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CERTIFICATE OF LIABILITY INSURANCE (15) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/20/2017 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(ies) must have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER NAME: Brown & Brown Insurance - Clearwater FAX PHONE 727-461-6044727-442-7695 (A/C, No): (A/C, No, Ext): 83 Park Place Blvd., Suite 101 E-MAIL acarter@bbpinellas.com Clearwater FL 33759-3925 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Southern-Owners Insurance Company10190 INSURER A : CLEAGOL-01FFVA Mutual Insurance Co.10385 INSURED INSURER B : Clearwater Golf Associates, Inc. INSURER C : 1875 Airport Drive INSURER D : Clearwater FL 33765 INSURER E : INSURER F : 1914427263 COVERAGESCERTIFICATE 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 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD AY201155516/17/20176/17/2018 COMMERCIAL GENERAL LIABILITY X 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 300,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT A 6/17/20176/17/2018 $ AUTOMOBILE LIABILITY 20115551 1,000,000 (Ea accident) BODILY INJURY (Per person)$ ANY AUTO OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNED PROPERTY DAMAGE XX $ AUTOS ONLYAUTOS ONLY (Per accident) $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION BWC84000161062017A3/17/20173/17/2018 X STATUTEER AND EMPLOYERS' LIABILITY Y / N 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ Y N / A OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below A Liquor Liability201155516/17/20176/17/2018Each Occurrence1,000,000 Aggregate1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Clearwater is listed as Additional Insured with regard to General Liability if required by written contract. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Debbie Reid ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 4748 Clearwater FL 33758 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD