CERTIFICATE OF INSURANCE (218)
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omrlFICA ,1::iO~It8JRANCE--"-..""_...."--'--'I"
ISSUE DATE (MM/DD/YY)
5-5-92
THIS CERTIFICA-fin~nSSUEDA'S A MAfTERO'FINFORMA liON ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICAT
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW".__, .
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PRODUCER
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
GULF INSURANCE COMPANY
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COMPANY B
LETTER
RECEIVED
MAY 1 2 1992
CITY CLERK
8eN, 8
Y FIJX
MAY... 5
VAN 1992
DYKE IA.
1';8 UI
GOLDEN ERA PRODUCTIONS
19625 Highway 79
Gilman Hot Springs, California 92383
COMPANY C
LETTER
COMPANY D
LETTER
I"COVERAGES--' ~. ~. ,- --.--....-,.'........,
I THIS IS TO CERTIFY THAT THE 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
I 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
~~~~....., ..___.~,~~~.~~:~~RANCE ___ POLICY NUMBER P~~~i~~~~~~~~"p~~~~(~~g'bi~~N LIMITS
COMPANY E
LETTER
X COMMERCIAL GENERAL LIABILITY
A CLAIMS MADE X OCCUR,
OWNER'S & CONTRACTOR'S PROT,
x Blanket Contractual
i x Ind. Contractors
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CGL 549-42-55
4-8-92
4-8-93
GENERAL AGGREGATE $ 1,000,000
PROOUCTS.COMP/OP AGG, $ 1,000,000
PERSONAL & ADV, INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $
MED. EXPENSE (Anyone pereon) $
GENERAL LIABILITY
AUTOMOBILE LIABILITY
x
X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
BA 553-21-02 4-8-92 4-8-93
W ARNlNG-- This Policy does Dot cover any Auto
Stunt Activity.
COMBINED SINGLE
LIMIT
$ 1,000,000
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BODILY INJURY
(Per person)
$
BODILY INJURY
SEE SPECIAL EXCLUSION & LIMIT A TIONer eccldent)
ENDORSEMENT ATIACHED TO TInS POLICY
$
PROPERTY DAMAGE
$
,
I.....-;~CESS.~~~~;:;;.~--"._-
i UMBRELLA FORM
! OTHER THAN UMBRELLA FORM
!-----_....~--_.
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EACH OCCURRENCE $
AGGREGATE $
WORKER'S COMPENSATION
! AND
t.....___~~ERS.~,ITY
I OTHER
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STATUTORY LIMITS
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
l-------..-..-- ......-.....,...... ...... ...,.,.....
I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Coverage provides $1,000,000 Combined Single Limit of Bodily Injury and
I Property Damage Liability. The CITY OF CLEARWATER is named as an Additional Insured while fdming during 5-5-92
i to 5-8-92 at Fort Harrison hereunder. CERTIFICATE #10.
fCERTiFiCATE- HOLDER
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CANCELLATION
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL t!~\lI
MAIL....JQ.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
L1A 'I( OF ANY KIND UPON THE C M , ITS AGENTS OR REPRESENTATIVES,
ON 0 ",_i~.
'( __.~.___.. .p",A.~=~a;...i;~.~;!
CITY OF CLEARWATER
112 South Osceola
Clearwater, Florida 34616
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
SPECIAL EXCLUSION & LIMITATION ENDORSEMENT
MOTION PICTURE AND VTDEOT APE PRODUCTION
IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS HEREBY UNDERSTOOD AND
AGREED THAT THE FOLLOWING EXCLUSIONS AND LIMIT A TlONS APPL Y UNLESS
SPECIFTCALL Y DECLARED AND A PREMIUM CHARGE IS MADE.
AUTOMOBILE STUNT EXCLUSION
THIS INSURANCE DOES NOT APPLY TO ANY BODILY INJURY, PROPERTY DAMAGE OR
AUTOMOBILE PHYSICAL DAMAGE ARISING OUT OF (1) THE OWNERSfllP, MAINTENANCE,
OPERATION, USE, LOADING OR UNLOADING OF ANY AUTOMOBILE WHILE BEING USED
IN ANY PRE:ARRANGED--OR-'ORGANIZED RACING, SPEED- OR DEMoLmON'- CONTEST OR---'----------
IN ANY STUNTING ACTIVITY OR IN PRACTICE OR PREP ARA TlON OF ANY SUCH CONTEST
OR ACTIVITY.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
A~~~t
TRUMAN V AN DYKE. JR. CPCU
EN S-5
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