CERTIFICATE OF LIABILITY INSURANCE (11)ACORDM CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER pF INFORMATION ONI.Y ANp C�NFERS NO RIGHTS UPON 7HE CERTIFICATE HOLDER. THIS
CER7IFICATE DOES NOT AFFIRMATIVELY bR NEGATIVELY AMEND, FXT�ND QR ALTER THE COVERAGE AFFpRDED eY 7HE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CON7RACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRO�UCER, AND THE GER7IFICATE HOLDER_
IMPOR7ANT: If the cenificate holder is an ADDITIONAL INSUREp, the policy(iea) must be endorsed. If SUBROGATION IS WAIVEP, subjact to
the terms and wnditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
csrtifcate holder in lieu of such andorsement(s).
PRO�UCER NAME�
Alley, Rehbaum & Capes Assurance, Int. a�Na�:7Z7.797.5193 aicr
2433 Gul f to B�,y Bl vd. qp�RESS:
P.O. Bbx 4620 R°°ucER . 00007357
cusro �
�7@di'Wcit21'� FL �37SH � INSURER�S►AFFDRDIN.GCOVERAGE
INSURED INSURER A- Mdi'y� a11d C75Ud� ty COII�iciily
Carpenter Enterprises In�.
DBA: Marina Gifts
Z5 Causeway Blvd.
Clearwater Beach, FL 33767
wsuRERa: Zen9th Insurance
INSURER C :
�NSUReR o :
INSURER E : �
INSURER F :
oa7E (MMinDm^rv)
O8/11/2011
727.7Z5.5773
NAIC #
1s3ss
0041
COVERAGES CERTIFICATE NUMBER: 11-12 REVISION NUMBER:
THIS IS TO CERTIFY THAT TH� POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE� NAMED A80VE FaR THE POLICY PERIOD
INDICAT�p. Np7WITHSTANDING ANY REQUIREMEN7, 7ERM QR CONDITION OF ANY CON7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUE� OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRI6ED HEREIN IS SUBJECT TO ALL 7HE TERMS,
EXCLUSIONS AN� CONpITIONS OF SUCM POLICIES. LIMITS SHOWN MAY HAV� eEEN REDUCED BY PAI� CI.AIMS.
INSR TypE OP INSURANCE ADDL SUBR ppLICY NUMBER MIUODY� MMIDDIVYYY LIMITS
LTR INSR WVp
GHNERAL LIABILITY PA5316 5U13 07/25/2011 �%�Z�Z�� Z EACH OCCURRENCE S 1� ��� 0�
X COMMERCIAL GENERAL LIABILITY DREA occurcence a 1 OOO � OO
CLAIMS-MAOE � OCCUR M�p EXP (Any one person) S 1O � OO
A X PERSONAL & A�V INJURY $ 1� OOO � OO
GENERAL AGGREGATE S Z� OOO � OO
GEN'L AGGREGATE LIMIT APPLIES PER: � PRDOUC7S - COMP/OP AGG 5 �� OOO � OO
X POLICY jE� LOC �. ...-����1 ��"' $
AUTOMOBILE LIA0ILIN COMBINE� SINGLE LIMI7 §
L, �� � � ��� (Ee eccident)
ANY AUTO �! � BOpILY INJURY (Par person) $
ALL OWNED ALITOS BODILY INJURY (Per accident) $
SCHEpUIEbAUTOS y„oa�,`�"��,,I� �{,��y� ��'+,j� � pROPERTY DqMAGE a
�.����6N111V1_:.��A"w �.,7 �,l�rj (Peraccidant)
HIREb A11T05 .� �
NON-OWNED AUTOS $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE 8
EXCESS LIA6 �LAIMS-MADE AGGREGA7E S
OEpUCT16LE $
RETENTION 3
a
WORKERSCOMPENSA7IQN Z83351971 07/25l2011 0712512012 X WCSTATU- OTH-
AND EMPIOYERS' WAelLlll' y/ p TORY LI IT
ANY PROPRIE70RlPARTNER/EXECUTIVE E.L. EACM ACCI�ENT b ZOO � OO
B OFFICER/MEMBEFt EXCLUDED7 � N I A
(Mandatory in NH) E.L. �ISEASE - EA EMPLOYEE S ioo � 00
It yes, descnbe under E.L. DI5EASE - POLICY LIMIT a 500 00
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERAi19NS / LDCAl10NS / VEFIICLES (Adach ACOR9 7D7, AddRional Remarks Schedule, H moro space is raquired)
ity of Clearwater is an Additional Insured for General Liab'ility
CERTIFICATE HOLDER
FAX: 7Z7.462.6957
City of Clearwater
Marine & Avia#ion Department
Ca�herine
25 Causeway Blvd
Clqarwater, FL 33767 �]ames Parenti N/ CH
� 1986-2009 ACC
The ACORD name and logo are registered marks of ACORD
GANGtL1..A I IUN
SHOULD ANY OF THE ABQVE DESCRIBED POLICIES 8E CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DEI.IVERED IN
ACCORPANCE W17N 7ME POLICY PROVISIONS.
AU7HOWZEU REPRESENTATIVE
ACORD 25 (2009/09)
��7.�—'"',
TION. All rights reserved.