CERTIFICATE OF LIABILITY INSURANCE (5)Wells Fargo 3/312009 3:29:37 PM PAGE 2/003 Fax Server
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ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
3/3/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wells Fargo Ins Services Southeast, Inc.
311 Park Place Boulevard suite 400 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33759-3923
(727) 796-6666
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURERA, Associated Indeami! Cat orati 21865
Alexandra of Clearwater Beach, Inc. dba Pier INSURERS: National SUX€t COT 21881
60 Concessions
INSUaeRC:
P o Box 3337
Clearwater FL 33767 INSURER D:
INSURER E:
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THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
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.
POLICY NUMBER DATEY EFFECTIVB POL C LIMITS
GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000
A 0M MERCIAL GENERAL LIABILITY rtlxX90885947 2/15/2009 2/15/2010 ORE
SES aoco?Eence
$ 100,000
4 CLAIMS MADE a] OCCUR
7 MED EXP one person) $ 10,000
PERSONAL & ADV INJURY 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000
1 7 POLICY jP9 LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
A ANY AUTO MZXBOB85947 2/15/2009 2/15/2010 (Eaaocident) 1.000 000
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED ALTOS
(Per Person)
X HIRED AUTOS BODILY INJURY
$
X NON-OWNED ALTOS (Per aooiders)
PROPERTY DAMAGE $
(Per aoedent)
GA RAGE LIABILITY ALTO ONLY - EA ACCIDENT
ANY AUTO OTHERTHAN EA ACC $
ALTO ONLY: AGG
EXCESS/UMBRELLALIABILITY EACHOCCURRENCE $ 1,000,000
B OCCUR ? CLAIMS MADE XAF90974676 2/15/2009 2/15/2010 AGGREGATE $ 1,000,000
$
DEDUCTIBLE $
RETENTION $ $
S OT
WORKERS COMPENSATION AND
EMPLOYE'RS' UABILMY
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVB
OFFICER/MEMBER EKCLU09D? E.L. DISEASE - EA EMPLOYE $
It yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONS) LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Florida statutes mandates 10 dayB notice of cancellation for nonpayment of premium- RE-10 Peir 60
Driver Clearwater Beach FL 33767 ]:rental of Beach Umbrellas, chairs and Footstools
The City of Clearwater, A Muncipality is an additional insured with respects to the above general
liability policy.
! AMrGl 1 ATI/ M
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, The ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City of Clearwater
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL
25 causway Blvd IMPOSE NO OBLIGATION OR LIASIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Clearwater FL 33767 AUTkORCZED REPRESENTATIVE
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3/3/2009
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
rcquiro nn cndoracmcnt. A atatomcnt on thin eortificatc doca not confor rights to tho oertificatc
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance an the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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