CERTIFICATE OF LIABILITY INSURANCE (9)® CERTIFICATE OF LIABILITY INSURANCE OP ID JQ DATE (MM/DDIYYYY)
CLEARl7 10
421410
PRODUCER .
THIS CERTIFICATE I ISSUED
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
83 Park Place Blvd., Ste 101 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 (33757-2456) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Clearwater FL 33759
Phone:727-461-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: FFVA Mutual lnaura Ce C=Pany 10385
INSURER B: American EG
onoLn Ins. Co. 19690
Clearwater Golf Associates Inc
dba The Landings _
INSURER C: Travelers Calty & surety Co.
19038
1875 Airport Drive INSURER D:
Clearwater FL 33765 ---?
INSURER E:
COVERAGES
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.
4
INZ?K LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEECMMIEFFE DD C/YY 'Y DATE MM/DD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
B X X COMMERCIAL GENERAL LIABILITY 02CE07957860 06/17/10 06/17/11 PREMISES(Eaoccurence)TT 31000000
CLAIMS MADE y OCCUR MED EXP (Any one person) $ 10000
PERSONAL & ADV INJURY $ 1000000
X Liquor Liability 02CE07957860 06/17/10 06/17/11 GENERAL AGGREGATE s2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2 0 0 0 0 0 0
POLICY PROJECT - LOG
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$ 1000000
B ANY AUTO 02CE07957860 06/17/10 06/17/11 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
X HIRED AUTOS RE ENE BODILY INJURY
$
X NON-OW NED AUTOS (Per accident)
PROPERTY DAMAGE $
1) 1; Min (Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
ANY AUTO
OFFICE
RECORDS
G OTHER THAN EA ACC
AUTO ONLY: $
_. w.-.. -?
AGG $
EXCESS! UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR F-ICLAIMS MADE AGGREGATE $
DEDUCTIBLE
RETENTION $
14 $
WORKERS COMPENSATION
ITY
'
BI
X TORY STAITU ER
AND EMPLOYERS
LIA
L
A ANY PROPRIETORIPARTNER/EXECVT]Vn WC84000161062009A 03/17/10 03/17/11 E.L. EACH ACCIDENT $ 100000
OFFICER/MEMBEREXCLUDED7 Il
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYE
$100000_.__._
1F yaedescribe undeSPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 O O O O O
OTHER
C Contractor's Equip QT6605315C685 06/17/10 06/17/11 60 Golf C 217258
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Clearwater is listed as Additional Insured with regard to General
Liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITOF- 8 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
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Debbie Reid
REPRESENTATIVES.
PO Box 4748
Clearwater FL 33758 AUTHORI DREP SENTATIVE
?
, t?;
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