURANCE POUCY NUMBER re.~~rM~~~ POUCY EXPIRATION UMITS LTR A GEl'lERAL UABlUTY 3CQ5970 2/15/05 2/15/06 EACH OCCURRENCE $ 1000000 - X COMMERCIAL GENEiiAL LIABIUTY RRE DAMAGE (Anyone fire) $ 50000 I CLAIMS MAO~ W OCCUR MED EXP lAnv one person' $ 1000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PftOOUCTS. COMPIOP AGG $ 1000000 -'-- POLICY n ~~RT n LOC ~OMOBILE UABIUTY COMBINED SINGLE LIMIT $ _: ANY AUTO (Ea lICCldent) ALL OWNED AUTOS BODILY INJURY - $ SCHEDULEO AUTOS (P....persor.' - HIRED AUTOS BODILY INJURY - lPer accident) $ NON-ClWNEO AUTOS - - PRO.~ERTY DAMAGE $ (Per accidentl RRAGE UABIUTY AUTO ONLY - EA ACCIOENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS UABlUTY EACH OCCURRENCE $ ~ OCCUR 0 CLAIMS MADE AGGREGATE $ $ =j DEDUCT1BL~ $ RETENTION $ $ WORKERS COMPEl'lSATlON AND I T"6~, STJ~U' i I 10TH. o YU ITS ER EMPLOYERS' UABIUTY E.L. EACH ACCIDENT $ E.L. DISEASE. EA EMPLOYEE $ E.L. DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY B\lDORSEMEl'lTISPEClAL PROVISIONS RE: FIELD'S, INC. DBA BAREFOOT BEACH HOUSE. 332 S. GULF BLVD, CLEARWATER BEACH FL 33767 RENTAL OF BEACH CHAIRS. UMBRELLAS & CABANAS. CERTIFICATE HOLDER IS ADDITIONAL INSURED WfRESPECTS TO GENERAL L1AB. C ERTI FICA TE HOLDER I X I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION CITY OF CLEARWATER,A MUNICIPAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILl. ENDEAVOR TO MAIL ~ DAYS WRITTEN CORP., c/O CITY ATTORNEY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAIWRE TO DO SO SHAU PO BOX 4748 IMPOSE NO OBUGATlON OR UABIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR CLEARWATER FL 33767 REPRES~TI1ES. ^ /\ AUT~ , - ACORD 25-S (7/97) 46- 36 lil ACORD CORPORATION 1988