CERTIFICATE OF LIABILITY INSURANCE (4)cvRar CERTIFICATE OF LIABILITY INSURANCE DATlPLMIDDIYYYYI
ODI' Allied Specialty Insurance, Inc
10451 Gulf Blvd.
Treasure Island, FL 33706 O IN Y AANDFCONFERS NO RIGH S UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
800/237-3355
R+ISURERS AFFORDING COVERAGE
NAIL S
IN"u"'D Emerald Coast Bungee, Inc. uNSI1RER
150 Bays ide Drive INSURER B:
Clearwater FL 33767 NSURERC:
INSURER D.
rNSURER E:
J+MMCsrsae
`THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLUENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFQRDEC7 BY THE POLICIES DESCRBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POL, ES. AGGREGATE LJMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS.
em ADM POL16YNLODLlR POLJCY EOMA7M
GENERAL UASRM EMM DICE § 1,000,000
A coMME0ALQENER4LUA9M.ITY CPP0100575-00 03/11/10 03/11/11 wan m- ib acown) s 50,000
CLAIMS MADE ® OOCUR M9DE*&yowE!Lwjn $
PERSONAL&ADVINJURY i
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LOWT APPLIES PER: PRODUCTIS - COMPIOP AGG S 1_00Q. gQ0
POLICY 11 P LOC
AUT OMOBILE LMJMLTTY 1300N SINGLE LIMIT
ANY AUTO RECE D $
ALL OWNED AUTOS
SCHEDULEDAUTOS
V,p GODLY KAIRY
(p"Wo" i
HIRED AUTOS ??YO 16
WWMYRQUW
f
N0N4N*= AUTOS I
A"n DAMAGE
Ip"MON s
GA RAGE LIABLLJTY AUro ONLY - EA ACCIDENT 5
ANY AUTO OTHERTHAN EAACO $
AUTO ONLY: AGO S
MICE89I UMBRELLA UMIUTY EACH O YCE S
OCCUR ? CLAM MADE AGGREGATE !
S
DEDUCTIBLE S
RETENTION S S
ylO gCdILPBNSILTiON
' INC AT1F 07111-
EEL
AND EMPLOYERS
LIABILITY YIN
ANY PPMRSTTOWARfNER 17ME E.L EACH CIDENT S
O(Mi - ryIn p" I&L. DISEASE • EA S
K PRdViBIONS 6mmw E.L. DISEASE -POLICY LIMIT S
OMER
DE"GRI WN OP OPRIATTONOI LOCATI MS 1YEYCLES I EILCLUSIONS ADDED BY BOORSF7LEIT1010AL PROVISIONS
ADDITIONAL INSURED: CITY OF CLEARWATER AS RESPECTS TO THE GENERAL LIABILITY
OPERATIONS OF THE NAMED INSURED ONLY.
100 MYRTLE AVENUE
CLEARWATER FL 33767
ACOR:D 25
SHOULDANYOFYHEABOVEDEWPWCIESBECANCM.UMBL1 UTHEEXMATM
DATE THEREOF, THE ISSUBIO INSURER WILL ENDEAVOR TO NAIL DAYS wmtTEN
NOTICE TO TINE CERTS+ICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL.
ORNME NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE DISURER, ITS AGENTS OR
a 99"4009
re"rVGd.
Q&?k The ACORD III=* and Wq* are Ta9SEBred marks of ACM