CERTIFICATE OF LIABILITY INSURANCE (11),t ApJ- I09 03:27p Day Mark Marine 727#360#2333 p.2
DATE (MMIDOM0
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PRODLICER AND THE NAMED INSURED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
I.E.B.S. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE
8722 South Harrison Street AFFORDED BY THE POLICIES BELOW.
Sandy, Utah 84070
INSURERS AFFORDING COVERAGE
INSURED INSURER A_ The Prime Insurance Syndicate, Im
INSURER B:
Wavejafmncn; Inc. INSURER C:
INSURER D:
25 Causeway Bd
INSURER E:
Clearwater Beach, FL 33767
INSURERR
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 DISCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUIMR D?ATEY INDDIM D TE MMO TION GNIrr$
GENERAL LIABILITY ! I EACH OCCURRENCE IS $500,000.00
r
COMMERCIAL GENERAL LIABA.ITY 1 1 NIA
FIRE DAMAGE Any am 5m)
CLAIMS MADE OCCUR ; SP09041t6 ? 04/01/E009 04/01/2010 _
MED EXP (Any orn peman `S N/A
n I CogllllCPeial Y.g17il11y ?PERSONAL ADV MUURY Is N/A
,.. iManuscript Policy ? { (
51,000,0110.00
GENERAL AGGREGATE is
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GEN'L AGGREGATE LIMIT APPLIES PER: i
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PROD)CTS - COMPIOP AG is
I i j I-INIITS SHOWN ARE ( 100
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fi POLICY , EcT
LOC pB1 P?? s $
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y Au ra UA89M THOSE IN E"ECT AS ANNUAL AGGREGATE s
i? OF POLICY INCEIF'j'IDNr1 1
. ANY AUTO BODLYInWRY
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Per Portion)
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BODILY INJURY
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RETENTION II AGGREGATE
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LIMITATION OF COVERAGE FOR ADonx NAL INSURED
Liability Coverage is only provided to the Additional Insured with nnspea to Accidmis od=vAse covered under the Policy/Coverage Corbact wheys; the insured is found directly
liable and not where the Additional Ins iced is found bldependently negligent oftht Insured.
DESCRIPTION OF OPERATIONAACAT04$' E111CLt:Sl MCL115ION3 ADDED BY ENCORSEMENTTSPECIAL PROVISION
Coverage is limited to only iraned activities or operations identiAod in the Policy. Rehm] - Plersonal Wakwmil & Jet-Skis., Reuel - Persorsal Wattnxaft & Jet-Skis., Rental -
Ranw boat Boats., herds( - Kayaks.
'CERTIFICATE HOLDER ADDITIONAL INSURED I I LOSS PAYEE
City ofCleanvater - City MNins SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
25 Causeway Blvd NOTICE TO THE Ct.1RT1CICA1E HOLDER NAILED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Clerwater Beach, FL 33767 IMPOSE NO OBLIGATION ORLIABLrrYOFANYKIND UPON THrzINSURER. rf5AGENTS OR
Catherine Yellin REPRESENTATIVES.
AUtt14RRBP REPRESENTATIVE
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ULJA- --= U3W F2005
Rprk E,8 09 03:27p Day Mark Marine 727#360#2333 p.3
ADDITIONAL INSURED ENDORSEMENT
PAP-99-12
This Endorsement changes the terns and conditions of the Policy Issued. Please read it carefully!
The following requirements govern coverage under the Policy and must be adhered to for coverage to be
provided to the Insured under the Policy. No activities conducted by the Insured are covered under the Policy
unless they are conducted in full compliance with all of the requirements specified below and in the Policy. The
Insured must advise its employees, agents, contractors, and/or subcontractors of these requirements and
ensure that they also abide by them for coverage to be provided. The Insured agrees and understands that any
noncompliance with the following specified requirements and/or the terms and conditions set forth in the Policy
will result in the denial of coverage under the Policy meaning the Insurer will not be obligated to indemnify or
defend you.
Policy Number: SPOWX116
Insured: Wavejammerx, Inc.
Effective Date: 4/8/2009
Additional Insured: City of Clearwater - City Marina
25 Causeway Blvd
Clearwater Beach, FL 33767
Generating an additional premium of. $0.00
The "Who is a Insured" provision of the Policy shall be amended to include the person or organization
scheduled in this Endorsement as an Additional Insured for the limited purpose of liability arising from Your
Work, as that term applies to the Insured only, and subject to all other terms and conditions of the Policy and
The coverage provided by this Endorsement only extends to cover the Additional Insured for allegations of
liability based upon alleged, actionable conduct of the Insured and only to the extent the Insured would have
been liable and coverage would have been afforded to the Insured under the terms and conditions of this Policy
had such Claim been made against the Insured.
The Policy expressly provides that coverage is to be construed and enforced In accordance with the laws of the
State of Utah, and the Insured has consented to the jurisdiction of the courts of the State of Utah and has
agreed that time courts shall be the exclusive forum to hear and decide disputes consisting of or relating to
coverage issues.
The Additional Insured is subject to all of the terms, provisions, conditions, exclusions, definitions,
limitations, representations, and Endorsements of the Policy issued to the Insured, and all related documents
providing coverage to the Insured. The failure of the Insured to adhere to any such provisions will also
defeat coverage under the Policy for all Additional Insureds.
A copy of the Insured Policy may be obtained from the Insured or by contacting the Insurer office in Salt Lake
City, Utah, during normal business hours.
Endorsement No.: 2
. , Surplus Lines Tax
l .
' (r Surplus Lines Fee
Jose E. Figueroa
D002028
PAP-99-12 12DEC2007 pow 1 of 1