CERTIFICATE OF LIABILITY INSURANCE a DATE(MM/DD/YYYY)
CERTIFICATE LIABILITY INSURANCE
05/11/2018
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).
PRODUCER CONTACT NAME: Sherry Wilt
Lancaster Insurance Inc PHONE Extl: (727)461-3704 FAXC No): (727)441-3298
510 Druid Rd E.,Ste.#C E- AIL ADDRESS: ry�sher lancins.com
P O BOX 2856 INSURER(S)AFFORDING COVERAGE NAIC#
Clearwater FL 33757 INSURERA: Auto Owners Agency#12-0253-00 18988
INSURED INSURER B:
Clearwater Shuffleboard Club INSURER C
1020 Calumet St INSURER D:
INSURER E:
Clearwater FL 33755-1813 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL185409696 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.
INSR ADOL SUBK POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE 10 REN rEIT
CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 50,000__
MED EXP(Any oneperson) $ 5,000
A Y 20540898 12/13/2017 12/13/2018 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
❑ PRO-
POLICY
JECT ❑LOC PRODUCTS-COMP/OPAGG $ 1,000,000
OTHER: INADJ $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED Y 20540898 12/13/2017 12/13/2018 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Paraccident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N1.
--
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Clearwater is named as Addtional Insured with respect to the General Lialbity and Auto Liability
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
706 N Missouri Ave
AUTHORIZE EP ESENTATIVE
Clearwater FL 33758
~p c 1988-201 CORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered ma ks f ACORD