CERTIFICATE OF LIABILITY INSURANCE (3) rE
CERTIFICATE OF LIABILITY INSURANCE 6/5/2012
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 INISURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed- If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain poftles may requIre an endorsement, A statement on this certificate does not confer rights to the
certificate holder In Ilea of such endorsement(s).
PIRODUCER CONTACT
NAME: Kris Thompson
Commercial Lines - (813)639-3000 PHONE 81 3-639-30E5 8 FAX
(A�C,No,Exq: (AIC Not 813,639 7192
Wells Fargo Insurance Services USA, fnc. E-MAII,
ADDRE55- tam t ecmn
2502 N Rocky Point Dnve, SuitG 400 INSURER(SI AE FORD04G COVERAGE NAIC IF
Tampa, FL 33607 3NSURER A Afnencan ZLJFiCl)15-ISWFarlCe CORIP20y 40142
INSURED
04SUREk 8 FIc"fida Hu,-,pitality Kifutu�fl 4is Co 10699
Ruth Fr kercl Hall, Inc
INSIJRER C
1 11 McNlLdlen Booth Roadl
NSURER E
Clecirwater, FL 33759
INGURERF
COVERAGES CERTIFICATE NUMBER; 4428717 REVISION NUMBEW See Delow
TI-HS S 10 CERT iFY II AT TI!E POl-!CIES OF INSURANCE LISTED BELOW HA:,/E BEEN ISSUED TO FHE INSURr-l-) NAMED ABOVE FOR THE POL FIE 1110D
�NDIGAII-C) N1O1VVIFIlSrAN,1)ING ANY RUQUfRC WEN,�, I-LH9,1 OR 006011-iON OF ANY CONTRACT OR OTHER DOCUMEN! VVIIH RE PLCT 10`VIE (,H H-HS
CF-,R-IIFIGArF MAY BE ISSUE[) OR MAY PERTAN, THE INSURANCF AFFORDED By HE POLICIES DESCRiBIED HEREIN IS SUBJE:CT f0 A]A, FHF FERM&
EXC','L.USIONS AND(,',OND+ FaONSOF SLICH POLL C,ES I IM ITSSHOWINMAY HAVE BEEN[RE I.)u(,lIDB'Y PAILICLAIMS,
ADDLSUSR POLICY EFF POLICY EXP
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UMBRELLA LIAB AUG96729441,03 1 05/312012 05 5i3l,'2013 --ACH OCCURRENCE
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cedfficatp holder Is lan-fed as adidifional iiisured with respecks to Genc-.cal L ability
CERTIFICATE HOLDER CANCELLATION
City of G[ea€wa[er
SHOULD ANY OF THE ABOVE DESCRIBED POI-ICIES BE CANC EE[-ED BEFORE
Parks.and Re-creation THE EXPIRATION DATE THEIREOP, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROWSiCBS.
P 0 Box 4 74 8
Clearwater, H- 33758 4148 AUYHORIZED REPRESENTA FIVE
Th, A D ,aryie and logo are rec --
gisten,54j �iwk�of ACOkl) (0 1988-2010 ACORD CORPORATION, AR dghts reserved'.
AC RD 25(201010)