CERTIFICATE OF LIABILITY INSURANCE (8) To: Chrystal From: Maria Crowell 3/1012014 8:28:52 AM (Page 2 of 2)
' k- � CERTIFICATE CF LIABILITY INSURANCE °"3/ �4
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 POLKNI5 f
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUGe&AND THE CERTIFICATE HOLDER.
IMPORTANT. If the cerHfkate holder k em ADDITIONAL NMURED.the pollcAbsI must be endorse& N SUBROGATION IS WAIVED. sult)eat to
the terms and cordiliow of the policy,certain policies+nay mquim an endarsemmL A stalemard an this oertifiicata dales not oanfw rights to the
cortillaate holder In he"of such M 'M sernent(s).
I""OmU Allied Specialty Insurance.Inc
Treasure is and, FL 337367408
8002373355
IN81JR COVI`J�AW R rLARC e
INelJW A _ _T.H,E_ Insurance Co� _2 86 6
Ian Emerald CoaS t Bu ngee, Inc. INSWINA a: __
19 Causeway Blvd. IIrs1111e11 c
Clearwater Beach FL 33767 ---
INeSA1a1Q
1 F:
COVERAGES CERTIFICATE NUMBEFI, REVK NON NUMBER.
THIS IS TO CERTIFY THAT THIS POLICIES OF INSURANCE LISTED BELOW KkVE BEEN ISSUED TO THE INSURES}NAMED ABOVE FOR THE POLICY PFRtOD
INDICATED. NOTWrINSTANDINI3 ANY REQUIREMENT.TERM OR CONDITION OF ANY OONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHcH THIS
CER'nFICJITE,MAY BE ISSUED OR MAY PERTAIN,1)1E INSLNW40E AFFORDED EY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS.
EXCL USIONS AI D OONDITIONS OF SUCH POLICIES-LINgTB SHOIAe+I MAY FLAME BEEN REDUCED BY PAID CLAIMS.
R rwFs dF eaelwwcaE roLcy NNI1ea1 jMNaKrfYM I==% LOW411
dENEML LIAR IrY EA0400DURREWCE. $ 1,000,000
A =MMENIAL OB49M UANUTY GPP0109575-04 P3lxltlak 03/11(35 ,BOB
d�LIM6 MADE COOLIE MEN EXP ons 3
POMONAL&ADVINJURY $ 1,000,000
OENERALAOORE"TE S 2,666,00
0EN*L.A00RIMATE LIWr APPLIES P6t_ PRODUCTS-ODMPOOP AAO S
PaUCY L6E $
AUTQWMILE IlAMILOY
ANYAUTO BODILY INJURY f Nr Pas" S
ALL.OMa D SCHEDULED aDL7FLY INAIriY
AUTOS AUTW � S
HIRED AUTOS AUT� S
S
U11WIMLALIAR OCCUR P0404 OCCURRENCE t
IMMIUMI AeITRBOATE s
QED RMNnQN 6 ;
WORKEMODWENsATIDN H.
ANQ 04101.9Mr LAA RLITY TIN _
ANY PRpPRIE aWlE7IBC1lT1VE
C7Ft9CE16MEi1E!E7ad UDB77 N 1 A El EACH/ICdQN"i S
pundowy in NMI E.L.DISEASE-EAMPLQ S
N unasr ..�..,•.
IDM PTIDN OF P bdpw E.L.DISEASE-POLICY LOW $
D IPrrDN OF OFMkTX MBI r,L TQNS1 VSGCIUW(Aftft AODRD W.Addffiml RW4M sditk a r Mm Moem lanw to
ADDITIONAL INSURED: CITY OF CLJtKRWAMM AS RESPBM TO TER
PRIMARY & NON-CONTR13EFUT7RY OPERATIONS OF THE NAIM INSURED ONLY
WAIVER OF SUBROGATION APPLIES TO GE20RAL LIABILITY.
RE. (1) FOUR STA`T'ION SURO BURGER #006
CERTIFICATE HOLDER CANCELLATION
OF CLEARWATER SH IJLD ANY OF THE ABOVE DMIURE D POLICIES BE CANCIE3.ED BEFORE
MYRTLE AVENUE THE EXPIRATION DATE THEMOP, NOTICE W LL BE DEL.NEfIM IN
CI.EARWATER FL 33767 ACCORDANCE WITH THSE POLICY PROVISIONS L
A RED
C 1985-2019ACORD CORPORATION. J0 rlghta reserved.
ACORD Z5(2010105) The ACORD name and lWo,are regishwed marks of ACORD