INSURANCE CERTIFICATE (23)
Return Completed Certificate To:
c;,1TY (:t;-.CLEARW A TER
r.o. Box"4748
CIe.'D\ 'Hater I ~L 34618-4748
AUn: RISK ~^NAGEMENT
I
CERTIFICA TE OF INSURANCE
TO
CITY OF
CLEARW A TER
FLORIDA ("the City")
A Municipal Corporation
1Q00nly This Certificate
Of Insurance form
I will be accepted.
RECC:IVED 0 r. T 2 3 1987
T!-','$ certifies to the City that the following described policies have been issued to the Insured .named below and are in force at this time.
Insured: West Coast Water Sports. Inc.
Address: 2273 Willow Tree Drive
Clearwater, FL 33576
Description of operations/locations/products insured:
Boat Rentals
ContracUPurchase Order No. (if any):
-v
POLICIES LIMITS POLICY EXPIRA TION
AND INSURERS Bodily Injury Property Damage NUMBER DATE
. ~..f/
Worker's Compensation
Employer's Liability $
(NamE> of Insurer)
Best's Rating
Owners, Landlords & Tenant's
Liability "Claims-Made"_ "Occurrence"-X-
Check policy type:
tiZalltQl.?~~~~ml:~R~ Each Occurrence Each Occurrence
or $ $200 , 000.00 GLA 286542 8-27-88
iXlmmer.E.il!lkia:eRaook:kia1o~ _ Aggregate Aggregate
$ $
Western World Ins. Co. or
(Name of Insurer)
Combined Single Limit $
Best's Rating Aggregate $
SURf1.us lInFS AGf!4T. F n(~$ L B...:n
lIC. . O1182Gi237 ~. 0 Ilox 207~
Business Auto Policy Each Person 5.10' "d. Floridl 32772
Liability Coverage Symbol _ $ Each Accident PROD ....Gr. _ ~~p.
Each Accident $ ns.
$ CITY ~!!sa~ol~, FL
(Name of Insurer) or
l.nis In:;ur~ll\:e is is '.iO<'\d LfJr~!I~'lt kl lie
fic;id~ $~IiP'lI:; llr.e~ L~l\I. Pr.rSf>fl! iosur.
Best's Rating Combined Single Limit $ 00 by S",!,/'" tir.(:~ C.;l"~, ~ do not h~W!
Ih~ rrlll'.l,~:tiun ~" Itl~ rl rid. Insurijnc~
rt ~ ,.'.. " " ,
c'
;JeCov,,1 y fur 1h~ (;~li.~lion .1 any insolvent
"Claims-Made"_ "Occurrence"_ . unli('''/o.!n~~d il!~t;H:,'.
Umbrella Liability ::IllE ~ 1586-87 4 h
Occurrence/Aggregate $
(Name of Insured) Self-Insured Retention $
Best's Rating
The following coverages or conditions are In eHect: Yes No
The City, its officials, and employees are named on all liability policies described above as insureds as respects: (a) activities
perf~~~ed for the City by or on behalf of the named insured, (I )~Af'..4.- PO~C~ ~L A X.
and c premises owned, leased or used bv the Named Insured.S pe r SCle u e,
Products and Completed Operations X
The undersigned will mail to the City30days written notice of cancellation; reduction of coverage or limits; aggregate erosion; X
advance of the Retroactive Date; an%r renewal.
Cross Liability Clause (or equivalent wordirlCl X
Personal Iniurv, perils A, Band C i)
Broad Form Property Damage ^
- I X
X. C. U Hazard"lnc!uded ,-- , ".' - ' , ,., '.
Contractual liability CoveraQe app'lvino to this Cont~acULease/AQreement X
Liauor Liabilitv X
Coverage afforded the City, its officials, employees and volunteers as an insured applies as primary and not excess or con- X
tributing to any insurance issued in the name of the Citv.
Waiver of subroaation from Workers' Compensation insurer. X -
This certificate is issued as a matter of information. This certificate is not an insurance policy and does not amend, extend or alter the coverage afforded by
the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance
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.
Creative Insurance Specialists Insurance Company
Agency or Brokerage
P. O. Box 2074 - Sanford, FL 32772
Address
Frances L. Brown
Name of Person to be Contacted
305-321-2040
Telephone Number
3
/ / -/ z -a:--7
Authorized Ignature . Date
Note: Authorized signature may be the agent's if agent has ptaced insurance
through an agency agreement with the insurer. If insurance is brokered,
authorized signature must be that of official of insurer.
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PRODUCER
Log~ Insurance Agency, Inc.
3801. North 9th AYe.
Pensacola, PIa 32503
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEIlS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AME/40,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANIES AFFORDING COVERAGE
INSURED
~est Coast ~ater
2273 Willow Tree
Clearwa.ter, Fla
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
Sports,
Drive
33576
Inc.
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COMPANY 'I:'
LETTER .. CIS/Adriatlca DiSicurta
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THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOtC) 1 ED
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE ,~A\'
BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CUNDI.
TIONS OF SUCH POLICIES.
1
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POLICY EFFECTIVE
DATE IMMIODIYY)
POLICY EXPIRATION
DATE iMMIODIYY)
LIABILITY LIMITS IN THOUSI'.ND5
OCCE~~~NCE AG(,.,..EG.. ,
TYPE OF INSURANCE
POLICY NUMBER
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
BODILY
INJURY $ $
PROPERTY
DAMAGE $ S
BI & PO $ $
COMBINED
PERSONAL INJURY $
f;r.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV. PASS.)
ALL OWNED AUTOS (OTHER THAN)
PRIV. PASS.
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
BOOllY
INJURY
(PER PERSON) $
BODilY
INJURY
[PER ACCIDENT) $
PROPERTY
DAMAGE $
BI & PO
COMBINED $
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EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
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~6t~~ED $
s ~t'*~j
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lEACH :'CCl'f'I.. .~~
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(DISEASE.P011C::-:"""u I.
'/,1I'1\"~i
(DISEASE-E.l.l'!I ~Hl,
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STATUTORY
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WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
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City ot C1earwa~erFlorida
("the city")
A Unnle1pal Corporation
P.O. Box 4748
Clearwater. Fla 34618-4748
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THIS CERTIFICATE IS ISSUED AS A MATTER O~ INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS Cl:RTIFICATE DOES NOT AMEND.
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
,
Corp. dba
COMPANY A
LETTER C-:OLONY IN~UTU:H~
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY 'C'
L::TiER -
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LTD.
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FL J.356R
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THIS IS TO CERTIFY THAT 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 POLlCIE$ DESC'lIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI.
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
'OllCY m~CT:vE
DATE ,MMIDD'YYI
Pg}i~Y(:~~~~~ ALL LIMITS IN THOUSANDS
POLICY NUMBER
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE DOCCURRENCE
OWNER.S & CONTRACTORS PROTECTIVE
GENERAL AGGREGATE
PROOUCTS-COMPIOPS AGGREGA IE
PERSONAL & ADVERTISING INJURY
EACH OCCURRENCE
fiRE DAMAGE (ANY ONE fiRE)
MEDICAL EXPENSE (ANY ONE PERSONI
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AUTOMOBILE LIABILITY
ANY AUTO
All OWNEO AUTOS
SCHEOULED AUTOS
HIREO AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
CSL $
BOOll Y
INJURY
(PER PERSON) $
BGOIL Y
INJURY
rlC~DENn $
PROPERTY
DAMAGE $
EACH
OCCURRENCE
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EXCESS LIABILITY
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OTHER THAN UMBRELLA FORM
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WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
OTHER
PAR1.SAILING LIAS CC 10014 - !dI
06/08/87 06/08/88
1,000,000 CSL
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(EACH ACClOENT)
(DISEASE-POLICY LIMIT)
(OISEASEHCH EMPLOYEE) ;'S~'
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS
IT IS HEREBY UNDERSTOOD AND AGREED TIIAT THE CERTIFICATE HOLDER IS N~MED ~S
ADDITIONAL INSURED IN RESPECTS TO TilE PARAS AILING OPERATIONS OF THE NAMED
INSURED.
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CITY OF CLEARWATER
1 MARINA PLACE" - ., I
CLEARW^TER BEACH FL 33515
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C.l.NCELLED BEFORE THE EX.
PIRATlON DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1. (pAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
liABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHCRIZED REPRESENTATIVE
HOLDER-ID AD.
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