CERTIFICATE OF INSURANCE (8)
COMPANIES AFFORDING COVERAGES
AIM lnsurance Agency, Inc.
P. O. Box 4985
Clearwater, FL 33518
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY 0
lFTTEll
COMPANY E
LETTER
Kent Insurance Co.
''>r
NAME AND ADORESS OF INSURED
Tillie O'Too1es Goodtime Jazz Emporium
Decade, Inc. dba
519 Cleveland Street
Clearwater, FL 33515
MAY 1
crrY p..E.RK.
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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.
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits of Liability in Thousan
EACH
OCCURRENCE
GENERAL LIABILITY
A
o COMPREHENSIVE FORM
[Xl PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
o PRODUCTS/COMPLETED
OPERATIONS HAZARD
o CONTRACTUAL INSURANCE
o BROAD FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
o PERSONAL INJURY
SMP1696221
10-29-80
BODILY INJURY $
$
PROPERTY DAMAGE $
$
BODILY INJURY AND
PROPERTY DAMAGE $
COMBINED
500
500
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON-OWNED
-~
\J- r, /J
vf
l'~'~~Q'Y I ~ 0_ L
~ltJ' r" }: '~)/) \ to)
PERSONAL INJURY
$
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
$
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
$
COMBINED
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
City of Clearwater is named as co-insured for the liability at the described
locations which extend to the curb of the premises.
Cancellation: Should any of the above describ~d policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail --1JL days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
DATE ISSUED,
5-12-80
City of Clearwater
P. O. Box 4748
Clearwater, FL 33518
Attention: Denise Cowdrick
m.