CERTIFICATE OF INSURANCE (237)
CERTIFICATE OF LIABILITY INSURANC~Tgr~~ AI DA~E~;~~7;}3
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ACORD..
PRODUCER
Wachovia Insurance Services
DavisBaldwin Division
P.O. Box 25277
Tampa FL 33622
Phone: 813-287-1936 Fax:813-282-1020
INSURED
Outback Steakhouse, Inc.
2202 N. Westshore Blvd
Tampa FL 33607
COVERAGES
TYPE OF INSURANCE
GENERAL LIABILITY
-
A X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE ~ OCCUR
~ $1,500,000 Ded
~ 1,000,000 Ded
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY n jr8,: Iil LOC
AUTOMOBILE LIABILITY
-
C ~ ANY AUTO
ALL OWNED AUTOS
-
SCHEDULED AUTOS
-
X HIRED AUTOS
-
X NON-OWNED AUTOS
-
~ $25,000 Ded
GARAGE LIABILITY
==l ANY AUTO
EXCESS LIABILITY
B ~ OCCUR D CLAIMS MADE
C
-'
I DEDUCTIBLE
XI RETENTION $ 10,000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
POLICY NUMBER
XSRO 04 J.023 S/XSROOU023 6
GENERAL LIABILITY
LIQUOR LIABILITY
TC2JCAP395J501504
TC2ECAP395J502704 TEX
741-1820
TC20UB395J499504CAF
. . --'-'-. '--~-----~JtiB395J498304Ti:i.-
OTHER
INSURERS AFFORDING COVERAGE
INSURER A: Clarendon America Insurance CO
INSURERB: American Internationa1 Group
INSURER C; The Trave1ers
INSURER D;
INSURER E;
b~'rlrrMM/DDIVY
OOCVEXPlRATI9N
DATEIMM/DDIVYI
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.
INSR
LTR
01/01/04
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
Em1:l Ben.
01/01/05
01/01/04
01/01/05
COMBINED SINGLE LIMIT
{Ea accident}
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
{Per accident}
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY;
EA ACC
AGG
01/01/04
EACH OCCURRENCE
AGGREGATE
01/01/05
LIMITS
$ 1000000
$ 100000
$ EXCLUDED
$1000000
$ 2000000
$ 2000000
1000000
$ 1000000
$
$
$
$
$
$
$20000000
$20000000
$
$
$
01/01/04
01/01/05
X ~~?':sl IUJ~-
E.L.EACHACCIDENT $ 1000000
---~=-.=-~==--" ~-~ -~ -=~~-~---~..",~
E.L, DISEASE - EA EMPLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER:
CITYOFC
City of Clearwater
100 So. Myrtle Avenue
Clearwater FL 34616
I
ACORD 25-5 (7/97)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ..3..0....- DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTrt7~~
(//tY~' ,;r _.D CORPORATION 1988