CERTIFICATE OF LIABILITY INSURANCE (4)
nm POLlGIES OF INSLRANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWm iSTANDING
ANY RE'JlJd~MI:NT, Tl:RM OR eONDITICN 01' ANY (,ONTAACT OR OTHffi DOCUMeNT WITH RESPeCT TO WHICH THIS CERiIFlCI\TE MAY BE ISSUE 0 OR
MAY PIOHT" IN, THE INi URANCS AFFORDED BY THE ,-'OllCIES DESCRIBED HEREIN IS SUBJECT TO All TME TERMS, EXCLUSIONS AND CONDmoNS OF SUCH
POLICIES P.GGf:EGAT:: LIMITS SHOWN MAY HAVE e':EN REDUCED BY PAlO CLAIMS,
lNSR no -~...,...-.--~
LTR NSRI ____.-!!.
GENEML L
A X ~tJ-:
---
IE OF INSURANCE POLICY NUMBER DATEiMMIIi"DiWr DATE'UVIMlDDiffi'
-
I 'BILITY EACH OCC' JRRENCE
EqCIAL GENt;RAL LIABILITY ~502CY2581862 10/16/05 10/:1.6/06 ~'es'=~
UIMS MADE ~ OCCUR MEO EY.P (;.ny onl! pe
~~--_.
PERSONAl. &ArN liIIJ
GENERAl/,GGREGA
nE LIMIT AP~lS PER: PRODUCT! " COMPII;
~T Loe .
" UA8lUTY COMeINEO SINGLE: L I
TO 6502CY2581862 10/16/05, 10/16/06 (ea acclden)
.--.
'NED AUTOS BODILY IN" URY
ULED AUTOS (~r p~I$Ol'
-
t,UTOS BDDIl Y IN~ URY
ImED AUTOS (Pet 8ctiden)
.........-............--.-.-- PROPERn DAMAGE
(pet a~<ider I)
----
.atLITY AUTO ONL'I- EA AGe:
--'--------"--
TO OTHER lHi IN
AUTO ONl' ': -
F.lRElLA LIABILITY EACH OCCJRRENCE
D CLAIMS MAD5 ~~--
4602CY258189 10/16/05 10/16/06 AGGRIOGI.'E
--IBllO
...........-..............'--
nON 510,000
'lSATION ANll X IT~~/(~ i
!~ITY 33014799 04/01/05 04/01/06
'PAIUNE~CUTJVE E.L. E!\r;H"CClOENT
---
EXC~UDED? E.L DISEA:"E - EA Ell
,NS below E.L. DISEAl;E 0 POlIe
-.
11/0i',' 2005 )WN 16: 32 FAX 7277998993
AJG TAMPA BAY4
~C'(J}Rl).. CERTIFICATE OF LIABILITY INSURANCE
THIS CERnFlCATE IS ISSUED AS A MJ
ONLY AND CONFERS NO RIGHTS UP<.
Llagher &: Co. ("la) HOLDER. THIS CERTIFICATE DOES N
i:k Dr., Suite 300 ALTER THE COVERAGE AFFORDED e.
t. 33759
7-4190 ]i'ax; 727 -791-1613 INSURERS AFFORDING COVERAGE
INSURER A; Harkel Insuranca
INSURER B: aridpfield JIlaployan zu.. C',
and GirliJ Clubs of the INSURER C;
)ast Inc:.
66th Street North Ste 200 INSURER D:
~tersburg rL 33709
INSURER 5:
PRODUCER
Arthur J. Ga
2600 )l(ccozmi
Clearwater- J1'
phone; 72'1',,75
INSUiUID
BIJYS
g11ne,
5:L11
St p,
COVERJ\lil:::S
A
GEN'l A,OOF!
J POLICY
AUTOMOBIL
:ll: ANy AU
ALL 011I
SCHED
HIRED
NON-O
G MAilE llll
~f:Y AU
E:(CEl:sJUM
A iJ CCCUR
UO'l DEDlIC
_x~mN-
WORK!;RS (;~MP"
B I!MPLO'fEiR!i' WAil
ANY PR,;)PRIIITO~
OFFICE;'VMEM8ER
Ir~, ~,~~t<: ~nd'"
SPECIAL PRl)VISIO
O'I'IlE..
DESCRIPTION OF OPERI nONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The Cert.iJ:icat.e Holder is added as an addit.ional insured wit.h respect: 1:0 the
General Liability. Fax #~;62-4e2S
CER!!E!CA,TE toOL1 lER
CANCELLATION
141002
OP I~~;r-;,~';;;:~_u
rOYS~.::.!..~_-,:h.!L07 /05
~ncR, OF fNFORM,l\TION
IN 1lllE CE'RTlFICATe
01 AMEND. EXTE:\jf) on
Y THE POUCIES ,3 I,; LOW.
~!:~~-
I>IJUC#
;iU!170
-....--.--,....,....
LlMrrB
1-
~~-
_~'~,~Q.QO, 000 ___
$ ;~;~o, 000
,~:.:~!.. 000
_$::-,-000,000
$ ;1,. 000,000
...--.--------
!j~,~ 000 1000___
,son,
Ufl"
TE
'PAGG
Mil
$ :_. 000,000
$
$
1DE!~T
r,A ICC $
AGe $
$ ;1., 000,000
$ :: , 000 tOO 0
S
$
:=I~t
$ !iI)OOOO
---------
F'LOYEE $ !i!JOOOO
YUMIT $ 51)0000
C:tTY OJ!' CLEARWA'I'D
p;1UtK &: RECREATION II!:PT
A~t''l'N J REID
P 0 HOX 474B
C::'EAHWA'l'ER J!'L 33758
SHOULD ANY OF THE ABOVE DlSSCRIBED POLlClf S BE CJ":CElLED ';.EF 0 ~" THE EXPIRATlO ~
DATE TIlEREOF, TME ISSlING 11ISURER WILL END !AVOR TO ~J1. ~i 0 ___ ClAYS WRITTEN
NOTlC," TO THE CERTIFICATE .,OLDER NAMED Te, THE ~EFr, DlIT FA1LORI~ TI) f.JO SO SHAlL
IMPOSE NO OBUOATION OR ~"',BIlJTY OF ANY KlNll UPOII THE IllSU~EF. ITS AGENTS OR
REPRESENTATIVES.
AUTHO D IU!PRES
CLEARWA
ACORD 25 (2001/0S:)
@ A5i5iiO;C::~li)'ORA.TION 19li ~
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