Loading...
CERTIFICATE OF LIABILITY INSURANCE (19)06/21/2010 13:36 FAX ACaRq CERTIFICATE OF LIABILITY INSURANCE PRODUCER 727.797.5193 FAX 727.725.5773 ONL AND TIFIONFECATE NO RIGHTS UPON Alley, Rehhaum A Capes Assurance, Inc. HOLDER. T1113 CERTIFICATE DOES NOI 2433 Gulf to Bay Blvd. ALTER THE COVERAGE AFFORDED BY P.O. Box 4620 Clearwater, FL 33758 INSURERS AFFORDING COVERAGE INSURED Thomas & Patricia Wo ows y INauRERA First Natl Ins Co of AmE DBA : Pirates Pantry McURER R. 25 Causeway Blvd INSURER C: Clearwater Beach, FL 33767 INSURER D, INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P( DOCUMENT OTHER CON ACT F ANY CONDITION SPECT MAY REQUIREMENT ANY THE INSTERM URANCE AFFORD DO Y THE POLCCI DESCR BED HEREIN 18 SU8 EC ETO ALL THEIR POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R 1YK OF INSURANCE POLICY NUMBER DATE MMI GENERAL LIABILITY 25CCZ765562 06/07/ZO10 06/07 Oil X COMMERCIAL GENERAL LmivrY CLAIMS MADE © OCCUR A X GEN'L AGGREGATE LIMITAPPLIES PER POLICY MOT- LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTO$ 10 SCHEDULED AUTOS JU 0 1 HIRED AUTO$ 0 NON-OWNED AUTOS 0?vlcl y RECORDS . rr+ICl VE socs GARAGE LIABILITY I ANY AUTO EXCESS 1 UMBRELLA LIABILRY OCCUR M CLAIMS MADE DEDUCTIBLE RETENTION I WO S COMPENSATION AND EmrLOYeRS LIABILITY Y I N ANY PKOPRIETOMFARTNEPjL*CUTIVEi--i OFFICERIMEMBER EXCLUDED? U (Man;jonry In NH) ItyB9 dmcrft under SPECIAL PROVISIONS baR W IPERATIONF LOCATIONS l VENKX-E9 / EXCLUSIONS AMM ENOORSBMENTI I Late der Is listed as an Addi t anal Insure . 30 notice of cancellation except for non-payment which is 10 days. 1@ 001/001 DATE (MMIDDIYYYIr) 06/21/2010 TER OF INFORMATION THE CERTIFICATE AMEND, EXTEND OR fHE POLICIES BELOW. NAIC # ca 24724 LICY PERIOD INDICATED. NOTWITHSTANDING i THIS CERTIFICATE MAY BE ISSUED OR AS, EXCLUSIONS AND CONDITIONS OF SUCH LIMITS EACH OCCURRENCE $ 1, 000, D p I nce S 1.000100 cD cxr V_y ens person) 0 f 10. PERSONAL S ADv INJURY $ 1 000, GENERAL AGGREGATE $ 2,00o,000 PRODUCTS-COMP/OPA= 6 2 000, COMBINED SINGLE LIM17 (E6 aacidwit) BODILY INJURY Irv pa-) 6 BCnILY INJURY (Per aavulore) $ PROPERTY DAMAGE (Par eatlderlt) AUTO ONLY-EA ACCIDENT ; I THER THAN EA ACC I O AUTO ONLY. AGO EACH OCCURRENCE S 6 AGGREGATE S S 6 RY ?ATOR s E.L. EACH ACCIDENT 6 E.L. DISEASE - EA EMPLOYE E I E.L. DISEASE - POLICY LIMIT $ SHOULD ANY OF THE ABOVE DESCRIBED POLLS BE CARr."Uo BEFORE THE EXPIRAT101 DATE THEREOF, THE INNING INSURER WILL DMVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE C 1"FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 25 Causeway Blvd. REPREBEHTATnlES Clearwater, FL 33767 WDICIR®REPRMNTATIVE Si nature on file w c an 125(200001) FAX: 727.462.6957 1988-2009 ACORD CORPORATION. I rights reserve( The ACORD name and logo aro registamd marks of ACORD