CERTIFICATE OF LIABILITY INSURANCE (2)' RU�
14795
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
4/25/2012
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 policy(fes) 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 CN^OMEACT Kris Thompson
Commercial Lines -(813) 639-3000 PNONE , g13.639.3058 F'0'X 813.639.7192
(A/C. Nol:
Wells Fargo Insurance Services USA, Inc. ApDR�ESS: kris.thompson@wellsfargo.com
2502 N. Rocky Point Drive, SUIY@ 400 INSURER S AFFORDING COVERAGE NAIC M
Tampa, FL 33607 iasuReRn: Burlington tnsurance Company 23620
INSURED
INSURER B :
Ruth Eckerd Hall, IIIC. INSURER C:
i i 1 i McMulien Booth Road
INSURER E :
Clearwater, FL 33759 iNSUaee F:
COVERAGES CERTIFICATE NUMBER: 4239928 REVISION NUMBER: See below
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MMIDD LIMITS
A GENERAL LIABILITY 164B053322 09/30/2011 09/30/2012 �CH OCCURRENCE $ 1,000,000
X DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
PREMISES Ea accurrence $ 100,000
CLAIMS-MADE � OCCUR
MED EXP (Any one person) $ 5,000
X Special Events PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included
POLICY PR� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED MAY 0 2 201 BODILY INJURY (Per acadent) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS �F��� �D Per acadent
$
UMBRELLA LIAB OCCUR SRVW � EACH OCCURRENCE $
EXCESS W1B CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y� N
ANY PROPRIETOR/PARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED? � N/ A E.L. EACH ACCIDENT $
(MandaWry in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATtONS / VEHIClE3 (Attach ACORD 101, Additlonal Remarks Schedule, if more space Is requlred)
City of Clearwater is named as additional insured.
Clearwater powntown Events, Inc. is named as additional insured.
Liquor Liability $1,000,000. Founders Insurance Company. �iPR �:0 .2011
04-27-2012 Blast Friday
����� ` � RISK MANAGEMEN
�� ✓
CERTIFICATE HOLDER 5 CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
P O Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33758
AUTHORIZED REPRESENTATIVE
9��.,�,�
001651 The ACORD name and togo are registered marks of ACORD U 19SS-2070 ACORD CORPORATION. All rights reserved.
ACORD 25 (2070/OS) I IIIIIII III IIIIIII IIII IIIII IIIIII IIII IIIII IIIII IIIII IIIII IIII) IIIII IIII) IIIII IIIII IIII IIII 'CVB01A25/000814/02/02IOI0/0/0�