CERTIFICATE OF LIABILITY INSURANCE (10) Ia 7!s5
CERTIFICATE OF LIABILITY INSURANCE VATE(MMfDDIYYYY)
611512011
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 T14E CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject 10
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 enclorsement(s),
PRODUCER I4NTAC7 Khs Thor ripsoch
Commercial Lines-(813)639-3000
-ance Sei vices USA, h ic. PHONE E,� 813.639.3058 al3,639,7192
Wells Fargo I nsui _tI:
]
E-MAIL kris thompson@wellsfargo.ccm
ADDRES&..........
2502 N.Rocky Point[4,rve,SUite 400
Tampa,FL 33607
INSURER A Arneduain Zwich Insurance Cofinpany 40142
..................... ........ . ...........
INSURED Ruth Eckeird Hall.Inc INSURER 8, FloNda Hospitality Mutual Ins Co 10699
1 1 1 1 1 mcmullon Booth Road IN S1�R FR C
INSURER D;
INSURER E
C!Laarwalor,FL 33759
INSURER F
COVERAGES CERTIFICATE NUMBER: 2873123 REVISION NUMBER: See below
THIS is TO CERTIFY T-ZATTHTT371ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TCJ Tl,,I['-,' INSURED NAMED ABOVE FOR THE POLICY PERIOD
NUIUA I bt). NO I VVIA HS[ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAC"T OR OTHER DOCUMENT WITH RESPECT 'ro tJVI99C I i Trips
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POIJC�IES DESCRIBED HEREIN IS SUBJECT 1'0 ALL, THE IERMS,
EXCLUSIONS AND CONDITIONS OF SUCFI POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDI MIRRI I P�oucV Oirr I POU-O EX P-
-JR-1 I Y11k,U INSURANCE I POILICYN MEER fMMIDDfYYW fMMIPRE�M LIMITS
...........
A GENERAL LIABILITY I CI D0278060506 FACI I 0G,,'%,,RRENCE
05(3 1120 1-1 05/31/2012 R-A-
I AM AUF TO RE`N--
X C OMME.RCIALGENF..R.A.I,.t,,IAI.ill.-ITY I
X
ME IT FXP(Ar,y,,,,,e
$
1 PERSZONAL&ADV INJURY
GF-NEIRAL ACOAEGATL
GENrL AGGREGATE tMAIT APPUES
PRODUCTS-COMP,01'AG,(,', $
PRO-
X
..............
—77717—
A AUTOMOBILE LIABILITY CID0278060506 05/31i201 I 05i3lQulz �.000,0010
ANY AULO BODILY INJ[)RY(FK
......................
ALI CY'NEL scirFr)l 11-r)
BIJUILY INJUNY IlEm
AU71')S AUTOS
aC.IU r.F ill Sr
I X NON-OWNED PROPERTY DAMAGE $
',D A I-ITQS 1 1
HIRL (111derli
AUTOS
UMBRELLA LIAS Coo cwx�,
A X OCCUR UMB967294101 05x31/201 1 05,31,120121 EACH OCCURRLNC-L
-
EXCESS LIAR -----------
CLAIMS MADE AGGREGATF
L)F[) 1 RELE-FI()N I
-
1 WORKERS COMPENSATION
WC.sTATI i- ()Tli-
B AND EMPLOYERS LIABI LFTY Y�N WC306-0020798-2010 V112011 1!V20-12 1-2, 3CgY L T, LE
ANY L.L.LACH A,.-,CIDEN-f S
11 fA -----------------.......-
OFF CXULUDLIJ!
(Mandalory In NI-1) E,L.Cis EASE-EA EtN'LOYE EI 1,0 0 0 U-10
If yes,describe ndw
-1
DESCRIPTION OF OPEF-�AP ONS I>elow EL D SEASE POLICY ""T
-J-
............
DESCRIPTION OF OPERATIONS;LOCATIONSIVELflCLES (Attach ACORD Y6:,Additional Ro mwkg SQhedule,!K more space i,s rectmcd),
Cerfiff(,cife hoIder is narned as additional flnsure(J with rPspects to General Liability.
.......................
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
cIly Of Clearwater THE EXPIRATION DATE 'IftNtUl-, NOUGE WILL BE DELIVERED IN
Parks and Recreation Depart m wt. ACCORDANCE WITH THE POLICY PROVISIONS,
P 0 Box 4748
AU I 11LIKILLU KEPRE JENTATIVE
Clearwater,Fl-33758-474&
..............
The ACORD aireand logo are Fegistered riarks MACORD t)1988-201'0 ACORD CORPORATION, Ail rights reserved,
ACORD 25(2010/05)