INSURANCE CERTIFICATE (7)
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CERTIFICATE OF INSURANCE
Certificate Number: 1
Thj~ certif leate neither affirmativeLy nor negativeLy amends, extends or aLters
the ..:.ov~~r-i:l~je afflJ1"ded by thC0 Pol.icy(ies) descl"ibed hf.~n:~on and is; h:;';:;ued a~:; ~\
tni:dt,:.,)r of inf{n"mation and COnff?)"!:; nc. i"i<,:Jht upon thE- /')ol.de.....
TI'l(;.~ poL Ic:Y( ies) ident if led b€-!l.ow b)" a poL icy' numtH?i" is in f()....c:E~ on ttH:~ d.::ib'0 of
re....tificatE' i!;:-suanee. InSUi"Clnce i~;; affo',"ded only \.\.lith )"esPf:~ct to those
,:: 0 V (:,),,:. a 9 (0-::; for w hie has p e C i fie l i i!l i t 0 f I. i a b i Lit y h a.:;; b ~:~e n E' n t (.? r' E' d "Hi d i,:;;
~:.,ub Ji.:-!c:t to lZll.l tel-ms of the pol ic;y havi ng 'f'ef'e'f'E'nCf2 ther'eto. Nothi n~J h(.::)"(.;,'1 n
con*ained shall modify any provision of said poLicy.
In t!..!(.~, t~'v(;~nt of c..~nceLl.ation of the poLicYt the company issuing j:;aicl potic;l
';.Ii!.!. makl~~ all l-eason.:;lbLe (.0ffo".t to sf.:nd Notice of Cancelldtion '1:0 th'::~
certi1'i(::..ite holdl}'~ll-at Ute. a(;ldn:'~'1!i~; shol,A1ft l'i€'rt"int but 1.'11,::: COil1P.any .t-iSSUiflE:S no
r<'?spons it.li I. it ies for' any mistakf? (nO fall.uretogivensuch noti(~e..
Any Insurance made a part of the poLicy IncLudes as a person insured with
respect to an occurrence taking place at a Watersports site, (1) the
Fail" 0 \- ex h i b j t ion ass 0 c i -,':) 'I' ion t S pons 01- i n 9 0 r. 9 ani z a t ion () I" C 0 mm i t 1.' e f,,- ( 2) t l"t >:;'
owner or Lessee there of (3) a municipality granting the Named Insured
p(21"lnj~.;s ion to operat(,? a(n) Watel"sPO\..ts, but only as; l-espects bodi ly
injurY or property damage caused by or contributed to by the negLigence 01' the
N,:HIl(,,'d I nSI.li-ed wh i le act i ng in the C:OU1'"'i:;e and scope of the il- €tmp Loym~)nt.
NA ME: ~ AnDRESS OF INSURED:
Na 'l: i on a I. W.:ite'( sF' OJ'' t!',;
240 Wi ndward Pass ~ 201
C I. (;~,:irw <':l h:~'('
Fl... J46 30
ADDITIONAL INSURED:
City of Clearwater
NAME ~ ADDRESS OF CERTIFICATE HOLDER:
Ci tv of CLearwater
~2::; t;a U i,;.;!:,\.'.j"t Y B l V<'J
CLearwater, FL 34630
DATES: 04/24/?7
_._.E:RIMARX.._CQVEBAGE_. ._. _.....EXCESS_.CQVERAGE........
T . H . E. :r Tl !:;U i...:1 nc t:~
C omp.~ ny
Po I. icY Numb er: 97LF6643
LIA):U:U: TY LIMITS Bod i Ly Inju\"y ~
BI/PD oce: 11~QQQ~QQQ__________ Property Damage
A GO: 11.t.QQQ.t.QQQ.... ....,......"........... __._.... IQ_............................._.......... ..__.............
C ()ill Fii:\ ny :
Food Products: IQ__________________
Po I. i C'y pel" i od:
. F~" 0 m: {) 4./24 /97
To: 04/24/98
E xc t'ss of
IQ________________
iQ________________
to 04/24/98
Bodi Ly Injuxy I,!.;
Pro Of) t?T ty Itamaq E\
IQ.........................................................".....
Ex ce~;;s 0 f
IQ________________
12-_____----------
{~.O ,I 00./ 0.0 <:.0,1 0 (:.,1 <~.O
00/00/00 00/00/00
* - COMBINED SINGLE LIMIT
C>:i\f':.:n..a~H:.~ ';,;hol.A.ln l1en:-!in appli€-!s only' to thils;e itE~ITr5 '5chE)duled on 0\" enclor":;ied to
tl"lii1 po l iC:Y.l
This certificate is not valid unless an original signature appears below.
(Copies Not VaLid)
A.. ... I ~l"" 1 0<:'''''
DA Tj~""o f:11:~b~ Ft:fI~ I"cAT~J.. INSURANCE
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AUTHORIZED
A
ALLIED SPECIAL TV INSURANCE, INC.