CERTIFICATE OF INSURANCE (3)
J A N - 0 =1' 02 (MO N I 14: 02
JI. .
ALLIED SPECIALTY
Tt-L: ILl jbJ 14UI [, UUl
A~LIED SPECIALTY ~NBURANCE. INC.
10451 CU~f BOULEV~RD, TR ASURE ISLAND, FL. ~3706
Toll F~ee 1-aOO- ~7-3355 Nation.l
1-BOO-2a2-677b Fla~id~
Ce..tiilic:ate Number: 5
CERTIFICATE OF INSURANCE
ihi& cert1'ic_te ~.1ther a~ft~mativ~l~ no~ negatively amend~; ..tends OT' .lte~&
the ~ov'raQ. ~rfo~d.d bU th. ~Qli~ij(i'l) de5c~ibed hB~.pn end i. i56U~d as a
mG~t'r of Info~m.tiQn ~nd Conf8~. no right ~pdn the holq.~.
Th8 poli~u(ies) 2dentifie~ below by . PQlic~ number i. in force on _he d.tw of
'.rtlf1cate i5~uance. In5urance iti affOrded onlu with respect to thot.
coveraQPI far Which a 9p.c~fic limit of liabilit~ h.s be.n ente~ed .nd is
subjlct to ~ll t~T'm~ of thw policy ~aving Telerence thereto. Nothing herei~
contained ~hall modify ~nw pravi~ian of ~.id p01icW.
In the event of t4ncellation of th. PQlic~. the company is.vine said ~Qli~y
luill m.ke ~11 ~ee.sanabl. effort to lend Notice of C_n,el1.tlon to th.
certj'i~at. hold~r at the ~ddr.a5 ;hp~n h.~~inl but the COMpanu assume. no
raspon~ibilitiQ6 for an~ mi.t~ke Q~ failure to give such nati,e.
An~ l1Hturanc:e m~d. a part of the polic~ inclLlde~ ali. per$on inSured usith
~espect to an occurrence taking place .t a Wate~spo~ts _it.. (1) the
Foir or exhibition association. lipansarlng org~n1:atian or committ~. (2) the
owner O~ le~5@e the~. of (~) . qunic~palitij gr.ntin~ th. N~med Insured
p~rMission tp operate 8(n) Watersportl. b~t Qnl~ as respects bDdily
inju~~ or py'op@rty damage c~LI.ed by or cantributed t~ by th. neiligence of tha
N~med Insured while actlng in the CD"r~e ~nd 5CQpe of t~ei~ emp oijment.
tW1E *c ADDRESS OF' INSURED; I\DDITIaNAL IN6URED~
National Wat~Tsport.1 tne, CITY OF' CLEARWATER
7 CT'itotie LanEP
Lakll George
NY 12G45
NNtE 81 ADDRESS OF CERTIFICI\TE tG-DEA:
CITY or CLEARWATER
25 CAUSEWAY B~VD.
CLEARWATER, rL ~37~7
DATES:
...--EIlln&RY ctOVl8"i~
Gpmp.-nll: '", H. E. IIHlu.,.afltlt
C a mlum \I
PQlicy Number: M1LF'SJ74
LIAnI~ITV LIMITS
B I IPD AGG: ,,1, 09P, 000
oce: $t,OOO,OQ9
EX~E88 CDYEl'~
BodU" Injury ~
Prape1'ty Dacnage
~
ElCC.'~ of
.0
.0
Bodily In.jury ~
PrQperty Oam<ilge
to
FQod P~odu~t~: $0
Pclicy periOd:
r1'om:
To:
Ext.llili of
18 ~:
~
00/00/00
00/00/00
LIMiT
Ob/15/01
06/15/02
00/00/00
00/00/00
* - COMfiIN&O SINGLE
CQver~g~ ~hnwn herein applie$ onl~ to those item. 5cheduled on Dr .ndo~~.d to
ttls pollc~.
This f.~tificat. is nat valid un!..s an OTitinel .iln.tb~. .pp..~. b.law.
(Cople. Not Valid)
..Ja~ ,. ,ao,
trA'l1: Of' nCA 95uMcE
~l;_(j&~
A ALLIED SPECIAL TV INSURANr.F I~r.
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