CERTIFICATE OF LIABILITY INSURANCE (14)D�,te: �/Z9i2011 Time: 8:51 AM 'Po; Gathy � yl�izr4��b�5r,,,,14
-256-�393 Page: QOZ
Client#: 27616 CLEA6EA
DATE (PAPAIDD(YYVY)
�4�'��I�.M CERTIFICATE OF LIABILITY INSURANCE 812g/2011
7HI5 CERTIFICATE IS ISSUED AS A NUITTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT�, HQ�pER. THIS
CERTIFICATE DOES NOT AFFIRMATIVEIY QR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFqRPED BY THE POLJCIES
BELOW. THIS CERTIFICATE OF INSLIRAMCE DOES ND'C CONSTRUTE A CONTftACT 6EfWEEN TH� ISSUING INSURER(S�, AUTHORIZEU
REPRESENTATNE OR PRODUCER, ANp TME CERTIFICATE HOLDER.
IMPORTANT: If the tertificate holder is an ADb1710NAL INSURED, the polity(ies) must 6e endorsed. lf SUBROGATION IS WAIVED, subject to
the terms and tonditions of the policy, tertain policies may require an endorsement. A statement on this certifitate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PROIXICER NAME:
IMA of Kansas, Inc. (Wichita) P"ONE 316 267-9221 I 316 26fi-6254
pIC No Ext : _� I(AIC, No�: _,w
PO BOX Z�Z E�AAII
ADDRE
WICIIIia�KS BI�LQ� INSURER(SAFFpRDINGCOYERAGE NAICA
316 267-9227 Burlington Insurance Company i23620
INSIIRER A :
I
INSUftED INSURER B :
Clearwater Beach Seafood, Inc. - ------------- ------ - ......,------------- --------------- �- ...._...- ------------------------- --- ----------- �-�-�
INSURER C : I
dba Crabby Bill's �
INSURER D : •• __ ____' _________________
_______________________________________'.._........ .- .-
3001 Executive Drive, 5uite 217 •••-•-----------------------------------" • -
INSURER E : ,_,.._ ___ I
Clearvuater, FL 33762 -----------------------------------------------------------------•-�-�• ------------------------•---------------..
COVERAGES CERTIFICATE NUM6ER: RHVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURPNCE LIS7�D BELOW HAVE BEEN ISSLIED TO THE INSUREA NAMEA ABOVE FOR THE POLIGY PERIp�
INdICATE�. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY GON7RACTOR OTHER DOGUMENT WITH RESPECT TO WMIGH THI5
CERTIFIGATE MAY HE ISSUED OR MAY F�RTAIN, THE INSURANCE AFFORDED 8Y THE POUGIES dESCR16E� HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIpNS AND CON�RIONS OF SUCH PpI.IGIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLISU6 P LI Y EFF POLICV EXP � ____-LIMI'TS
LTFi W"'�"'""""TYPE �F INSURANCE _Y 1M�'�yyY�' """"""� ._POLIC� NUMBER "_" MMIDUIYYYY� f11MlUDlYYYY���^_"�"'_W'_' ''r'�'�___�_"__�
A GENERAL LIA81LI7Y j HGLQQ284Q3 8104/Z011 08/04/201 EACH OCCURRENCE ;$� OOO DOO
_ X� COMMERCIpL GENENAL LIABILITY � j PREMISES�Ea occurrance�____+�50 OOO_____________
CLAIbISMA�E �J OCCUR � I MED EXP (Any one per n) E 1iOOO_
_ X Liqupr Liability___ I I PEHSONAL 8 ADV INJURY *s1 �O�OOQ
_ --------�...�------ --
�1�0OO�OUO I � GENERALAGGREGATE i $Z�OOO�OQO
GEN'LAGGREGATELIMITAPPLIESPER: � j IPROWC75-COMPlOPAGG ;$Y�OOO�OOO
���..... T____�"""""_'_�________
""'"'_'_,____—_
� POLICV PECa X LOC I I ;$
�AUTOM061LELIA81UTy I;B��LY�INJURVGPerLpersan} T$
.....� � - - _ _._._.. �,,.
I� ANYAUTO I_�_�,.@.a4n!...!)_____________ ___ ___ ' �______.y-...
' ALL OWNE� SCHEWLE� BDDILY INJURY (Per accidenQ j$
—____ _ ' __..""""'+_ --___
r�' �AUTpS AUTOS IpROPERTY DAMAGE �$
HIRED AUTOS p� $�E� � Per accidenl
� � �$
� � 11M8RELLA LIAB OCCUR I , � EACH OCCURRENCE I$
�i
� EXCESS LIA6 CLAIMS-MADE � � � � AGGREGATE !$
I
I UEO � RETENTION $ � ' $
;1/ifOFiKERSCOMPENSATIDN � �� I WCSTATII- �OTI+�
; ANU EMPLOYERS' LIpB141TY
YIN '
� ANY PROPRIETOR/PARTNERIEXECUTIVEI------ � E.L EACH ACCI�ENT �$
� OFFICERlMEMBER ExCLUbF'0? I N� A I �/ t� � y �
i(Mandetory In NH� L-----' � 1/� �. �1� �(.:/'^ ,j� I E.L. �ISEASE - EA EMP40YEEj $
� If yec, dasaiGa undar ! ��'�,^ � /q►��y�
I DESCRIPTION OF OPERATI9N5 6elaw � E.L. �ISEASE - PDLICY LIMIT �$
. ._........_ _..._._.. i .di\C/ �J i
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DESCRIPTION OF OPERATIONS I LOCA710NS l VEHICLES (Attech ACORD 1D7, Addltlonal Remarkc 5chvdule, If more space le requUad)
Certificate Wolder is included as Additional Insured (Landlord) on the General Liability policy if required
by written corrtratt or agreemerrt subject to the policy terms and conditians.
Loc# 1- 3T Causeway Blvd; Clearwater 8each, Fl.
Gity of Clearwater Marine
Praperty
25 Causeway Blvd
Clearwater Beach, FL 3376i
SHOULD ANY qF THE ABOVE �ESCRIBED POLIGI�S 6E CANCELLED BEFORE
THE FJ�IRATION pATE THEREOF, NOl10E VNIL BE �ELIVERED IN
AGGORUANCE WRI� THE POLICY PROVISIONS.
AUTNORIZE� REPRESENTATIVE
�-� �. �'1�-°�.r
d 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) � of 1 The ACORD name and logo are registered marks of ACQRD
#S7398101M739799 DUC
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