CERTIFICATE OF LIABILITY INSURANCE (10)12/08/2010 11:32 FAX
ACORD, 1l -
THIS CERTIFICATE IS ISS
CERTIFICATE DOES NOT
BELOW THIS CERTIFIC/
REPRESENTATIVE OR PI
IMPORTANT: If th9 certif
the temw and conditiOns
certificate holder in lieu c
WtODUCER
A11ey, Rehbaum A Co
2433 Gulf to Bay B1
P.O. Box 4620
Clearwater, FL 337!
INSURED
Carpenter Ent
OBA; Marina C
25 Causeway B
Clearwater Be
THIS IS TO CERTIFY THAT
INDICATED. NOTWITHSTA
CERTIFICATE MAY BE ISSI
EXCLUSIONS AND CONDn
TYPO OF INSUII
ITR GEry9RAL LIAERMY
X COMMERCIAL GENER
-7 CLAIMS-MADE
A
GWI. AGGREGATE LIMIT
7 POLICY M PAPT-
ANY AUTO
ALL OMCD AUTO$
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
UNRIMLLA LIAR
EXOM LIAR
DEDUCTIBLE
RETENTION S
COYPENSATB
AND EMPLOYERS' LIABIL
ANY PROPMETORIPARTh
B OFFICERIMEMBEREXCLL
1001/001
L:1:2:/08/2010'
IHWDDIYYYERTIFICATE OF LIABILITY INSURANCE AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
:IRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIFS
OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED
IUGER, AND THE CERTIFICATE HOLDER
q holder is an ADDITIONAL INSURED. the pollcyClog) must DA endorsed. If SUOROGATION 19 WAIVED, Subject to
he policy, certain policies may requlra an endorsement. A statumnt on this certificate does not confor rights to the
s; Assurance, Inc.
INSURER A
ses Inc. and Simply Dara' s , iNSURER e
INSURER C
FL 33767
INSURER E
INSURER F
7.797.5193 AICNo.7Z7.72S.5773
INSU a AFFaRDINO COVERAGE N= 0
Maryland Casualty Company 19356
Zenith InsuraoCe LoWanY 0041
CERTIFICATE NUMBER; 10-11 RMSION NUMBER;
POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NQ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
IS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE OMEN REDUCED BY PAID CLAIMS.
-POLICY EFF 3UBR .E IN9R O POLICY NUMBER N N LIMITS
PAS3165013 07126/2010 0712612011 EACH OCCURRENCE S 1,000
ABILITY pR rrem $ 1,000
OCCUR MED EXP (Any am prrson) $ 10
x PERSONAL & ADV INJURY 1,000
GENERALAQDREGATE S 2,000,
:B PER_ PRODUCTS - COMPIOP AGG i 2 , BOO,
L00
m
.?... l
COMBINED SINGLE LIMIT
(Es Kaido i
S
BODILY INJURY (Per pardon) 9
BODILY INJURY (Per awkienl) 0
PROPERTY DAMAGE
aradem)
(P?r
9
@??' iy
OCCUR EACH OCcuRRENCE S
CLAIMS-MADE AGGREGATE e;
Z833519713 07/2512010 0112512011 X YTATIH
YIN
EafrnlE E.L. EACH ACCIDENT $ 100
? N r A E L DISEASE - EA EMPLOYE f 100
-_.. E.L. DISEASE -POLICY LIMIT $ .... _,_ 500
I
nONS I VEHICLES ACORD 101 Add lor.W Remake SghedukL H R1SI0 Bowe Is required)
an AdditiNtinai Insured.
rANrFI I Alnnu
FAX: 727.462.695
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCMLAD BEFORE
" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Cl ea ter
1
Marine & Avi ion Department
Catherine AUTHOR{ZBGRESENTArrvE
25 Causeway vd
C1 rmrater, . 33767 ]ames Parenti/NCIi
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD