CERTIFICATE OF LIABILITY INSURANCE (9)
).
Client#: 27616
CLEABEA
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDfYY)
06/04/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
IMA of ~ansas, Inc. (Wichita)
PO Box 2992
Wichita, KS 67201
316267.9221
INSURERS AFFORDING COVERAGE
Clearwater Beach Seafood, Inc.
dba Crabby Bill's
PO Box 99
Indian Rocks Beach, FL 33785
INSURER A: Markel American Insurance Company
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURED
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~~ TYPE OF INSURANCE POLICY NUMBER Pgk!fit~J5gJ.%~ P%~fl t'il';t'~;w{I LIMITS
A ~NERAL LIABILITY 8521 RS0043791 06104/07 06/04/08 EACH OCCURRENCE $1 000000
~ COMM ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $100000
1--- =:J CLAIMS MADE W OCCUR MED EXP (Anyone person) $Excluded
I--- PERSONAL & ADV INJURY $1 000000
>-- GENERAL AGGREGATE $2 000.000
A'LAGGREfil LIMIT AP~r PER: PRODUCTS - COMP/OP AGG $2 000,000
POLICY X P,~8,: X LOC
~TOMOBILE LIABILITY PI rEIVEC COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
>--
I--- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS , ,) ~OO7 (Per person)
>-- ,,' ~I" i
-'-- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
- OFriC:.u, .,).;.. .;..i~OS At
- D PROPERTY DAMAGE
LEGISlA IVf .;P\l~~ DE PT (Per accident) $
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
:=JESS LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
==1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND IT'1,~~T ~J,~;, I IOJ~-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is Additional Insured (Landlord) as respects to the referenced
location:
37 Causeway Blvd; Clearwater Beach, FL
CERTIFICATE HOLDER I I ADDmoNAL INSURED . INSURER LETTER: CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3D..-DAYSWRITTEN
Marine Property NOTlCETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
25 Causeway Blvd 1M POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURER,ITS AGENTS OR
Clearwater Beach, FL 33767 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I ~~ lot4.J.a . (}../IIIJ
COVERAGES
ACORD 25-5 (7/97)1
of2
#S343405/M343404
MAV
@ ACORD CORPORATION 1988
.~
.>
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD2S-5(7/97)2 of 2 #S34340S/M343404