CERTIFICATE OF INSURANCE (5)
A CORDm
CERTIFICATE OF LIABILITY INSURANCE D6i(2M5~
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
INSURERS AFFORDING COVERAGE
INSURER A: T ; H. E. Insurance Company
INSURER B:
INSURER C:
INSURER D:
INSURER E:
NAIC#
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.
I~~: ~~~ POLK:Y NUMBER POUCY EFFEC11VE ~~~ EXPIRATION UMITS
~ERAL UABIUTY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY M3LF9992 06/25/03 06/25/04 DAMAGE TO RENTED 50,000
$
I CLAIMS MADE 00 OCCUR MED EXP (Anv one cersonl $
PERSONAL & ADV INJURY $ 1rOOO,OOO
-
GENERAL AGGREGATE $ 1,000,000
-
~'LAGGREn LIMIT APPnER: PRODUCTS-COMProPAGG $
POLICY ~~R,: LOC
~TIDMOBILE UABIUTY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
~GEUABIUTY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
::5ESSlUMBRELlA UABIUTY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ s
WORKERS COMPENSATION AND I we STATU- I 10~
EMPLOYERS' UABIUTY
ANY PROPRIETOR!PARTNERJEXECUTIVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.~. DISEASE - EA EivlPLOYEE Ii
~~:~,~~scribe under E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
OPERATES WAVERUNNERS AT: ROCKAWAY GRILL
7 ROCKAWAY ST.
CLEARWATER, FL 33767
ADDITIONAL INSURED: CITY OF CLEARWATER
25 CAUSEWAY BLVD. CLEARWATER, FL 33767
CITY OF CLEARWATER
25 CAUSEWAY BLVD.
CLEARWATER, FL 33767
SHOULD ANY OF THE MOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE,THEREOF, THE ISSUING INSURER WILL ENDEAVOR TID MAIL ~ DAYS WRITTEN
NOTICE TID THE CERTIFICATE HOLDER NAMED TID THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBUGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108)