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CERTIFICATE OF LIABILITY INSURANCE (794)/IMRE) `.� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/2/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 Brown & Brown Insurance - Clearwater 83 Park Place Blvd., Suite 101 Clearwater FL 33759 CONTACT Linda Waldorf (A /CC,NNo, Ext) 727 461 -6044 FAX No)* 727- 442 -7695 E -MAIL ADDRESS: lwaldorf@bbpinellas.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Southern- Owners Insurance Company 10190 INSURED PETE &SH -01 Pete & Shorty's Clearwater, Inc. Pete & Shorty's On Park, LLC do J.D. Griffith & Assoc 433 2nd St., S, Suite B Safety Harbor FL 34695 INSURER B :Auto - Owners Insurance Company 18988 INSURER C : EACH OCCURRENCE INSURER D INSURER E : CLAIMS -MADE INSURER F : OCCUR • INC VIJIVI\ IVUIVIDC,[. 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/Yl'YY) POLICY EXP (MM /DD/Y1'YY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 20329144 u e ' a "4I{ :i rw ,. Id's) v -t. 4/19/2016 b' . ,-L I i t): r 4/19/2017 t'. EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 GEN'L MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE POLICY OTHER: LIMIT APPLIES PRO - JECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL AUTOS HIRED AUTOS X AUTOS SCHEDULED UTOS NON -OWNED AUTOS 5032914400 rr • n s .•; -� I ' .� '8/9/261.6 s -;i. . t .`' `9/2/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City of Clearwater, PO Box 4748, Clearwater, FL 33758 and The Clearwater Jazz Holiday Foundation, Inc., PO Box 7278, Clearwater, FL 33758 are Additional Insured with regard to General Liability. CERTIFICATE HOLDER CANCELLATION The City of Clearwater PO Box 4748 Clearwater FL 33758 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD