CERTIFICATE OF LIABILITY INSURANCE (23)06/07/2612 09:19 7274469147
SANDBERGEN
PAGE 02/03
�COR�� oa� cMwuoom�rr�
�.- CERTIFfCATE �F LIABILfTIf INSURA,NCE 6/7/2p12 _
THIS CERTIFICATE IS 15SUEA AS A MATTER UF INFORMATIQN ONLY AND CONFERS NO RIGH7S UPON TH� CERTIFICATE HOLOER- THIS
C�Ri'fFICATE DOE9 NOT AFFIRMIATNELY OR NEGATIVELY AM�ND, EXTEND OR ALTER 7HE COVERAGE AFFORDEQ BY THE PQLICIES
pELQW. TH13 CERTIFIGATE dF IN3URANCE DOES NOT CdNSTITUTE A CpNTRACT BE7IN�EN THE ISSUIFtG INSUR�R(S), AUTHORIT.E�
REPRE3ENTATNE QR PRODUCER, ANa TH� CERTIFICATE HQLDER.
IMPORTANT: If the certificate holdar ta an ADOITIONAL INSURED, tha po{Icy(ies} must ba endor�ed. li SUBRQGATION IS WANED, 9ubJact to
the tarms and conditiot�s of tha poifcy, deft�tin poltcles mgy reputra a� endotsementi A statemeet o� this Certificate does not confer hgfits to the
carttflcate hoider in lieu M such entlor9eme s).
PROWCEft NAMeACr Staven Sasidbo�gen
,�N� �... (727y 442-007.2 t� �t: (?27)�46-91a�
Sandberg�li iasurance Ine.
2127. NE Coac+hman Rosd
Clearaater E'L 33765-2616
inauR�o
Marina Rest�v,Xat�t
Thomas ar�d Pattx t4olko�+sky
25 Causexay Soulevaxd
Cloaxwater Heach k'L �3767-2a64
c
0
TNIS 1$ TO CERTIFY 7NA7 THE PQRI�IES OF INSURANCE L13TED BELOW HAVE BEEN ISSUED TO TWE 1NSURED MAMED ABOVE FOR 7FIE PQLICY PERIOD
INDICATED. N0T1M7HSTANDING ANY REOLlIREMENT, T�RM OR CONDIT�pN OF ANY CONTRAC'T OR OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO QR MAY PERTAIN, TM� INSURANCE AFFORDED BY 'fNE PQ�IG�ES DESCRIB�D HEREIN IS SUBJECT i0 All THE TERMS,
EXCLU510NS AND CONGITION$ QF SUCH PBUCIES. LIM�T'S SWOWN MAY HAVE BEEN REDUCED eY PAIO CL41MS•
vTYPE t!F INBURANCE �s ...�.. un� inv uen�000 iuu�n��wiin ruumnmrv�n UNKi3
QENF:IAL LIA81lITY
X CONMO@RCIAL GENERAL LIABIUTY
A CWM1S•aMDE a OCCUR X
GErrL AGCREGA� LIMR APPLIES PER:
PULICY PRa ioc
At1TOM081LE 11ABILITY
A,NV AviO
�� EO A�E�sULEb
HiRED AIJTOS �N-0WNED
��
urasrceu.n uae occuR
���gV� r.�nwc,uen�
AND EMPI.O7ER$ W191UTY
ANY PROPRIETORfPARTNflRfEXECUiIVE ❑ N J �
!N
O�F�CE�EMBER EXCLUDED7
7R40ACOF12
FJACH OCCURRENCE 5 2 ��OO � OOO
PR '� y 100��00
013 MEO Exp An ane e�+ g 5, 000
PERSONAI a aoV tt�WURV ! 2, 000, �QO
GENERALAGGRECn7E E 4, OOO, OOO
vRaouCT6-COaeProPnOG s 4,000,000
LlouefLledllN s Z.00O.00O
BOD14Y INJURY (Per pnrsan) !
JUN 0 8 201 BOCIIYINJURY(PereccMenlj S
PR DAMAOE 3
ar xc'
S
�LATIVE SRYCS DEPT �H OCCURR�NCE S
AGGREGATE i
s
wC STATU- 7'W-
� E.l. ENCM ACCIDENT t
B,L OfSEA36 - F.a. EMPLOYE 6
E.L. DISEASE - rOLILw �IMIT 3
� 1 1 1 x I �
DE�CRIP710N OF OPERAT�ONS 1lACATIOteS I YEMICLE9 (Att�ch AooRD 1et, Atltlleton�t RwnaA�s sehe�te, R maR .p�ee ia eequlndl
(727)462-6957
City oP Clparwater (Larnii.oXd)
�la.rine S Avi8tiClra AePpartmetit
Catherine Xe].lin
2S Causeroaa�,r Houlevard
C�.eax�ater, FL 33767
9HOUI.D ANY OF THE ABOVE DESCRIBED
THE PIRATION DAT� T F. N'
ACC��ANCE WITW THE iCY P f51
AGORD �5 {2D70105j � 7988-201Q A'�.Z
INS025 �2oiaos�.o� fhe ACQR� �arne and logo are regi9tered marks of ACdRA
:,s ee caNCE� eEFORE
iNILL BE DELiVEREO IN
All rights reservcd.