CERTIFICATE OF LIABILITY INSURANCE (14)
B5/08/2007 14:38
7274469147
SANDBERGEN
PAGE 01/02
.
ACORct CERTIFICATE OF LIABILITY INSURANCE D~;)~;;;;;;'
P/l: t1UCER (727)442-0012 FAX (127)446-!n47 TH ERTlFlCA ISSUEDAS AlTER OF IN MATION
Sandbergen Insuranc:e Ine ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
· . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2121 N. E. CoachJltan Rd . ALTER TJ.II~ COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater, FL 3376~-Z616
INSURERS AFFORDING COVERAGE
NAIC#
INGIJIW) Patricia & T mas Wolkows y
25 Causeway Blvd
Suite 4
Cle.rwater Beach, FL 33767-2000
INSUReR ,,; Cranada Insurance Co.
INSUReR B:
Il\lSURER C:
INSuReR 0;
INSURER Ii;
COVERAGES
THE; POLICIES OF INSURANCE LISTED BaOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F"OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TE;:RM OR CONDlilON OF Afot( CONTRACT OR OTHEA DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY ~ERTAIN, THE INSURANCE AFFORDED BY Tl-E POLICIES D~RrBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SI-tOWN MAY HAVE BEEN REOUCE08Y PAID CLAIMS.
I.TIl NSR TYPE 01' INSURANCE POt..1CY NUMBeR DATIi IIIIWDDlYYI DATe fMM/OD/YYl LIMITS
GENERAL UABILITY CP141457 06/07/2007 06/07/2008 EACH OCCURRENce $ 1.000.00C
X COMMERCW. GION5fW.. LIABILITY ~MlSES I~ """"~n<;@\ $ SO. DO(
Cl.AtMS MADE 00 OCCUR ""ED f!XJ> (Any aM pott;r;m) $ 1, DO(
A f'eRSONAL a fIDIIINJU'W S 1 OOO,OO(
-
GeNERAL AGGAEGATE $ 1,OOO.OOIl
GEN'LAGGREGATli LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ (J
h POUCY n~,: n 1.0C
AUTOMOBIU;; UAllIUTV COMBiNeD SINlW!: UMIT
I--- AIoN AUTO (& ~denI) $
--- AI.l. OWNl:!o AUTOS
90DlL V INJIJA,y
L.- (Per person) $
SCHl!:DULED AUTOS
"-
HIRED AUTOS BODILY INJURY $
- NQN'OWNED AUTOs (Par ac;dd\ll1l.)
.---
~OPER'tY DAMAGE $
IPw 8cc1dem)
G.Il,IlAGE LIABILITY AlJTO ONLY - EAACCIDENT $
~ ""IV AUTO OlHE~ 1HAN EAACC $
AlITO ONI. Y; AGIO $
EXCESSlUM8ftEI.LA UABIUTY e-'CH OOCURIlENCE $
tJ OCCUR 0 CI.AIMS MADE AGGREGATE $
$
R DEiDUCTIBLE ill
RETE:NTION $ $
WORKERS COMPENSATION ANtI I TORY I..IMITS I IOl~-
EMPLOYERS' LIA8111'lV E.l. EACH ACCIDE;NT $
AIoN P~OI"RIETORlPARTNERIEX"CUTIVE
OFFICER/MEMBER EXCI.UOED~ E.L D'S~1i - EA EMPLOYEE $
If~. describe ulKler
S ECtAL f'ROVISIONS baI_ ,",\.,. OISEASI: - POLICY LIMIT $
l;JTtlER CP141457 06/07/2007 06/07/2008 A<lGRECATE $500.000
A LIQUOR LIABILITY EACH COMMON CAUSE $ SOO 1000
DESCRIPTION OF QPIiiiRATKlNS I LOCATIONS /VI;tlICLES I EXCWSlONS AIlIIl;I;l8T liNCCRSEMENT t SPE~ PROVISIONS
-ERTIFlCATE HOLDER IS NAMED AS AN ADDnIONAL INSURED-LANDLORD.
CERTIFICATE HOLDER
CITY OF CLEARWATER
ATTN: CATHERINE
lS CAUSEWAY BLVD
CLEARWATER BEACH, FL 33767
CANCELlATION
$lfgULD IWY OF THE A.oW OESCRl81!D !>OLlel!;$ Ell: CANCELLED BEFORE nlE
!JCPlAATlON DATe THI!JlI!;OF, THe ISSUING INSURER WII.1. ENDeAVOR TO MAIL
-1L. DAYS WRITTEN lienee TO TIfE CERllFICATE iotOLDER NAMED TO THE l..el'T,
aUT "AILURE TO MAJI..l5UC:H NOTICE SHALL IMPOse NO OBLIGATION OR: I.IAElll.lTY
OF ANY K1Nr1 ON iteR, IT5,AliENTS OR REPRI!SIONTjI,T1VE9.
AUTHOAlZi;1l R rtrA
@ACORDCORPORATION1988
ACORD 25 (2001/08) FAX: 462-6957
05/08/2007 14:38
7274469147
SANDBERGEN
PAGE l 02/ 02
.!.
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 endol"$9ment(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the poUcy I certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing in$urer(s), authoril:ed representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage affon;fed by the policies listet:l thereon.
ACORD 25 (2001/[18)