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CERTIFICATE OF LIABILITY INSURANCE AND EVIDENCE OF PROPERTY INSURANCE6689 CERTIFtCATE OF LIABILlTY INSURANCE ( DATE(NIM/DD/YWY) ?.l7Y2013 THIS CERTIFICATE tS �SSUED AS A MATTER OF INFORMATION ONIY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLI7ER. THtS CERTtFICATE DOES NOT AFFIRMATIYELY OR NEGATIVELY AME1�4D, EXTEND OR ALTER Tt1E COVERAGE AFFORDED BY THE POLlCIES BELOW. THIS CERTiFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TFFE ISSUING INSURER(S), AU'fHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPURTANT: If the certificate 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 dces not confer ri��hts to the certificate hoider in lieu of such endorsement(s). PRODUCER NAMEACT Certificate Department Commercial Lines -(813) 639-3000 PHONE . g13-639-3000 aC N, : 813-639-7180 Wells Fargo Insurance Services USA, Inc. AppR�� ciw.certrequest@wellsfargo.com 2502 N. Rocky Point Drive, SUIt@ 4OO INSURER S AFFORDING COVERAGE NAIC # Tampa, FL 33607 �NSURER A: Associaied lndemnity Corp 21865 INSURED INSURER B: N8t101181 SUfBty COfPOfBtlOft 21881 Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions INSURER C: P O Box 3337 ,,,,,,,,,�„ „ _ Clearwater FL 33767 COVERAGES CERTIFICATE NUMBER: 5575061 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLfC:Y PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO NJHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAfN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TI-IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. IIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDlYYYY MM/DDM(YY A GENERAL LIABILITY MZX80938110 f .� 2/15/2014 - EACHOCCURRENCE $ ��•� X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED �pp,000 PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP (Any one person) $ . 10,000 � y'4 v� sn I'6f;�� t �� PERSONAlBADVINJURY $ 1,000.000 m a'�L„� _ _ GENER,4L AGGREGATE $ 2��.�� GEN'L AGGREGATE UMIT APPLIES PER: ��'r6�€,.�Zj, � i"a�'�,�k ��e y: �. � PRODUCTS - COMP/OP AGG $ _ 2.�� POLICY PRO- LOC t ";�°;'°fi(.' .. 'e'= � � ,-�� ...�.,�.. . . $ A AUTOMOBILE LIABILiTY MZX80938110 02/15/2013 02/15/2�14 COMB�NED SINGLE LIMIT � Q� � Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS . NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ . $ B x UMBRELLA LIAB x occuR XAU00024184582 02/15/2013 OZ/15/2014 �CH OCCURRENCE $ . i.000,000 EXCESS LIAB CLAIMSMADE AGGREGATE $ �.0�� DED RETENTION$ � $ WORKERS COMPENSATION WC STA7U- 07FF AND EMPLOYERS' LiABILRY Y/ N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A - (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is additional insured re General Liability. Named Insured includes Pier 60 & Barefoot Beach House CERTIFICATE HOLDER City of Clearwater Parks and Recreation Attn: Billie Kirkpatrick P.O. Box 4748 Clearwater, FL 33758 ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLI: D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE jj �(.tar��i�.. ��T The ACORD name and logo are registered marks of ACORD OO 1988-2010 ACORD CORPORATION. All rlghts reserved. 6689 EVIDENCE OF PROPERTY INSURANCE I DATE(ANMIDD/YWY) ti2or2o� s THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U�ON THE ADDI710NAL INTEREST NAMED BELOW: THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETVW�EN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL IN7EREST. AGENCY PHONE 813.639.3000 COMPANY Commercial Lines -(813) 639-3000 Wilshire Insurance Co. Weils Fargo Insurance Services USA, Inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 F!!?� „_,.813.639.7180 E:.Mai�,,,, clw.certrequestC�wellsfarqo.com CODE: SU8 CODE: INSURED Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions P. O. Box 3337 Clearwater, FL 33767 LOCATION/DESCRIPTION 10 Pier 60 Drive Clearwater Beach FL 33767 13234 LOANNUMBER EFFECTIVE DATE EXPIRATION DATE 2/15/2013 2/15l2014 THIS REPLACES PRIOR EVIDENCE DATED: POLICY NUMBER CP00063040 CONTINUED UN'IIL TERMINATED If CNECKED THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IPJDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION .OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIi1CH THIS EVIDENCE OF PROPERTY �NSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IFtERE1N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CtAIMS. COVERAGE INFORMATION , COVERAGE / PERILS 1 FORMS AMOUNT OF iNSURANCE DI:bUCTIBLE Building - Gift Shop & Concession Stand - Replacement Cost 250,000 1,000 [iusiness Personal Property - Actual Cash Value 50,000 1,000 Business Interruption - 1/4 Monthly Limitation 150,000 Special Form excluding Wind/Hail proof of coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPtRAT10N DATE THEREOF, NOTICE 'WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NAME AND ADDRESS The City of Clearwater A Municipal Corporation � lA0 STPAYEE �X � I ADDITIONAL INSURED IOAN ii 25 Causway Blvd AUTHORIZEO REPRESENTATIVE /� �JC ,..._ Clearwater FL 33767 � ACORD 27 (2009112) The ACORD name and logo are registered marks of ACORD OO 1993-2009 ACORD CORPORATION. All tights; reserved. 470995 00000� I Iilllll Iillli IIII Ilii IIIII flllil IIII IIIiI IIIII IIIII filll IIIII IIIII IIIII IIIII IIIII IIII IIII A Om' DATE (MMIDD/YY7Y) OR EVIDENCE OF PROPERTY INSURANCE 2/20l2013 —�� TNIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW: THIS EVIDENCE DUES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX7END OR AL.7ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETVNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY PHONE 813.639.3000 COMPANY Commercial Lines -(813) 639-3000 Phoenix Insurance Company Welis Fargo Insurance Services USA, inc. 2502 N. Rocky Point Drive, Suite 400 Tampa, FL 33607 F.^.?� ,._,_ 813.639.7180 E:t^p��,.,. clw.certrequestCc�welisfarqo.com CODE: SUB CODE: INSURED Alexandra of Clearwater Beach, Inc. dba Pier 60 Concessions P. O. Box 3337 Clearwater, FL 33767 LOCATION/DESCPoPTION 10 Pier 60 Drive Clearwater Beach FL 33767 25623 LOANNUMBER EFFECTIVE DATE EXPIRATION DATE 09/06/2012 09/06/2013 THIS REPLACES PRIOR EVIDENCE DATED: POLICY NUMBER BM213C11669A CONTINUED UNTIL TERMINATED IF CHECKBD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIOtV .OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIiICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I�IEREIN IS SUBJECT TO ALL THE TERMS, EXCIUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID Cl_AIMS. :OVERAGE INFORMATION COV6RAGE/PERILS/FORMS REMARKS AMOUNTOFINSURANCE DIiDUCTIBLE 250,000 1,0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE NIIILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAI. INTEREST NAME AND ADDRESS MORTGAGEE ADDITIONAL INSURED City of Clearwater �pqN g A Municipal Corporation — - - --- — 25 Causeway Blvd AUTHORI2E0 REPRESENTATIVE /� �/C ,•� Clearwater, FL 33767 ACORD 27 (2009/12) The ACORD name and logo are registered marks of ACORD �O 1993-2009 ACORD CORPORATION. All rights reserved. 470997 ooao� � ■ I(��IIII IIII'I IIII'lll I'III (IIIII I�II (IIII ��II) II�II I�III'�III I�II) I�III IIIII'/III (I�I I�II 'EPIli1A[0/OOOOOfIi.:!�11[ll�lU.;ll/U'