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CERTIFICATE OF LIABILITY INSURANCE (24)ACORD CERTIFICATE OF LIABILITY INSURANCE ATMIdIDD1YYYY) E ( DATE MwD2013 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 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 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 endorsement(s). PRODUCER Alley, Rehbaum & Capes Assurance, Inc. 2433 Gulf to Bay Blvd. P.O. Box 4620 Clearwater, FL 33758 CONTACT NAME: ?7.725.5773 HOONN,Ext): 727.797.5193 (ac,NfF" ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: First National Insurance Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Thomas & Patricia Wolkowsky DBA: Pirates Pantry 25 Causeway Blvd., #4 Clearwater Beach, FL 33767 INSURERB: INSURERC: X INSURER D : S 1,000,000 INSURERE: I CLAIMS -MADE INSURER F : MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 13/14 Liability REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) 06/07/2013 �{/y IT! POLICY EXP (MMIDD/YYYY) 06/07/2014 LIMITS EACH OCCURRENCE S 1,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X 25CC2765565 1 �,,,,� �'' 1 (-+F � X PR i U KEN i tU PREE MIS MIS ES (Ea occurrence) S 1,000,000 I CLAIMS -MADE X MED EXP (Any one person) $ 10, 000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I 1 PEA II LOC PRODUCTS - COMP /OP AGG S 2,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS 1I HIRED AUTOS j SCHEDULED AUTOS NON -OWNED AUTOS - '4 " ' CO accident) INGLE LIMIT $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERLY DAMAGE (Per accident) $ I S — UMBRELLA LIAB OCCUR CLAIMS -MADE (' -t. �,- - -r - EACH OCCURRENCE S EXCESS LIAB AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIV OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS YIN N / A I WC STATU- I 'OfH- i TORY LIMITS j ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S below E.L. DISEASE - POLICY LIMIT S A Liquor Liability 25CC276665 06/07/2013 06/07/2014 $1,000,000 Occurrence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The Certificate Holder is listed as an Additional Insured. ATE HOLDER CANCELLATION FAX: 727.462.6957 City of Clearwater 25 Causeway Blvd. Clearwater, FL 33767 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Signature on file w /Co. ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD