CERTIFICATE OF LIABILITY INSURANCE (7)ACORD. CERTIFICATE OF LIABI
PROPUCER Commercial Lines - (727) 796-6666
Wells Fargo Insurance Services USA, Inc.
311 Park Place Boulevard, Suite 400
Clearwater, FL 33759-3923
rryaunru Field's, Inc. DBA Barefoot Beach House
P.O. Box 3337
Clearwater Bch FL 33767
10087
N
LITY INSURANCE DATE (MM/D?YYY1n
1/25/20
10
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.
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Markel International Insurance Company Limited
INSURER B:
INSURER C:
INSURER D:
INSURER E:
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 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.
SIR ADn'
TR INSR9 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
9M 'M orm _DATE (Mmmo"_
A GENERAL LIABILITY MKS2560 01/14/2010 01/14/2011
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ? OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY jROT LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
1 ANY AUTO
EXCESSIUMBRELLA LIABILITY
] OCCUR D CLAIMS MADE
DEDUCTIBLE
WORKERS-COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
It yes, describe under
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Clearwater is additional insured re General Liability.
City of Clearwater
A Municipal Corporation
25 Causeway Blvd.
Clearwater, FL 33767
ACORD 25 (2001/08) 1 of 2
LIMIT$
EACH OCCURRENCE $
1.000,000
DAMAGE TO RENTED $ 50,000
MED EXP (Any one Person) $ 2,000
PERSONAL & ADV INJURY $ 1.000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 1.000.000
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY
(Per Person) $
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE
(Per accident)
AUTO ONLY-EA ACCIDENT $
$
OTHER THAN EA ACC $
AUTO ONLY: AGG
EACH OCCURRENCE $
$
AGGREGATE $
W STATU- OTH- a
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
CANCELLATION I en uay Notice for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
`11! ?
O 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.
ACORD 25-S (2001/08) 2 of 2 #5915260/M915043