CERTIFICATE OF INSURANCE (174)
NAME AND A~DRESS OF AGENe,
COMPANIES AFFORDING COVERAGES
Becher & Carlson Insurance Services, Inc.
21600 Oxnard Street, Suite 900
Woodland Hills. CA 91367
COMPANY A
LETTER
COMPANY 8
LETTER
Argonaut Insurance Company
General Reinsurance Corporation
.\lAME AND ADDRESS CF INSuReD
Marriott Corporation
and subsidiaries
Marriott Drive
Washington, D.C: 20058
Attn. Dept. 924.36 (Insurance)
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES
Marriott Family Restaurant
56 Causeway Boulevard
Clearwater Beach, Florida
This IS 10 certlly that polic'es O/Insurance ilSlea oeiQw nave Deen Issunc 10 IMe Insured namec aOOvE' ana ale In lorce at trl1S lime. NotwlthstanOlng any reaulrement. term or condlllon of any
contract or other documenl wllh respect to WhlC~ II'lIS cendleate mav be Issueo or may pertain t"e .nsurance alforoec 0\1 Ihe DOllCles descrlbeo herem 15 suo]ecl to atlthe terms. eJlciUSlcns and
conditions 01 suct"o DollCles
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY EXPIRATION DATE
GENERAL LIABILITY
A
~ COMPREHENSIVE FORM
~ PREMISES-OPERATIONS
Iv1 PRODUCTS COMPLETED
~ OPERATIONS HAZARD
~ CONTRACTUAL INSURANCE
Iv1 BROAD FORM PROPERTY
~ DAMAGE
~INDEPENDENTCONTRACTORS
~ PERSONAL INJURY
(8J L10UOR LIABILITY
CL-56-483-001853
10/1/89
BOOILY INJURY AND
PROPERTY DAMAGE 52,000
COMBINED
PRODUCTS COMPLETED
OPERATIONS
54,500
X-7205
10/1/89
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
52.000
A
AUTOMOBILE LIABILITY
~ COMPREHENSIVE FORM ~ HIRED
[g) OWNED ~ NON,OWNED
CA-56-483-001854
10/1/89
EXCESS LIABILITY
U L -56-483-001859
10/1/89
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
53,000
A
~ UMBRELLA FORM
8
EXCESS WORKERS' COMPENSATION
(Self Insured Slales)
and
EMPLOYERS' LIABILITY
S 10,000
A
and
CALIFORNIA: WC-56-483-001 851
ALL OTHER: WC-56-483-001852
10/1/89
~
1
,
1 'J~(Gm;rl7~illJ
SEP 30 1988
WORKERS' COMPENSATION
EMPLOYERS' LIABILITY
-_.~
'./
~
'..<.-.---' .,~,-
1 lJ. ~ ('"
~'! p: '1 .~ "i':"
"Of 11\1. i; ti.I ..... ~
j ~ ... '.., .. ~
'\lA~..1E AND ADDRESS O~ C::~TIr=IC':"7E HOLDE:::; .
city of Clearwater
P. o. Box 4748
Clearwater, Florida 33518-4748
Attn: Donald J. Petersen
Risk Manager
DATE ISSuED
62
13M :fjncellation: In the event of any material change or cancellation of. said pOliCies, the companies will give
60 days written notice to the party to whom thiS certificate IS issued.
. SEE REVERSE SIDE FOR DESIGNATION OF ADDITIONAL INSUREDS,