INSURANCE CERTIFICATE (20)
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TO:
FROM:
COPIES:
SUBJECT:
DATE:
I
C'I T V I OF CLEARWATER
Interdli#partment Correspondence Sheet
Elizabeth S. Haesekert Assistant City Manager
William C. Heldt Jr.t Harbormaster~
Cyndie Goudeau, City Clerk
Insurance Policy - West Coast Water Sports Inc. - Waiver
April 16, 1987
I have received and reviewed the insurance policy for West Coast Water
Sports, Inc. This policy meets the requirements of their lease
agreement with the city. Expiration date is August 21, 1987.
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THIS CERTIFiCATE IS iSSUED C A~!!!! ~N~~!! O~ !AN~ C~-~R~N~I~~S~~ THE CERTIFiCATE HOLDER.
THIS CERTIFICATE DOES NOT'tMEND, EXTEND OR ALTER THE COVERAGE AFFORDED E THE POliCiES liSTED BELOW.
NAME AND ADDRESS OF AGENCY
LOGAN INf.;UF.:ANCE
{..)GENCY INC
3801. NORTH 9TH AVE
PENSACOLA FL 32503
COMPANIES AFFORDING COVERAGES
WEST COAST WATEI:;:
SPOF.:TS INC
2273 WILLOW TREE
CLEARWATEI:;:
TI:~
FL
3::!~j76
COMPANY A
LETTER DANA RDEHIUG 8. ASSClC
COMPANY B
LETTER
COMPANY C CITY Of CLEARWATER
LETTER
COMPANY D APR 1.6 7
LETTE R
COMPANY E HARBORMASTERS OffiCE
LETTER
NAME AND ADDRESS OF INSURED
Ttlis is to certify tllat 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.
COMPANY'
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EFFECTIVE DATE
POLICY
EXPIRATION DATE
limits 0
AGGREGATE
t,
GENERAL LIABILITY
COMPREHENSIVE FORM
3GL8-'1767
Inception d:3te
8/21/87
BODILY INJURY
8/21/86
PRE M tSES/OP E A'A TlONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/CaMP LETED
OPERATIONS
CONTRACTUAL
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PROPERTY DAMAGE
BODIL Y INJURY AND
. PROPERTY OAMAGE
COMBINED
1.000
,1000
PERSONAL INJURY
PERSONAL INJURY
AUTOMOBILE LIABILITY
~ COMPREHENSIVE FORM
OWNED AUTOS
HIRED AUTOS
J... ,
NON OWNED AUTOS
BODIL Y INJURY
(PER PERSONI
BODIL Y INJURY
(PER ACCIDENT!
PROPER.r:Y.OAMAGE.
BODILY INJURY AND
PROPERTY OAMAGE
COMBINED
EXCESS LIABILITY
B UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
and
EMPLOYER'S LIABILITY lEACH ACCIDENT!
OTHER
...., .:.';!;'"
WORKER'S COMPENSATION
DESCRIPTION OF OPERATlONS/LOCATlONSIVEHICLES/SPECIAL ITEMS
SAILBDAT RENTAL
The 1 Million Limits of Liability are effective SfZ7-'/87
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuin~company
will endeavor to mail :I. 0 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, its agents or representatives.
NAME AND ADDRESS OF CERTIFICATE HOLDER
ISSUE DATE
. March .20 # 198-?' ~.
CITY OF CLEARWATER
CLE{~d:;:WA TER
r.,tS.a41 29 "; t ' ., , '/,,;,,,,' ~ - " ~'.' .
MICHAEL E SUSKIND