CERTIFICATE OF INSURANCE (11)udcdr Z/al/EVll Arne: d:3V FM TO: 9,17274626957
Page: 002
CERTIFICATE OF INSURANCE DATE (MMIDONY)
03/31/2011
/31/2011
PRODUCER AND NAMED INSURED
IE.B.S. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OF INSURANCE DOES NOT AFFIRMATIVELY OR
8722 S. Harrison St. NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED
Sandy, UT 84070 BY THE INSURANCE POLICIES BELOW.
(801) 304-5500 INSURERS AFFORDING COVERAGE
INSURED INSURER A. Prime Insurance Company
Wavejanmerz
Inc
'
.
. INSURER B
INSURER C
INSURER D
25 Causeway Bd.
Clearwater Beach, FL 33767
"LIMITS SHOWN ARE THOSE IN
OVERAGES EFFECT AS OF POLICY INCEPTION"
The policies of insurance listed below have been issued to the insured named above for the policy indicated, Notwithstanding any requirement, term or condition or 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.
POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE 0AWDDIYY) LIMITS
0 Commercial Liability SC1103028 4/1/2011 4/1/2012 $100,000 Per Person
0 Claims Made $500,000 Per Accident
? $1,000,000 Policy Aggregate
® Excuding Products and Complet
? CAmm. ercial Auto U-0blilly
Any Auto
All Owned Autos
Scheduled Autos
Hired Autos
Non-Owned Autos
O.T,R.P_D.
? Guaae Coverage
G.K.L.L.
Drive Away
D.O.C-
Cargo
On Hook
Contractual Liability
Wrongful Repossession
? Excess Liability
? Claims Made
LIMITATION OF COVERAGE FOR ADDITIONAL INSURED
Liability Coverage is only provided to the Additional Insured with respect to Accidents otherwise covered under the Policy/Coverage Contract where the Insured is found
directly liable and notwhere the Additional Insured is found independently negligent of the Insured.
DESCRIPTION OF OPERA'rIONLOCATIONSIVEHICLESIEXCLUSIONS ADDED BY E DORSEMENrISPECIAL PROVISIONS
Coverage is limited to only insured activities or operations identified in the Policy. Rental - Personal Watercraft & Jet-Skis - receipts, Rental - Bananaboat goals - units.,
Rental - Personal Watercraft & Jet-Skis - units.
CERTIFICATE HOLDER N-6", ADDITIONAL INSURE :. LOSS PAYEE
City of Clearwater - City Marina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
25 Causeway Blvd .
Clearwater Beach , FL 33767
Catherine Yellin
AUTHORIZED RE PRESENfAT"
?, T
DA-F-030 03OCT2005
I-- -v rdyel VV-3
ADDITIONAL INSURED ENDORSEMENT
PAP-99-12
This Endorsement changes the terms and conditions of the Policy issued. Please read it carefully!
The following requirements govern coverage under the Policy and must be adhered to for coverage to be
provided to the Insured under the Policy. No activities conducted by the Insured are covered under the Policy
unless they are conducted in full compliance with all of the requirements specified below and in the Policy. The
Insured must advise its employees, agents, contractors, and/or subcontractors of these requirements and ensure
that they also abide by them for coverage to be provided. The Insured agrees and understands that any
noncompliance with the following specified requirements and/or the terms and conditions set forth in the Policy
will result in the denial of coverage under the Policy meaning the Insurer will not be obligated to indemnify or
defend you.
Policy Number: SC1103028
Insured: Wavejammerz, Inc.
Effective Date: 3/31/2011
Additional Insured: City of Clearwater - City Marina
Catherine Yellin
25 Causeway Blvd
Clearwater Beach, FL 33767
Generating an additional premium of: $0.00
The "Who is a Insured" provision of the Policy shall be amended to include the person or organization scheduled
in this Endorsement as an Additional Insured for the limited purpose of liability arising from Your Work, as that
term applies to the Insured only, and subject to all other terms and conditions of the Policy and this Endorsement.
The coverage provided by this Endorsement only extends to cover the Additional Insured for allegations of
liability based upon alleged, actionable conduct of the Insured and only to the extent the Insured would have
been liable and coverage would have been afforded to the Insured under the terms and conditions of this Policy
had such Claim been made against the Insured.
The Policy expressly provides that coverage is to be construed and enforced in accordance with the laws of the
State of Utah, and the Insured has consented to the jurisdiction of the courts of the State of Utah and has agreed
that those courts shall be the exclusive forum to hear and decide disputes consisting of or relating to coverage
issues.
The Additional Insured is subject to all of the terms, provisions, conditions, exclusions, definitions, limitations,
representations, and Endorsements of the Policy issued to the Insured, and all related documents providing
coverage to the Insured. The failure of the Insured to adhere to any such provisions will also defeat coverage
under the Policy for all Additional Insureds.
A copy of the Insured Policy may be obtained from the Insured or by contacting the Insurer office in Salt Lake
City, Utah, during normal business hours.
Endorsement No.: 2
-w _- Surplus Lines Tax
Surplus Lines Fee
Rick 1. Lindsey
P000663
PAP-99-12 12DEG2007 Page 1 of 1