CERTIFICATE OF LIABILITY INSURANCE,�� OF' Ib: PR
ACaR�'" UATE (MMIOG/YYYY)
�� CERTIFICATE OF LIABILITY INSURANCE 09/29/11
TH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CQNFERS NO RIGHTS UPON 7HE CERtIFICAtE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POI.ICI�S
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 15SUING INSURER�5), AUTHORIZE�
REPR�SENTATIVE OR PRODUCER, AND THE CER7IFICATE H�LDER.
IMPOR7ANT: If the certificate holder is an ADDITIONAL INSURED, the policy�ies) must be endorsed. If SUBRaGATION IS WAIVED, su6ject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does npt confer rights to the
certificate hvlder in lieu of such endorsement�s).
PRODUCER
%Z%"�%-B�LS� NAMEACT
Bouchard-Clearwater 727-449-1267 PHONE ac, No�:
101 StarcrestDrive ruc No EM: _._.._,....._,,,�..,_�
P O BOX GO9O E-MAIL
AOURE33:
Clearwater, FL 33758-6090 PRODl10ER CLEA-37 �~ �
Josh Bouchard CUS70MER ID #: �_,,_�,,,,_,__
iNSUREO Clearwater Marine Aquarium
Mr. David Yates
249 Windward Passage
Clearwater, FL 33767
COVERAGES CERTIFICATE NUMBER:
INSURER�S) AFFORDING COVERAGE
�r,suReRn:Scottsdale Insurance Campany
iNSURER e: Indemnity Ins Co of North Amer
iNSUReR c; Aspen Specialty Insurance Co
�NSUReR o: Travelers Insurance Company
�r,suReR e: United States Liability Ins Ca
NAIC #
1297
1071T
87726
,-:_--
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELQW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. N�7WITHS7ANbING ANY REQUIREMENT, TERM OR CONDITION OF ANY GON7RAG7 OR Q7HER bOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEP OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT tQ ALL 7HE TERMS,
EXGLUSIONS AND CON�ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY MAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE � � POLICY NUMBER MMlDDr/VVYY MMlDD/YYYY �� ��MITS
LTR
GENERAL LIABILITY EACH OCCURRENCE S 1,000,00
l�1 i� COMMERCIALGENERALLIA8ILITY CPS1240107 10/01N1 10/01/12 �WV�� ���,00
PREMISE5 Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (My one person) $ 5r��
B X P811nsurance HUN0087'6008008 10/01111 10I01112 pERSpNALBA�VINJURY S �,���r��
GENERALAGGREGATE � $ Z,OOO�OO
GEN'L AGGREGATE LIMIT APPLIES PER: PRp�UCTS - COMP/OP AGG $ Z,OOO�OO
X PpLICY PR� LOC P&I Liabi $ ��������
AUTOMOBILE LIABILITY COMBINEd SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURV (Per person) $
ALl OWNEp AUTO5 �""-"
60DILY INJl1RY (Per accident) $
SCHE�ULED AUTOS """"�"""""
PROPEFt7Y DAMAGE $
HIRED AUTOS (Per accidenl)
NON-OWNEDAU705 YW� $ T�Tf
$
UMBRELLA LIAB X OCCUR EAGH OCCURRENC� $ g�OOO�OO
EXCESS LIAH ��q�M5-MADE AGGREGATE $ 9�000�00
--- -� - -- -- __. .__�.:�.�__._.._� . _ ---c-x�,a�a�r�o-=----- ---- - �s�,,, - -�aw-�itz- - =.._�z
oeoucris�e --- - -- -$ --- -- --- --- -
X REiEN710N S $
WORKERS COMPENSATION WC STATU- OTH-
AN� EMPLOYERS' LIABILITY Y� N T Y 1 I R
� ANY PROPRIETOWPARTNERlE)(ECUTNE ❑ N/ A E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDE�7 ""-""""'
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under �m� ���� ��
DE5CRIPTION OF OPERATIONS 6elpw E.L. bISEASE - POLICY LIMI7 $
�] ERISA 6ond �70,OD0 105420842 03I23I10 03123l13
� D80 $5,000,000 ND01042863G 10/07/71 10/01/12
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 107, Addltional Ramarks 9chedule, IT mvre spa S required)
R�; F2EN7AL SPACE AT HARBQRVIEW CENTER, 320 CLEVELAND STREET, CLEARW R,
FLORIDA
i«
CITY QF CLEARWATER
112 S. OSCEDLA AVE
CLEARWATER, FL
CITY OF
CANCELLA'
SHOULD ANY OF THE A80VE DESCRIBED POLICIES 8E CANCELLED BEFqRE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORI2E0 REPRESENTATIVE
�
� 1988-2U09 ACORD CORPORATION. All rights reserved.
ACORD 25 (20U9l09) The ACpRD name and logo are registered marks of AC�RD