CERTIFICATE OF LIABILITY INSURANCE (15)Client#: 27616 CLEABEA
DATE (MM/OOIYYYY)
ACORD,M CERTIFICATE OF LIABILITY INSURANCE s�2si2o�2
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 AFFOROED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
IMPORTANT: If the ce�tificate holder is an ADDITIONAL INSURED, the policy(ies) 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 ;CONTACT
; NAME:
IMA, inc. - Wichita Division PHONE 316 267-9221 FA 316 266-6254
({UC No Extl: (A/C, NoJ:
PO Box 2992 � E-MAIL
ADDRESS:
Wichita, KS 67201
INSURER(S) AFFORDING COVERAGE NAIC #
316 267-9221 ' iNSUReRa: Burlington Insurance Company �23620
INSURED i INSURER B• I
Clearwater Beach Seafood, inc.
dba Crabby Bill's
3001 Executive Drive, Suite 330
Clearwater, FL 33762
INSURER C :
�--
i INSURER D :
INSURER
'INSURER
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW 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 REDUCEO BY PAID ClA1MS.
LTR TMPE OF INSURANCE I NSRL�WVD POLICY NUMBER MMID�DY� MM/DDY EXP LIMITS
A GENERALLIABILITY HGL0031184 5/15/2012 05/15/201 EACHOCCURRENCE 5� 0�� ���
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE � OCCUR
X Liquor Liability
� $1,000,000
GEN'L AGGREGATE LIMIT APPL�ES PER:
� POLICY � �E a n LOC
AUTOMOBILE IIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
UMBREIIA LIAB
EXCESS LIAB
SCHEDULED
AUTOS �
NON-OWNED
AUTOS i
OCCUR
CLAIMS-MADE
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY � Y� N
ANY PROPRIETORfPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED9 � N / A
(Mandatory In NH)
I/yes,desuibe under
DESCRIPTION OF OPERA710NS below !
JUL i 3 2012
I.EG'��L�4TIVE SRY�"S DEPT
MED EXP (My one perso
PERSONAL 8 ADV INJUi
GENERALAGGREGATE
PRODUCTS-COMP/OP
B s5
,� s1
:v � s 1
SZ
5
' BODIIY INJURY (Per person) � 5
' BOOILY INJURY (Per accident) S
� PROPERTY DAMAGE S
� Per accitlent
S
� �
�EACH OCCURRENCE IS
!AGGREGATE �S
STATU-
E.L. DISEASE - EA EMPLOYEE S
E.L. OiSEASE- POLICY LiWtiT S
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attacfi ACORD 101, AddiUonal Remarks Schedule, If more space Is requlred)
Certificate Holder is included as Additional insured (Landlord) on the General Liability policy if required
by written contract or agreement subject to the policy terms and conditions.
Loc# 1- 37 Causeway Blvd; Clearwater Beach, FL
City of Clearvvater Marine
Property
25 Causeway Blvd
Ciearwater Beach, FL 33767
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
i
I � !�. /r'G.�_�...
�O 1988-2010 ACORD CORPORATION. AII nghts reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S832595/M832553 LAE