CERTIFICATE OF LIABILITY INSURANCE (11)rne.,+ir• ??a•ta
r-1 FARFe
ACORD,u CERTIFICATE OF LIABILITY INSURANCE DATE 2 9?
PRODUCER
IMA of Kansas, Inc. (Wichita)
PO Box 2992 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.
Wichita, KS 67201
316 267.9221 INSURERS AFFORDING COVERAGE
INSURED INSURERA Massachusetts Bay Insurance Co.
Clearwater Beach Seafood, Inc. INSURER B:
dba Crabby Bill's INSURER C:
3001 Executive Drive, Suite 217 INSURER D:
Clearwater, FL 33762 INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REGUIREMENT, 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.
NSR TYPE OF INSURANCE POLICY NUMBER PO
LICY E
DATE,
PDL ON
LIMB
S
A GENERAL LIABILITY LUK5627741 06//04/09 06104110 EACH OCCURRENCE $1,000,000
X COMMERCLALGENERALLIABILITY FIRE DAMAGE (Any On lire) $100,000
CLAIMS MADE a OCCUR MED EXP (Any one person) 55,000
X Liquor Liability PERSONAL & ADV INJURY S7 000 000
1 000 000 GENERAL AGGREGATE $2,000.000
GEN'LAGGREGATE LIMrrAPPLIES PER: PRODUCTS -COMPIOPAGG $Z0091900
POLICY jRo- LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
S
ANY AUTO (Ea a=werH)
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Perperaw)
WIRED AUTOS BODILY INJURY
S
NON-OWNED AUTOS
(Par aeddenl)
PROPERTY DAMAGE
(Per seddent) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC 6
AUTO ONLY: AGO $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE S
RETENTION $ $
WC STATU• OTH.
WORKERS COMPENSATION AND -
EMPLOYERS* LIABILITY
E.L. EACH ACCIDENT
$
E1. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESMXCLUSIONS ADDED BY ENVORSEMEM/SPECIAL PROVISIONS
To the extent allowed by law, Certificate Holder is included as Additional Insured (Landlord) on the
General Liability policy if required by written contract or agreement subject to the policy terms and
conditions.
Loc# 1 - 37 Causeway Blvd; Clearwater Beach, FL
CtKIIFFIL:AIt HULUtK ADDITIONAL INSURED; INSURER LETTER: L.AN4eI.LAlwre lU ve s ]OF IYL)n-ra FINHIL
SHOULD ANYOFTHE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater Marine DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3O__DAYS wRrrIEN
Property NOMCETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT. BUTFAILURE TODOSOSHALL
25 Causeway Blvd IMPOSE No OBLIGATION OR LIABILITY OF ANYIGND UPON THE INSURER.ITS AGENTS Olt
Clearwater Beach, FL 33767 REPRESENTATIVES.
I AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97)1 Of 2 #S4506521M450524 LAE 0 ACORD CORPORATION 1988
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
require an endorsement. A statement on, this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on 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.
Ak;VK1Jzti-Zitf1s1t2 Ot 2 4S450652/M450524