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CERTIFICATE OF LIABILITY INSURANCE (10)OP ID: SW `4�°� °- CERTIFICATE OF LIABILITY INSURANCE DATE 07 /14D/YYY() 07/14111 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 pollcy(les) 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 72761 -6044 Brown & Brown of Florida, Inc. 727.442 -7695 83 Park Place Blvd., Ste 101 P.O. Box 2456 (33757 -2456) Clearwater, FL 33759 William Hancock CONTACT NAME: PHONE FAX iA .N,. Eem (NC, No): SUBR WVD E ADDRESS: PRODUCER CLEARI7 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Clearwater Golf Associates Inc dba The Landings 1875 Airport Drive Clearwater, FL 33765 INSURER A: FFVA Mutual Insurance Company 10385 INSURER B: American Economy Ins. Co. 19690 INSURER C :Travelers Cslty & Surety Co. 19038 INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED ISSUED TO CONTRACT THE POLICIES BY POLIO'tFF (MMIDD!YYYY) THE INSURED OR OTHER DESCRIBED PAID CLAIMS. (�LICP EXP (MMIDD/YYYY) NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, INSR LTR ')YPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR X 02CE079578780 02CE0795788780 06/17/11 06/17/11 06/17/12 06/17/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES f Ea occurrence) 5 1,000,000 CLAIMS -MADE MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 X Liquor Liability GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT 7 POLICY PRO- JECT APPLIES PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS" SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 02CE079578780 !' 6S RECEIVED A �^� VVV JUL 2 1 2011 06/17/11 — 06/17/12 COMBINED SINGLE LIMIT (Ea accJdent) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accdent) $ PROPERTY DAMAGE (Per accident) $ $ S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS. MADE (AVILIAL RECORDS ANC, LEGISLATIVE S 1C 5 DEPT EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AND ANY PROPRIETOR/PARTNEWEXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC84000161062011A 03/17111 03/17/12 X WC STATU- OTH- - TORY LIMITS °R E.L. EACH ACCIDENT $ - 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Contractor's Equip OT6605315C685 06/17/11 06/17/12 60 Golf C 217,258 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Clearwater is listed as Additional Insured with regard to General Liability. CERTIFICATE HOLDER CANCELLATION CITOF -8 City of Clearwater Attn: Debbie Reid PO Box 4748 Clearwater, FL 33758 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 -r-. ACORD 25 (2009/09) cc ' .LIZAAIL CSC © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD