CERTIFICATE OF LIABILITY INSURANCE Client#:26284 AIEXANDM
ACORD. CERTIFICATE OF LIABILITY INSURANCE r,A ��l
V17/2CN17
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE dCERTIF11"A"lI%HOLDEFL THIS
CERTIFICATE DDS NOT'AFFIRMATIVELY CSI NEGATIVELY AMEf^M(TENNi OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTffUTE A BRACT BETWEEN THE WSUING INSURERM AUTHORIZED
REPRESENTATIVE OR P RODUCFJI,AND THE CERTWICATE HOLDER.
IMPORTANT.N the ceruncew�is an ADDITIONAL INSURED,the )must be endorsed.NN SU13ROGAMON IS WAIVED,subject to
Ow Ums eRrd candhions,of the policy,cerseln policies a"re+gslrs an endonamem A statentent on this cerdficaft does not confer eights be the
holder In Neu of such a nl(&ri
PRODUCER
Bouchard Insurance(CLW) M:727447-Ml ;727 449.1267
101 N Starcrest Dr. mmmm, clt ertsf M aftouctwdlnsurancecorn
ClearwaW,FL 33M MURERMARPORDIMCOV19VAE RWC•
727 447-8481 VISURMA;Main Specialty Insurance Co 17159,
I INrlunEn :of lne utrance C ntpatny X78
Alexandra f Clearwater Beach
dbel Pier Gil Concessions MURERe.
PO Box 3=7 INeI>RER 0.
Clearwater,FL S&IM INSRlREItE
gEMR
COVERAGES CERTIFICATE NUIIIBER. REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLIO" OF W48URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NCYTwni-I:I"ANDING ANY RC-CTLnRENAENT; TERM OR CONDITION OF ANY OOWMACT CR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTWICATE MAY BE ISSUED OR MAY PERTAIN, THE MURANCE AFFORDED BY THE POUCrIES DESCRIBED HEREEIN IS SUBJECT M ALL THE TERM,
AND CONDITIONS OF SUCH POLICIES. LIM!TS SHOWN MAY HAVE BEEN REDUCED BY PAID i'ILAN&
4 TYFE OFINSURAMM MR PRICY NUMBER
A 19mmAL uAm rrvr Y Y CI 1/2017 02/01,r'2CI1 OlAcH occummmE slippqm
X commERm4L aeIEPAL LLrIY Rwrgazwonm
CLAIMS-MWE, OCCUR MEDEV LAM orm $5 gqQ
X BUM Ded.RWO PFJWDtW&AM INJURY 51 ON 000
._ ._ .�I. a...
OMERAL AGGREMTE s2.000.000
M TE RJMIT APPLES PER.
P wr LOC s
,A I I UMOSI S LUMM CI /N17 CE11D1=1 =mN00*LEW" 1 N
ANY AU 0 90my OWURY CPw pen-4 s
ALL OWNED SCHEDIKED
AUTOS AUTOS afJDILY wMJ w teen s
NONwOWNED
HIRED AUTO X A
s
B UMBRELLA LIAS I( Chi XOB 7 1/2017 0310 /2CI1 EACH OOCU 7s1
X LIAS CLA AM34AADE AGGREDATE s1 CNNI
DED wmam s $
WORKERS COMPENSATION 8TA
AND LIABILITY Y Y I N
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DESCRIPTION OF OPERATION/N OCATkK MI VONDLES VAsch ACORD 181,AMUNAi RwMft ealned 1k N mom mpm Is nrtp mdl
Certificate holder is additional insured as respects to CSe naval Liability only If required by written
conlraol,and subject to the terms,conditions Otte!INmCts as Specified In the policy.
CERTIFICATE ER CANCELLATION
City of Clearwater,A Municipal DoT DAB , NOTICE�E rllILL,, BE �s
Corporation ACCORDANCE 'WrFH THE POLICY
PO Box 4748
CkwwaW,FL 33758 ALNI ATIYE
eM 1988-2010 ACORD CORPORATION.AN r4jhts reserved.
ACORD G" 1 of 1 The ACORD name end logs we registered marits of ACORD
#S61 I9767 DANSU
CERTIFICATE III LIABILITY INSURANCE 1r /p /201
THIS CERTIF'ICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTWICATE HOLDER-THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE CCDVERArriE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHOR2120
REPRESENTATIVE OR PROBU'CEK AND THE CERTIFICATE IIOLOE€L
IMPORTANT-If the cerliftate holder is an ADDITIONAL INSURED,the policy(iies)must havo,
ADDITIONAL INSURED,provisions or be onal+nrsed,
If SUBROGA71ON IS WAIVED,subject to the teams and conditions of the policy,caartain policies may require an endorsement A statement on this
certificate does not confer " hts to the certificate Igfalder in lieu of such a entt
RZO IT
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AUTOMATIC DATA PROCESSING ITS AGCY '"q'°°ce FAX
dAAC.rtlrq,. rq .pnq
071-7 ; F:
PO BOX 33015 INSUAr.A4S)AFFCMfmr!ra;swv RA"
SAN ANTONIO TX 18265 11MURFRA ILILLl< . . _ .MufWf 1t !.y
ALEXANDRA OF CLEARi AT R BEACH INC DBA IA aperlc
PIER 60 CONCESSIONS TEL DS INC EDBA BARRP
PO BOX 3337 Vrf$LTRTwI1�
CLEARWATER FL 33767 INSUIWA F,
COVERAGES m_....®CERTIFICATE.NUMBER: REVISION NUMBER:
NY OR CONDITICN OF ANY �CC7�!"IRACT OR OTHER DOCUMENT WITH PIE'S LyC41 ,iTHIS
THIS IS TO CERTIFY TP AT THE F�KCiI S OF INSURANCE LISTED BEtGD'I�+� HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
INLDNCA"I'I. 1. NC'T'WWCTI "�iAIwIC6NC ANY RECl1IREI'ulEl�fT. TERM RESPECT "P"C gdWI3It:hI THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TIME POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIME
TERMS,EDTCUUSIONS AND CoI IIJITIONSOF SUCH POLICIES.LI6WITTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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COMIAERCIAL GENERAL LDAMLITY EACH OCCURRENCE �.
.. I CE AJMS-MADE �4!R DAMAGE TO D NTT
I �C I�� fWMAGSE�q uccxrerd�n�cmD '
MEAD FXP(A1ar one pprcon)
PERSONAL Dt 'MPJW INJURY
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d."WN'0 SCHEDULED _. ILY INJURY(Pat awdrAa4)
AUTOS ONLY AU'TGS _.
aRED NCNO YNE6 _ I
CMERTY DAMAGE
AD ONLY AUTOS P ar ,.
accidowp,D
YUNDRELLA.UAB OCCUR w, ._,...�.IT..,..... EACH CURPC-J C'E
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ANY pIP�P'�1ET'C!RlF"AA�RRTAP Ch.RTBYF"I'fN EL EA
Oa"I"D wovyio RE EXCLUDED? ,y,A .° fir„ i E.I.DISEASE-EAEMPLOYFF 61. 0�,0 0
A u�dartirryfpMlFiJ r5 T;d. C.r.krt$�r &11�°f�;C.T,�i:.(�"!..P / "'ro/"dDD*i E.L._.._... ..,.,......,..,.,��..
It yes..cDa rase pnaaer E.L.DISEASE-PCU CY UVJT J Q DESC;IPTION OF OPERA11ONS delaw , o('...
P.kESCRIP71ION OFOPERAIRONS"ILOCATtOVS r?✓EMCIA !RD 1101,IiucYdFldonal Ramnarks SchoduW.pray Irwl21aacawd if more spwo is ra gmkvdy
iThose usual to the Insured's Operations.
CERT'IFI'CATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,(NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH'THE POLICY PROVISIONS.
The City" CleerW ter AUINORMW AEPR'f:SEJNT4TDV
PO BOX 4748
,
CLEARWAT R F''L 33758
01988-201 ACORLT CORPORATIOfN"All rights reseed
ACORLI 2 (201!6M3) The ACOR'O name and logo are registered marks of ACORD
ALE9GAIAMMDR4
DATE 001610000"
ACORD. EVIDENCE OF PROPERTY INSURANCE I 02PI2=7
THIS EVIDENCE OF PROPERTY DWRAk= IS ISSUED AS A MATTER OF TION ONLY AND CONFERS NO RIGHTS UPON THE
ADDITIONAL INTEREST KAMEID BELOW. THIS EVIDENCE DOES NOT" AFFIRMATIVELY OR NEGATIVELY AMEND, ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVMEXCE OF DfAES' NOT CONSTITUTE A FACT BETWEEN THE
ISSUINIII aTSII REPRESENTATIVE OR PRODUCER. AND THE ADWIONAL INTEREST:.
7 'T 4471
BoucharO I (CL .. Main Insurance Co
101 N Slawrcrest Dr..
Clearwater,FL 33M
FAX M 445-1207 "AIL eNaeu MObo►ualmdlnmranete c om
CODE, BUD ems:
2M3M
w,4uREO Alexandra 01 Clearwater Beach Lail Numm POLICY NUMBER
dtla Pier 80 Concessions I CIP284963
PO Box 8337 EFFECTM DATE EXPIRATION DATE
Clearwater,FL 337167 OW0 /17 03'01/18 a CONTINUED °
CHECKED
TKIS REPLACES PRIOR EVIDINCE DATED:
PROPERTY INFORMAATION
LOCATIOWOSSCRIPTION
Location#110 Pler 819 Drive
Clearwater,FL 33767 Building#1 Concession Building
THE POLICIES OF INSURANCE LIS"T"ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,TERM ICI CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THS
EVIDENCE OF PROPERTY INSURANCE 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.
COVERAGE INFORMATION
AIMMTOPINSURANX D9DUCTIKR
Commrdal Prop"Location Specific Coverages
Location ;1', 10 Pier 60 Drive Clearwater,FL 33767
Bul #:1 Concession Building
Business Personal Property 5I1,000 $1,1900
Cause:Special
(See Attached Coverage Irma.)
REMARKS ucludl I C.a
T;AINI LLATTMR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEIMIRE THE EMRATION DATE THEREOF„ NOTICE WILL BE
DELIVER
IN ACCORDANCE WM ME (POLICY PROVISIONS.
INTER MT
AII1D1Tk7NAL INSURED
City of Clearwater,A Municipal RX Al-State or Political
Corporation LOAN■
25 Causeway Blvd
CleanNeler,IFL 33767 AUTHORIZED REPRESMAWE
2) 1 of 2 S13735 0 T ACORD CORPORATION. AD rights,
The ACORD name and kqo we mgkdemd amwits of LAID VICDE
COVERAGE INFORMATION (Continued from page 1.)
AlWUW CW
Covers";Buskmas Irwoffm onty 15, 0
Cauca.
Coverage:r:qtdpnwffl Breakdoian Endarsenterd
Cause:&p4xrKmt Breakdom
A:27.E LIM2 of 2 $13735 VICDE