CERTIFICATE OF LIABILITY INSURANCE (11)10087
CERTIFICATE OF LIABILITY I[�SURANCE I DATE�1AMIDDlVYYY)
1/30/2013
THIS GERTIFICATE IS tSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT{FICATE HOLDER. THIS
CERT►FICATE DOES NOT AFFfRMATIVELY 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), AU'THORIZED
REPRESEhtTATIVE OR PRODUCER, AIJD THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, ff 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 conter ri�ghts to the
certificate holder in lieu of such endorsement(s). '
vROnuc� CONTACT Certificate De artment
NAME: P
Commercial Lines -(813) 639-3000 PH°riE , g13.639.3000 F^� No : 873.63!a.7180
Wells Fargo Insurance Services USA, Inc. E�^�� clw.certre uest wellsfar o.com
ADDRESS: 4 @ 9
2502 N. Rocky Point Drive, Suite 400 INSURER S AFFORDING COVERAGE NAIC it
Tampa, FL 33607 iNSUreeR a: Covington Specialty Insurance Company 13027
INSURED
INSURER 8 :
Field's, Inc. DBA Barefoot Beach House INSURER C:
P.O. Box 3337
INStlRER D :
INSURER E :
Clearvvater Bch FL 33767
COVERAGES CERTIFICATE NUMBER: b5�b��5 REVISION NUMBER: See bela�v
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLfCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIiE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE ADDL SUBR pOLICY NUMBER MM%DDY� MM/DDY �P LIMITS
LTR
A GENERAL LIABILITY VBA21918700 1/14/2013 1/14/2014 -
EACH OCCURRENCE $ 1,000,000
X DAMAGETO RENTED
COMMERCIAL GENERAL LtABILITY PREMISES Ea occurrence S `���
CLAIMS-MADE � OCCUR MED EXP (My one person) $ . 2,000
PERSONAI 8 ADV INJURY $ 1.000.000
���� �'.� GENERALAGGREGATE $ z��.�
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ �,0�.�
POUCY PRO- �� $ -
AUTOMOBILELIABILITY ��� � � ���� EeacotleDSINGLELIMIT -
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED a�-�e y-y� ` / BODILY INJURY (Per accident) $
AUTOS Al1TOS �.d r�i��� ��.,„is" 95i�a:b d�rs 4.,i -
NON-0WNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS R o-,f'�`�°.������;� �,�-,P"G'.�- 4�zi:f,:�' Peraccident _
rhv Yi '
$
UMBRELLA LIAB p�CUR EACH OCCURRENCE $
EXCESS LIAB CLAIMSMADE AGGREGATE $
DED RETENTION$ S
WORKERS COMPENSATION WC STATU- OTI-F
AND EMPIOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N I A -
(Mandatory in NH� E.L. DISEASE - EA EMPLOYE $
H yes, describe under "
OESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarics Scbedule, it more space is required)
Rental of Beach Chairs, Umbrellas and Cabanas.
City of Clearvvater is additional insured re General Liability.
TE HOLDER
City of Clearwater
A Municipal Corporation
PO Box 4748
Clearwater, FL 33758
ACORD 25 (201U/05)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CQNCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE /� y,�q �
�(R�.SJIn,. Ji�...
P �.�T
The ACORD name and logo are registered marks of ACORD OO 1988-2010 ACORD CORPORATION. All rights reserved.
(T�is cehifirale replaces certificale3 5526269 isswd on 1!28l2013)