CERTIFICATE OF INSURANCE / 1875 AIRPORT DRIVE / CLEARWATER EXECUTIVE GOLF COURSE
ACORD~
CERTIFICATE OF LIABILITY INSURANCI;AR~b~~ S DA~E~;~~70}4
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
Brown & Brown Insurance
17757 US Highway 19 N, Ste 660
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
SAFE CO Insurance Company
Associated Industries
Tarpon Woods Count~ Club
H&M" Investment of Clw Inc dba
1100 Tarpon Woods Blvd
Palm HarDor FL 34685
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 ~~~lfrM~b5~YE P9L1CY EXP11~A~?N
LTR POLICY NUMBER DATE'IMMlDDIVY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
f----
A X COMMERCIAL GENERAL LIABILITY 02CE05657401 01/10/04 01/10/05 FIRE DAMAGE (Anyone fire) $100,000
I CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $ 5,000
X Liquor Liab 1mil/ PERSONAL & ADV INJURY sl,OOO,OOO
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000
I 'nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1000000
A X ANY AUTO 01CG48439901 01/10/04 01/10/05 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE S
=:J OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IU~~-
B EMPLOYERS' LIABILITY 2003331926 01/02/03 03/17/04 $ 100000
E.L. EACH ACCIDENT
---'- ,-- _0_..__.----'- "_ __.___~_._ .--"---,- . ,,',' __n__'_ __ '_..0---' ---- - --- ' ,----.----- -- ---'~"-'- ,- Ei.DISEASE - EA EMPLOYEE $100000 --
I"" " E.L. DISEASE - POLICY LIMIT $500000
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is listed as additional insured with respect to the
following location: 1875 Airport Drive, Clearwater, FL 33755.
ex ~,'G~,iLk0 G~-'
~
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION
CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
Clearwater FL 33758-4748 REPRESENTATIVES.
AUTH~~ ~- /.."
I I . 'rv ..." -
ACORD 25-S (7/97)
@ACORDCORPORATION 1988