CERTIFICATE OF LIABILITY INSURANCE (12) CLEAR17 OP is R4
NSURANCEIWM/DD1YYY`U
0
CERTIFICATE OF LIABILITY I F DATE,'MOM
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 l COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INS PRANCE DOES NOT CONST1TU-rE 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 SUBROGATtON 13 WAIVED, subj.ct t.
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 endorse inent(sp.
PROULIULIR Phone: 727-461-6044 coNYACT
Brown&Brown of Fiorida,Inc, MW
8 3 Park Place Blvd.,Ste 10 1 Fax: 727-442-7695 PHOIA�f FAX
(X!C,No, x I (AX,No):
P.O. Box 2456(33757-2456) E-MAH_
Clearwater, FL 33759 ADDRESS:
William Hancock INSURER(s)AFF QRDd',IG QQVERAGF NAIC
Ins,,Co, 10190
INSURED Clearwater Golf Associates Inc [IN'S"U'RER Gl;, Insurance Cornpany 10385
1875 Airport Drive I 1 11111
Clearwater,FL 33765 1 NS U PER C -
INSURER U.
INSU Res E
INSURER F.
COVERAGES CERTIFICATE NIJMBER' REVISION NUMBER:
QD
-THIS IS TO CERTIFY THAT"THIL POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To INSURED NAMED ABO�,,,E FOH I-HE P(_,DC'f PERiOD
INDICATED. NOVOA!'HO fAND G ANY REQUIRENIENH, TERNI OR GONDITION OF AIN'y CONTRACT OR OTHER DCt(,UNIEN 7 ',.4111 H TO 1111',5
CERTIFICATE &1AY BE ISSUED OR MAY PERTAIN, N-IF INSURANCE-,, AFFORDED BY THE POLICIES DESCRIBED iEREIN IS SUBJE(,T 1D AH, TI II FRVAS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, [AWTS SHOAN MAY HAVE IBEEN REDUCED BY PAID CLAINIS
INSR 'ADD USIJRRI
LTR I YPE OF INSURANCE POLICY NUMBER POLICY FFF POLICY FXP LIMITS t
GENERAL LIABILITY
EA CI I OCCURRENCE 1,000000
X -1 JAMAG-E-Y-0-,z,'-E-N-1 E-D
A X 20115551 06/1 7M 3 06/17,014 100�0616
CLAWISWAI)f X OCCUR $
NI,U E-0 ti,%ny one p I-son I 1o'00
_'ERSO,NAL ADV tNjur4.v 1,000,000
X Liquor Liability
CENERA�AGGREGAff_ 2,000,000
GI-N-L AGGI-fl,GATE LWIFAPPUES PER, HKODUC( GION11"K,31"AGG $ 2,000,000
j
AUTOMOBILE LIA131LITY
01`00NED 6INGLE LIWT
1,000,00
I,
A j ANY AU,10 20115551 06117113 i 06M7[14 80DII.Y iNXJRY
AH OWNID SCHEIDOLI-L)
AUlOS BODILY NjURY
AUI OS
Nr-_)N-ray eFiLD
X PROPERlY
HIR[D AUTOS' X A 1i 10 S
e UMBRELLA LIAr9
EACH'01GCLJR[*NCE
ZXCESS UA8
CLAIIN15-MADE ?AC GIREC.-AlF.
DED I i kFAT-N[IONS
$
WORKERS COMPENSATION
AND EMPLOYERS'LIAL31LITY 0 TIC
X
E3 ANY IDRC PRIE FOR�PARTN CU Y(N ERfEXE fiv� 1WO84000161062013A 03117/13 03117114 100,000
OFFICFRJMEMBER EXCLUOECO N A' I E.",...EACHACCIDENT 3
(MandawrV in NHJ
L FLISEASIF EAEMPLOYEF
100.0001
D SCRIPT KN OF OPERA UOINS L,,oicm PUC ICY LIM11T 500,000
7
DESCRiP'NON OF OPERATIONS LOCATIONS 3 VE141CLFS
City of Clearwater is liste-d as Add—itional insured with rGgard to General
Lial)ility,
CERTIFICATE HOLDER CANCELLATION
C IT OF 8
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLER BEFORE
' L
THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED, M
City of Clearwater ACCORDANCE VOTH THE PY)LICY PROVISIONS,
Attn: Debbie Reid
PO Box 4748
AU THORIZED REPRFSENTATA/5
Clearwater,FIL 33758
fr-1 1988-2010 ACORD CORPORATION, All rights ress_,,r,,eeu;,
.CORD 25 Thw-ACOR[,",riame amd iogo Are,re,,yistored marks of A,,C,0t'RD