CERTIFICATE OF LIABILITY INSURANCE
HLUKUIH MHIN LU~Y KM~ raX;(~(-(~l-l~~~
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ACOROTM CERTIFICATE OF LIABILITY INSURANCE 1 DAn IMMIDDIYY)
01/28/06
PRODUCER . THIS CI:RllFICATE IS ISSUED AS A MATTER OF INFORMATION
Acardia Southeast, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 31666 HOLDER. THIS C!FmFICATE DOES NOT AIIIIEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33631.3666 INSURERS AFFORDING COVERAGE
727-796-6666
INSUII8) Field's, Inc. DBA INSURER A: Alsa London Ltd
Barefoot Beach House INSUfIER II:
P.O. Box 3337 lN$UFlefl c:
INSURB'i D:
Flearwater Bch FL 33767 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED aa.ow HAVE BEEN ISSUED '1'0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATSD. NOTWITHSTANDING
ANY REQUIREMENT. TERM OA CONDITION OF ANY CONTRACT OR OTHEft DOCUMENT WIlli RESPECT TO WfIICH THIS CERTIFICATE MAY aE ISSUED OR
MAY J:>ERTAIN. THE INSURANCE AfFORDED BY THE ~OLlCII:S DESCRIBED HEREIN IS SUBJECT TO ALL THe TERMS. EXCUJSIOtiS AND CONDITIONS OF SUCH
POLICIES. AGGReGAiE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~ TYPE OF II\I~flANCE POUCY MJMBER ~g;FECT1VE ~il,~,,=JJe,N UNITS
A ~EAA1. I.lASIUlY MKS1151 1/1 0/06 1/10/07 EACH OCCURRENCE $ 1000000
X COMMERCIAl GENERAL LIAllllJTY FIRE ~AMA\liE lAnv one fire! $ 50000
I CLAIMS MADE W OCCUR MEO llXP CAny one personl . 2000
- PERSONAL .!It AOV INJURY 0 1000000
GENERAL AGGREGATE $ 2000000
-
~'L AGGIlEn LIMIT APn PER: PRQOi"lCTs - COMPjOP AGG . 1000000
POLICY ~~~ LOC
~OMOBl~ UAllUTY COMBINED S1NGU; ~IMIT 0
AAY AUTO lEa ..,,,;...0
I--
f--.. ALL OWNED AUTOS 800IL Y INJURY .
SCHEDUU;:D I>.IJT05 lPer per8Ol"O
-
- HIRED AUTOS BODIL V INJURY $
NON-OWNED AUTOS; lP~r 9cclderltl
-
- PflOPEIlTV DAMAGE 0
(Per aCGident)
Rl3EUABlUTI AUTO ONL" - iA ACCIDENT $
ANY IWfO OTHel THAN EAACC .
IWTO ONLY: AGG .
EXCESS UABI1.I'l'Y EACH OCCURRSVCiO $
~-OCCUR D CLAIMS MA.oIi AGGIII;GJr,TE $
.
q DEDUCTIBLE $
RETEN'I'ION 0 $
WOIIIUll'l$ (lOMPIiN5AllON AND I ~~vsrAT1J- J IO,w-
UMITS
EMPLOYERS' UASIWTY E.L. ~H ACCIDENT
0
E.L DISI;ASi - EA EMPLOVEE .
E..L. DISEASE - POLlCV UMIT .
OTliEIl
DE$CRlPllON OF OPERAnO{ll6ILOCATIONS/VS-II~llUJSIONS ADt8J BY IiNPOIlSEMENT/Sf'I!CIAL P1iOVlSlONS
R~; 332 South Gulf Blvd. Clearwater. FL 33767
Rental of Ele<lch Chairs. Umbrellils and Cabanas.
,he City of Claarwa.wr is Additional In,~red as respacts General
Liability.
CERTIFICATE HOLDER I .x I ADDITIONAL Q\I&UlW), INSURER lETTER, CANCElLATION
City of Clearwater, SHOULD ~y OF THE ~E OESCfUBED PO....~IES BE CANCEl.l,&g BEFORE THe EXI'IRATION
DATE nlERl!OF. THE ISSUINC INSURER WILL ENDE1AVOR TO MAIL ~ DAYS WfUTTEN
A Municipel Corporation NOlle!! TO THe cmnF'lOA.TE HOLDER NAMl;Q TO THE lEFT. IIUT FAILURE TO CO SO SHAll
25 Causeway Blvd. IMPO$E NO OBUGATION OR LIABIlITY OF ANY KIND UPON THE 1,N5UIIER,. ITS AGENTIj OR
Clearwater, FL 33767 RErRE ^ f"I
~~
r
ACORD 25-8 [7/971
45. 53
e ACORD CORPORATION 1988
.,
HLU~UIH MHIN LU~Y ~ML rax:(L(-(~l-lj~~
Jan LO 2006 15:52
P.03
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policylies) must be endorsed. A statfjment
on this certificate does not confer rights to the certificate holder in lieu of such endorsementfs).
If 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 confer rights to the certificate
holder in lieu of such endorsemendsl.
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-8 (7f97)
Jan Lb LUUb l~:~L
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HLUI'(VIH I"IHlN LUt"Y I'(I'TL t- ax; (L(- (~:ll-l~~::l
Bass Underwriters of Florida, LLC
INSURANCE BINDER
THE TERMS AND CONDITIONS OF iHlS CONFIR.MA.TION OF INSURANCE MAY NOT COMPI,. Y WITH 'fHE SPECIFICATIONS SUBMITTED
FO~ CONSIDERATION. PJ.eASE READ THIS CONFIRMATION CA.REFULLY AND COlli PARE IT WITH ANY QUOTE ANI) SUBMISSION
DOCUMENTS AND REVIEW THE POLICY FORMS FOR THE ACTUAL COVE RACES PROVIDED.
IN ACCoRDANCIi WITH YOUR INSTRucnONS. AND IN REL.IANCE UPON THI!! STATEMENTS MADE BY THE RETAIL BROKER IN THE
INSUREO'S APPLlCATIONJSUBlnSSION, WE HAVE OBTAINED INSURANCE AT YOUR kEQUEST AS FOLLOWS:
DATe ISSUED:
January 24,2006
PRODUCE~:
Acordia Southeast, Inc.
P.o. Box 31666, Suite 400
Tampa. Fl 33531-3666
INSURED:
Barefoot Beach House AKA Field's Inc
332 South Gulf Blvd,
Clearwater, Fl 33767
POLICY ~~
MKS1151
INSURER:
Markel International Insurance Company Umited A- AM Best Rating
Non-Admitted
COVERAGE:
Package X-Wind
POLICY PERIOD:
1/1012006 TO 1/1012007
TERM:
12 Month$
RENEWAL 0 F:
BUS2265
12:01 A.M. STANDAJ!t1) rlMI: AT THE LOCATION ADDRESS OF 'fHE NAMED INSURIiD. THIS INSURANtl: BINDER WILL BE TERMINATED
AND SUPERSI:DED UPON DI;LI'VERY OF THE FORMAL POUCY(IES) ISSUED TO REPLACE rr.
LIMITS OF liABILITY:
$1,000,000
$2,000,000
$1,000,000
$1,000,000
$50,000
$2,000
$227,000
$ 60,000
$150,000
Theft excluded
RATING BASIS:
Per Occurrence
General Uabi&ty Aggregate
Products / Completed 0 p s
Personal Injury & Advertising
Fire LimH
Med Pay
Buildings RC Special-90% Coins
BPP ACV Special- 90% Coins
Business Inc. 1/6 Monthly