CERTIFICATE OF LIABILITY INSURANCE (13)Date: 6/9/2011 Time: 2:36 PM To; 917274626957
266-6393 Page: 002
Client: 27616 CLEABEA
ACORD.- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
6/0912011
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 E;
IMA of Kansas, Inc. (Wichita) PHONE 316-267-9221 No) 316-266-6254
6254
AIC NO E,d : A1C
PO Box 2992 E-MAIL
ADDRESS:
Wichita, KS 67201
INSURER(S) AFFORDING COVERAGE NAIL #
316 267-9221 INSURER A: Hanover American Insurance Co. 36064
INSURED INSURER e'
Clearwater Beach Seafood, Inc.
dba Crabby Bill's
3001 Executive Drive; Suite 217
Clearwater, FL 33762
COVERAGES
CERTIFICATE NUMBER:
INSURER C :
INSURER D:
REVISION NUMBER:
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 CONTRACTOR 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,
C
L
AIMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID
INSR LTR TYPE OF INSURANCE IN R yy pR POLICY NUMBER MM CD//YY E7
(
L
MINW INW LIMITS
A GENERAL LIABILITY RZK577886401 610412011 08104/2011 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIAUII.ITY PREMISES Ea RoNaErcance $100 000
CLAIMS-MADE 51 OCCUR MED EXP An we arson $10,000
X Liquor Liability PERSONAL, & ADV INJURY $1 000 000
000,000
$1 GENERAL AGGREGATE s2,000,000
_
,
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000
RO LOC
POLICY P
jECT
p rr
r- 1% /in r
%
$
AUTOMOBILE LIABILITY i _ COMBINED G E LIMIT
(Eg accidenl)
ANY AUTO „
BODILY INJURY (Per person)
$
AALL UTOS OWNED SCHEDULED
AUTOS
JUN
13 201 BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS (Per
T-1.11 A _ $
UMBRELLA LIAR OCCUR OCCURRENCE $
H LMIQL A SRVC DEF
EXCESS LIAR
CLAIMS-MADE
vv-? AGGREGATE $
CEO RETENTION $
. $
WORKERS CO .. .,_
MPENSATION _-..?. _.,. - ...-.... WC STATL .
1- OTH-TO Y". FP
AND EMPLOYERS' UABLrrY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICERIMFMSER EXCLUDED? F1 N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
IF yes, describe under
DESCRIPTION OF OPERATIONS below
E.I.. DISEASE • POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1111, Additional Remarks Schedule, if more spare is required)
Certificate Holder is included as Additional Insured (Landlord) on the General Liability policy if required
by written contract or agreement subject to the policy terms and conditions.
Loc# 1 - 37 Causeway Blvd; Clearwater Beach, FL
ANY OF DESCRIBED BE
City of Clearwater Marine THEU EXPIRATIIONHDATTEvTHEREOF, NOTTICEIEWILL CBE CDELIVERED NE
Property ACCORDANCE WITH THE POLICY PROVISIONS,
25 Causeway Blvd
Clearwater Beach, FL 33767 AUTHORIZED REPRESENTATIVE
316-
C 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) 1 of l The ACORD name and logo are registered marks of ACORD
#S715759/M715635 S KP