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INSURANCE CERTIFICATE (10) t 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 " ~4'_~_~, '_, _ :.. ,.~---r--'-~.;----~-~-~~~~~-------~;~_,~:_~___,_____,~ ~U~~~_~.1 L _~~ ~_~~_.~ ".,... ~~. - 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..~'~,~~~~ '( ...,1 ~.. ~ ~' . ..... .. . ~ 4' , ~~~..~" ,:,~),:.~:J ~'.' ,,~:..Il!IJ"""'~' 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 ',', "- - . ,~.,':;~-'~~:~~'T--:::::-"~~';:-'; -:'.~ -~;.,,~':~~-':='-:_"'~:~.:',;7'~ ~":::-~"7~'-_7-"c-~t::-o"'-",:~,.-,~-~,,,: ~".~ .--. ...;.~~__ . ..,.....!'.....-...-.....-'-l('k..,- .-:' 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 'l~' "'1 '~C'." -'.j,a"-"'--''4I.._~_~~~~,, ","; l, ..~_~l",..-_\;~,~_......~"- ....,~~ '..,:" ...' .,...:, ;... ~ "," ~ r,,.. \.. .':" --;;~.. f _.~.~.,.t". t. 'c.-..r..:..- . ...01... 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.