CERTIFICATE OF LIABILITY INSURANCE (4)Client#: 8811 CLEARWAT3
ACORD,M CERTIFICATE OF LIABI�ITY INSURANCE DATE�MMIDD/YYYY)
3/27l2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE 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 CONTF2ACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HO�DER.
IMPORTANT: If the certificate hoider is an ADDITIONAL INSURED, the policy{iesy must be endo►sed. 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 conter rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
NAME:
Bouchard Insurance inc C�r RFCE� � PHONE 7 �Aic, wo : �27 449-1267
101 N Starcrest Dr. � OF �, V D EO'MA1Lo, exi>: 27 447-6481
��FA nooRess: cicerts@bouchardinsurance.com
Clearwater, F� 33765 � R�V,�T�
Ap O R INSURER(S� AFFORDING COYERAGE NAIC #
727 447-6481 �
iNSUReR a: Scottsdale Insurance Company 41297
INSURED K M �NSUReR B: Aspen Speciatty Insurance Co 10717
Clearwater Marine Aquarium ��V;q , _
9 �'�ME iNSUReR c:lndemnity Ins Co of North Ameri 43575
249 Windward Passage �7,� �lT Com O
Clearwater, FL 33767 INSURERD: p ptions Insurance Co. 10834
INSURER E : .
lNSURER P :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00
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, TtiE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7YPE OF INSURANCE ADDLSUBR POI.�CY EFP POIICY EXP
lTR INSR WVD POLICY NUMBER
(MMlDDIYYYY) (MM/DOfYYYY) LIMiTS
A GENERAL LIABILITY Y Y CPS2091834 10101l2014 10/01/201 EACH OCCURRENCE $ ��QQQ�QQQ
X COMMERCIAL GENERAL LIABI�ITY PREMtSES�(Ea occu ence $1 OO,OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ rj����
X BI/PD Ded:500 PERSONAL 8 ADV INJURY $ ��OOU�OOO
GENERAL AGGREGATE $Z�OQO�OOO
GEN'� AGGREGATE LIMIT APPUES PER: PRODUCTS - COMPrOP AGG $ Z�OOO�OOO
X POLICY �E � lOC g
AUTOMOBILE LIABILITY COMBINED SINGLE UMIT
jEa acc�denf) g
ANY AUTO BODII.Y INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURV Per acddenq $
AUTOS AUTOS (
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS (Per acciaent $
$
B X UMBRELLA UAB �( OCCUR CX002H214 10/0112094 10/01/201 EACH OCCVRRENCE $9��QQ�QQQ
ERCESS L�AB CLAIMS-MADE AGGREGATE $9 OOO�OOO
DED X RETENTION $$O $
D WORKERS COMPENSATION WC810007625-002 4/0112015 04/01l201 �( WC STATU- OTH-
AND EMPIOYERS' �IAB�IITY Y� N TORV �IMITS ER
ANV PROPRiETORlPARTNER7EXECUTIVE El. EACH ACCIDENT $�OOOOOO
OFFICER!MEMBER EXCLUOED? � N / A
(Mandatory in NH) El. DISEASE - EA EMPLOYEE $� �0�00�
If yes. describe untler
DESCRIPTION OF OPERATIONS beiow El. DISEASE - POLICY LIMIT $�OOOOOO
C Protection 8 HUN00876008012 10/0112014 10/01/20'I $1,000,000
Indemnity
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES �Attach ACORD 107, Additional Remarks Schetlule, i( more space is requiredj
NOTICE:
Bouchard insurance is required to comply with the licensing agreement we hold with ACORD.
ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations
pertaining to proper use of the Certificate of Liability Insurance form.
(See Attached Descriptions)
CERTIFICATE HOLDER rn�rc� � wT�nw�
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATIOfJ DATE THEREOF, NOTICE WI�� BE D£LIVERED IN
P O BOX 4748 ACCORDANCE WITH THE POLICY PROVIS�ONS.
CLEARWATER, FL 33758
AUTHORIZED REPRESENTATIVE
.Y\ ��
O 1988-20'10 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010I05) 1 of 2 The ACORD name and logo are registered marks of ACORD
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