CERTIFICATE OF LIABILITY INSURANCE (8) Client##.8811 CLEARWAT3
A+COM CERTIFICATE OF LIABILITY INSURANCE =3/3 INYYYYi
17
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(las)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 TA
Bouchard Insurance Inc. col€-
4 �Nag_727 447-6481 � »�?1J..727 448 1267
101 N Starcrest Dr. E-MAIL _..,. ,_.._
AS?AREA$wcar'tLkl�a es §ouchardinsurance.com
Clearwater,FL 3,3765 -
727 447.6481 .. _ MSURER(S)AFFORDING COVERAGE RAIC N
INSURE RA:Nautilus Insurance Company -.- 1-7370
INSURED `INSURER It:Scottsdale Insurance Company 41297
Clearwater Marine Aquarium, Inc. INSURER :g'a'lley Forge Insurance Co 2g51�8_
249'Windward Passage INSURER D:Navigators Insurance Company � 42307
Clearwater,FL 337'67 INSURER E Owners Insurance Company 32700
INSURER F;Kinsale Insurance Company 138920 _
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 PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TIIIS
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.
INSh
LTR TYPE QP INSURANCE POLICY NUMBER TMKDDrfYYYI M7pY lE7KP ._...,..,,.- .._.._.._— ..
.,�,.. LIMITS
A X COMMERCIAL GENERAL LIABILITY Y Y' )NN725807 /0101/3016 10101/2011,EACH OCCURRENCE $1 000 000
_. _
_1 CLAIMS-MMAVE DX�ocGUR ERaEt cTu:mince $100,000
X 8IIPI7 DedA,00t)_-_.....__...-. P EIJExr�iAny Iapr!$°"'�. 55,{DD
PERSONAL&Arse IN..U RY $1,000,000
ENLAGGREGATE LIMIT APPLIES PER: j G'CNC•RALAGGRE GATE� $2000000
PRO-
X POLICY JECT LOC PRoOucTs-C0IyPOPAGG s2,000, 00
OTHER:
AUTOMOBILE LIABILITY — COMBINED SINGLE.LIMIT
j 4857348300 913012'016 081301201 I 1 000,000
X. ANY AUTO BODILY INJURY(Pef perwn) S
ALL OWNED SCHEDULED ,t
AUTOS AUTOS 9 BODILY INJURY(Par accroderrli
-- II �_,... .��, ..._-...-
HIRED AUTOS . 1 °PFiC9PEI^tT`f CIAMIAGE S
AUTOS # }wtPe�mrclerati) w w._ ,LL.
•___ ......-. .-r.._ ._, .. ._....�, _•,may "4_--_
B UMMBRELLALIAe X OccUR w_n XBSO f1L
068510- ---- _ 01tI1J'20'16 101011201 EACH OCCURRENCE S9 000 000
F V1 EXCESS LIAAar CLAIMS Mar�E y y 1 01000324961 0101120'16 101012017,�ggrzqATE 000 000
C?ED RETENIION S
WORKERS COMPENSATION
C
ANY EMPLOYERS'PAIR'LmY � Y 1 6022.864,338 410112017 0410112:019% RTAT11TE g
AND EMPLOYERS I,1Aal
TNERIEXECUTIVE Y t IM i i E L EACH ACCIDENT $1,000,000
OFFICERIMMEMBER EXCLUDED? ,N N A
IINaMMMIa In rMNI I i E.L.DISEASE-EA EMPLOYEE S1,000,000
It RIIPTIO OFFCCPFRATIONSbelow I rELDISEASE-POLICY LIMIT $1t00C 000
D Protection$ NY16LIACFT154758 010112016 1010112017 9,000,000
Indemnity BSJH26583 010112016 101011201
pE:S...CRIPTIO N OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addlllwal Rarea*s schedule,maybe attached If(note apace Is regWrad)
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
112 S,OSCEOLA AVE ACCORDANCE W17H THE POLICY PROVISIONS.
CLEARWATE ,FL 33756
AUTHORt&0 REPRESENTATIVE
1988-2011 ACORD CORPORATION.All rights reserved.
ACORD 2.5(20141101) `1 of 2, The ACORD name and logo are registered marks of AC IRD
#S618071M651734 SHOFI
DECFt�� "I�N ( antifauid gratinae 1
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 farm.
We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of
Subrogation coverage applies.According to ACORD,the Description of Operations section must be limited
to describing information necessary to identify the operations, locations and vehicles for which the
certificate was Issued'.please note the Description of Operations section of the Certificate cannot be
used to add additional Information except as just described.Marking a Y next to the line of business
adequately documents coverage.Equally important,it satisfies the rules and regulations governing the
proper use of the Certificate of Liability Insurance form.
Certificate is a reflection of the current coverages provided for the Insured.Limits and coverages are
afforded to the certificate holder only If required by written contract..
RE: RENTAL SPACE AT HARBORVIEW CENTER,320 CLEVELAND STREET,CLEARWATER,FLORIDA
CITY OF CLEARWWATER IS ADDITIONAL INSURED ON GENERAL LIABILITY ONLY IF REQUIRED BY WRITTEN'CONTRACT AND
SUBJECT TO TERMS,CO'NDITION'S AND LIMITS AS SPECIFIED IN THE POLICY.
,SAGITTA 25.3(20,14101) 2 of 2
#5651807JM6 51734