CERTIFICATE OF LIABILITY INSURANCE (16)Client#: 13438 CLEARCOMMU
ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE(MMVDDIYYYI�
11 /07/20'12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI;3
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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject 1:0
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights ta the
certifcate holder in lieu of such endorsement(s).
PRODUCER NAME: �
Gowrie Group ac"N Ext : 860 399-5945 ac, No : 8603993615
70 Essex Road E-MAIL �-
ADDRESS:
Westbrook, CT 06498 INSURER(S) AFFORDING COVERAGE NAIC �
860 399-5945
iNSUReRa: Federal Insurance Company 202�1
INSURED INSURER B :
Clearwater Community Sailing Assoc.,lnc INSURER C:
1001 Gulf Blvd. --
Clearwater, FL 33767 INSURERD: _
l I INSURER F: � �
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEI710D
INDICATED. NOTWITHSTANDING ANY RE�UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 'iHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEI�MS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
INSR WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY ,
A GENERAL LIABILITY 35823516 11/06/2012 11/06/201 EACH OCCURRENCE $ � ��� �04
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occTuErence $ � OOO OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � O OOO .
PERSONAL 8 ADV INJURY $ �,OOO,OOO
��� � GENERALAGGREGATE $Y�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s includeci
POLICY PR� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
!\o� � Pj �o�� Ea accident _
ANY AUTO 3 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
HIRED AUTOS NON-OWNED ���'�� �� PROPERTY DAMAGE $
AUTOS Per accident
%.���TI�6'� S� CS �� $ .
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY -
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED7 � N/A -
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes,describe under -
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
The City of Clearwater is named as Additional Insured/Landlord on General
Liability Policy only ATIMA with respect to insured's use of holder
premises.
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BI�FORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERE:D IN
25 Causeway Boulevard ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33767
AUTHORIZED REPRESENTATIVE
O 7988-2010 ACORD CORPORATION. All rights re:served.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S59084/M59083 MED