CERTIFICATE OF INSURANCE (6)
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ACORDm CERTIFICATE OF LIABILITY INSURANCE
PRODUCER Allled Specialty Insurance, Inc
10451 Gulf Blvd.
Treasure Island, FL 33706
800/237-3355
DAlE (MMIDDIYYYYJ
6/18/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA 11:
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
m~~D National Watersports, Inc.
7 Cristie Lane
Lake George NY 12845
INSURERS AFFORDING COVERAGE HAIC #
INSURERA: T. H. E. Insurance Company
INSURER B:
INSURER C:
INSURER D:
INSURER E:
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~~ ~D'L POLICY NUMBER POLICY EFFECTlVE POUCY EXPIRA liON LIMITS
I...."..
~ERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY M4LF3804 06/25/04 06/25/05 DAMAGE TO RENTED 50 I 000
$
I CLAIMS MADE 00 OCCUR MED EXP (Anv one cersonl $
PERSONAL & ADV INJURY $ 1,000,000
r--
t---- GENERAL AGGREGATE $ 1,000,000
n'LAGGREFl LIMIT APnER: PRODUCTS. COMPIOP AGG $
POLICY ~~,e; LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
f- ALL OWNED AUTOS BODILY INJURY
(Per p8l8Of1) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per eccldent)
RGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
OESSIUMBREULA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
q DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I we STATU- I 10J~
EMPLOYERS' LIABILITY
,...i.[f,?~CP.R'IEtC;:tip,;~tHE~lEX.ECUT!VE E.L. EACH ACCIDENT $
,OFFICER/MEMBER EXCLllOED? E.L. DISEASE - EA EMPLOYEE $
g~~M~scribe under E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPlION OF OPERA liONS / LOCA liONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
OPERATES WAVERUNNERS AT: ROCKAWAY GRILL
7 ROCKAWAY ST.
CLEARWATER, FL 33767
CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED AS RESPECTS THE OPERATIONS
OF THE NAMED INSURED ONLY.
CITY OF CLEARWATER
25 CAUSEWAY BLVD.
CLEARWATER, FL 33767
SHOULD ANY OF THE AeOVE DESCRIBED POLICIES BE CANCELLED BEFO~ THE EXPIRAlION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERlIFICA TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGalTS OR
REPRESENTAllVE
AUTHORIZED RE
ACORD 25 (2001/08)