CERTIFICATE OF LIABILITY INSURANCE (12)Dates 6/30/2010 Timel 7153 AM Tol City of Clearwater Marine Prope R 917274626957,,„ 14 316-266.6553 Pagel 001-0
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AORD. CERTIFICATE OF LIABILITY INSURANCE 6/30/2010""'
PRODUCER
IMA of Kansas, Inc. (Wichita)
PD 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, K5 67201
316 267-9221 INSURERS AFFORDING COVERAGE
INSURED INSURER A Massachusetts Bay Insurance Co.
Clearwater Beach Seafood, Inc. INSURER B:
dba Crabby Bills INSURER C:
3001 Executive Drive; Suite 217 INSURER V.
Clearwater, FL 33762 INSURER E:
1'nVFRA/:FS
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.
11
INSR
TYPE OF INSURANCE
POLICY NUMBER
P Y EFFECTIVE
POLICY EXPIRATION
LIMITS
.
A GENERAL LIABILITY RZK5778864 06104110 06/04/11 EACH OCCURRENCE $1.000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one rve) $100,000
CLAIMS MADE FxIOCCUR MED E%P (Any one parson) $10,000
X Liquor Liability PERSONAL & ADV INJURY $1 000 000
$1,000,000 GENERAL AGGREGATE s2,000,000
GENL AGGREGATE LIMITAPPLIES PER: PRODUCTS -COMP/OPAGG s2,000,000
PR0.
71
POLICY
LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Perpenlnn)
HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Par accident)
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR ? CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
RETENTION $ 3
H-
W CSTATU- O
WORKERSCOMPENSATION AND F
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
E.L. DISEASE -EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSA.OCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENOORSEMENT/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
CERTIFICAIt:HULULK ADDITIONAL WSURED•INSIIRERLETTER: L:ANL:CLLAIIUN 7V LJa Inr IYOTI-y-y IIItl11L
SH OULD AN YOF TH E ABOVE D ESCRISED POLICIES BE CANCELLED BEFORE TH E EXPIRATION
City of Clearwater Marine DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30-- DAYSWRTTEN
Property NOTICE TOTHE CERTIFICATE H OLDER NAMED TOTHE LEFT. BUT FAILURE TO DO SO SH ALL
25 Causeway Blvd IMPOSE NO OBLIGATION OR LIABILITY OF ANY IUND UPON THE INSURE R,ITS AGENTS OR
Clearwater Beach, FL 33767 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
,#J4-
ACORD 25S (7!97)1 of 2 NS598804/M698760 THE 0 ACORD CORPORATION 1988
Date: 6/30/2010 Time: 7:53 AM Tos City of Clearwater Marine Prope ® 917274626957,,,,14 316-266-6553 Yage: UV6-0
4? r
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.
ACORD254(7197)2 of 2 #8598804/M598750