CERTIFICATE OF LIABILITY INSURANCE (7)_
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BEI_C)Vt FHI.` CEF?TIP1CA][F: OF INSURANCE OLS NOT CONSTITLITF" F, ?_,31NTRA T BETWEEN TFE I
RIPRLSENIA'lIVE (:)R Of'?ODU'CER, Ai'€D I,iIE CLRTIFICATL HIOLC?EL-%.
IP.1POR,TANT. If the cerfficate holder i,, an ADDITIONAL NsuRED, the policy{i• .} rt7ust be endorsed. Ir
the terms and conditions of &Ic- policy, certain policies: may require an endorses Wr,c. A statement on this
cartlfic,ste holder in fieE_I of such er dorsernpnt(s).
Cammercla l l II Es I,u 13j 1= I'?ul
`b`ells Far, -1_I?ii per Ise -;A, Inc.
2502 Fi. Rack, :-'hint Drive, Suite 400
T'ampa, FL 33607
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ANY OF THE ABOVE CECFI' F'l
T is ION BATE THEREO7
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AGO R F,
°0 CERTIFICATE OF LIABILITY INSURANCE DAT2/23/20111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
l
813
639-3000
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C NO?NEACT Certificate Department
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ommeraa
_ fAI . 813-639-3000 aC No ; 813-639-7180
Wells Fargo Insurance Services USA, Inc. uest@welisfar
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ADDRESS:
ADDR
2502 N. Rocky Point Drive, Suite 400 PRODUCER 6689
r,USIOMERID •
Tampa, FL 33607 INSURER(S) AFFORDING COVERAGE NAIC #
INSURED sociated Indemnity Corp 21865
Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions Cor
oration
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t 218$1
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RERB
P O Box 333 7 ff
INSURER E :
Clearwater FL 33767
INSURER F :
COVERAGES rERTIFICATE Numsi;R: 2385637 REVISION NUMBER: See below
THIS IS TO CERTIFY THAT 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE ADDLI SUBR
POLICY NUMBER POLICY EFF
MIDD POLICY EXP
MM/DD/YYYY LIMITS
A GENERAL LIABILITY MZX80928263 02/15/2011 02/15/2012 EACH OCCURRENCE $ 1,000,000
X_
COMMERCIAL GENERAL LIABILITY -OAMAGE To TED
PREMISES Ea omireng:al
$ 100,000
CLAIMS-MADE FxIOCCUR MED EXP An one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000.000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO- LOC $
A AUT OMOBILE LIABILITY MZX80928 02115!2011
1 02/15/2012 COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS FEB 25 2011 PROPERTY DAMAGE
X
HIRED AUTOS (Per accident) $
X
NON-OWNED AUTOS ryry?? A' +?
I'`FILI
REC
$
/L
ORDS $
B UMBRELLA LIAB x o ;CUR XAU48392564 " 5/2011 02115/2012 EACH OCCURRENCE $ 1,000.000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DEDUCTIBLE $
RETENTION $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
?
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) NIA
E.L. DISEASE - EA EMPLOYE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
RE: 10 Pier 60 Drive, Clearwater Beach, FL 33767
Rental of Beach Umbrellas, Chairs and Footstool
The City of Clearwater, A Municipality is an Additional Insured with respects to the above General Liability policy.
CERTIEIr_ATF Flnl nFR CANCELLATION
City of Clearwater
25 Causeway Blvd
Clearwater, FL 33767
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
U 195$-2009 AGOKU1 GUKI'UKA I IUN. All rights reservea.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD