CERTIFICATE OF LIABILITY INSURANCE (6)
FROM : LOSSING INSURRNCE
PRODUCER
PHONE NO. : 352 732
Ma':j. 15 200
~./JiL V-
:;~"'"'' ,..','....".'......"."..,. ,..., " ., ::!~~I.::.:.:.!;:~:.;.,.:.!.~:~~.!..~:-!-:~; . .... ',', .',
~" ACORD"';"";
;~<-:~::::::::::::; :.;~":::: :.:: ~:; !~;::;::;;~~~;:~;:~:;~l':~~:;:;~:::~:~:::;~ .
Lossing Ins.Agy.,Inc.
1724 SE 17th Avenue
Oca1a, FL 34471
(352) 732-4550
DA,", lUM!DDIYYl
1 2
THIS CEATlRCATE IS ISSUED AS A MATTER OF INFOAMAT10N
ONLY AND CONFERS NO RIGHTS UPON THE CER71RCATE
HOLDER. THIS CEATlFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
COIIIPANI&S AFFQ"[)ING COVERAGE
COMPANY
A ESSEX INSORANCE COMPANY
III$tJRED
CLEARWATER GOLF ASSOCIATES,INC
CCM'ANY
B
1875 AIRPORT DRIVE
CLEARWATER
COMPANY
C
FL 33765
<XlMf'ANY
D
.. "THIS 'IS 'To CEfmFv THAT THE POUCI~S OF INSURANCE USTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOve llOFl THE POUCY pERIOD' . ............'.
INDICATED. NOlWlTHSTANDING ANY ~OU1REMENT, TERM OR CONDlTlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MA'l! PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DesCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUClES. UMITS SHOWN MAY HAVE BEEN REDUCeO BY PAID ClAIMS.
co
LTR
'I"tPE OF INIlIRANCI!
POLICY "UNBUI
POUCY IEFRt'IIIIE POUCY DPlRAl10N
1M'"' (MlIIlIDOm') DATE (IIIWD/YY)
l.lMITS
A IIENBW. UAIILn'Y
COMMEFletAf. GENeRAl. L1ABl\..lTV
ClAIMS I\AAOF. liJ OCCUR
0wNS.A'9 .. CONlRACTOR'S PROT
2C86S1S01
03/01/02
03/01/03 QeJoIaW. AGGReGATE -~2,ooo.OOIL
PAOOUClS . COMPIOP AGO s.1,OQO.*....
PEFlSONAL .. ADV IN.lIllV s JI.ClCl.
EA04 OCCIJRRENC! s .000......
~IRE DAMAGe [IiIlV one nre) L 50.000_
UEO ElCP (Nri one llerlllll) S
COMBllIEO S1NOu! ~IMIT s
BOOIL Y INJURY S
(Pet plll8On)
BODILY INJURY S
(Per 8CCIaent)
PROPERTY DAMAGE S
.~,:.;-:-:.
~m:!;~:
AlITOMOBII..E UAIIaJTY
/lHY AUTO
AlL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
N~ AutOS
GARAGI! LlA8IL1TY
IUfY AUTO
AUTO ONLY - EA ACClDENT_._ .,~,.,..,_
. o~ TlofAN AuTO ONLy, ....
EACH ACCIDENT $
AGGFlellATE S
EXCESS UAIIIUn'
11MBAalA FORM
OlHl!l'I THAN UMBRaLA FORM
WORKERS COMPENSAllON AND
IM'lOYl!RS" l.IAIIILITY
THE PROPflIETORI
PAFl1NERSEXECUTJIII;:
0FFICIiRS All&:
OlllER
lNo..
EXCL
EACH OCCURRENCE S
.-..--.-
AGGREGATe S
s
S
S
El D~ . ~ BlPLOVEE .
Il&lICfV'fION OF OPMA7lOIIMOCATIONSIVBIICUlI/SI'ECIIL /1EIII
CERTIFICATE HOLDER !XS LXSTBD AS AN ADD1TIONAL INSURED FOR COMMERCIAL
GENERAL LIABILITY.
,"' "',:-'
. .,
..~....~....,:. ..'............ ,', .
CLEARWATER. FL
tIIOUIJ) ANY OP TNI! AItO\Ia DI!ICMm IIOUC_ .. ~ &&FORE l1fE
DJIRA'IlON DATI! 1HI!IIfal, litE .....G COMIANY WILL EtlDI!AVOA TO MAl..
.-JL DAY$ wmnEN NOtICI! 1'O'"11IE C1iInFICATE NOUIEA !WE) 10 TIlE I.S'T,
lIUT FALURI TO MAL IUCII NCmCE SHALl. IIIPOlII! NO 0IWGA'nON OR 1WI&m'
QlD lJIIlOtI lItl rrs AGENTS OR RDtoo..s....TATMS.
CITY OF CLEARWATER
ATTN: DEBBIE FAX #727-562-4825