INSURANCE CERTIFICATE (10)
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DEC-08-19'38 14: 11
CHHRTER LHI<E~; I ~~SUR~4CE
P.(H/01
. I
CER-rIFICATE OF INSURANCE
PRODUCER:
THIS CERTIFICATE IS ISSUED AS A MATTER OF
Charter Lakes Insurance Agency INFORMATION ONLY AND CONFERS NO RIGHT
P.O. Box 8797 UPON THE CERTIFICATE HOLDER. THIS
Kentwood, MI 49517-8797 CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
INSURED:
COMPANIES AFFORDING COVERAGE
Peace Harbor, Inc.
Gary Folden COMplIny
605 Palm Drive l..cttCt A - CrGNA INSUR<\NCE COMPANIES
Largo, FL 33i70 Company
utter B
COVERAGES:
This is to cenify 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 subje<:t to all the terms, exclusions. and
conditions of such policies.
Type of Insurance Policy Number Policy Effective Policy Expiration Limits
GENERAl. UABIUT'r'
^UTOMOBH",e LlABILlTY
EXCESS L1ABIUTY
WORKER'S
COMPENSATION AND
EMPLOYERS' UABILITY
PRoTEcnON AND
INDEMNITY UABILITY SPC5<i82675 01/lSt?8 01/15;99 500000
DESCRIPTION:
1996 - 26' Ocean Malilt:r
CERTIFICATE HOLDER and Additional CANCELLATION:
Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
City of Clearwater THE ISSUING COMPA.'IfY WILL ENDEAVOR TO MAIL 10
DAYS WRIITEN NOTICE TO THE CERTIFICATE HOLDER
FAX 727 462 6957 ~AMED TO THE LEFT, BUT FAILURE TO MAIL SUCH
~OTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON mE COMPANY, ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE: Wa"en Pettrson DAiE: 12/8;98
TomL P.01
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POLICY NUMBER
REN~WAL PULley lSSJL
PRODUCER
I
EFFECTIVE DATE 11/04/98
~ARKEL AMERICAN INSURANCEf>OHPANY
GLEN ALLEN, VIRGINIA I,~ lYf- /
1-800-236-2862 ~- I
BROKi:RlPRODUCER, A DR 55, ZIP COC
COMMERCIAL MARINE
DECLARATIONS PAGE
PAGE: 1 OF" 1
YOU AS NAMED INSURED, ADDRESS, ZIP CODE
AMERICAN ADVANTAGE IN SERV INC
8348 STATE RD 84
DAVIES F"L 33324
UENHOLDER, ADDRESS, ZIP CODE
NAVIGATIONAL LIMITATIONS
GULF OF MEXICO AND INLAND LAKES, RIVERS
AND WATERWAYS OF THE:. US,' .." ..~. ... J..,"
.,.".~",-~""",..~~:lt~,}(~...(Ul!j n..~'~,~~~~
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CITY OF CLEARWATER
2' CAUSEWAY BLVD
CLEARWATER
FL 34360
4
PERSONAL WATERCRAFT PER SCHEDULE
COVERAGES: This policy provides only the Insurance for which a specific premium charge is indicated below,. or which is indicated as includ(
without specific charge either below or in your policy. Detailed descriptions and any limitations will be found below orin your policy. .
ADO , AMOUNT OF INSURANCE I I PREMIUM
g~t~T~! COVERAGES , OR LIMIT OF LIABILITY ! PREMIUM CHANGE
WATERCRAFT LIABILITY-EI & PD
EXCL CREW LIABILITY
$500,000
EA O~CURRENCE
',', "- - .
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NIT 001 PREMIUM
OLICY TOTAl.:
MINIMUM EARNED PREMIUM $624.80
PLEASE REVIEW YOUR REVISED POLICY ROVISIONS
SUBJECT TO ACCELERATED CANCEL
ENDORSEMENTS APPLICABLE:
RM-0798* STWCFL1-1095 WC5001-1095 W WC5012-1 95
WC5036-1095 WC5008-0698* WC5010FL-O
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COUNTERSIGNED (DATE)
BY
NDVEl"lBER
04, 1998
AT (CITY & STATE)
ORLANDO
FL
Licensed Agent
..........,~
11/04/98
CG2C>02249
..v.JC 5000-1 095
POLICY NUMBER
. WhitenNSURED'S COPY. Blue/COMPANY'S COPY. Green/AGENTS COPY. Yellow/PRODUCER'S COPY. Pink/lIENHOLDER'S COpy.