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CERTIFICATE OF LIABILITY INSURANCE (16) Accllik" DATE�MMMWYYYY) CERTIFICATE OF LIABILITY INSURANCE F 6118/2018 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(les)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 rishts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT -NAME: Suzanne Cvetezar Brown &Brown Insurance-Clearwater PHONE T FAX 83 Park Place Blvd., Suite 101 _WC.,No,,,ExQ;727-461-6044fA_)CNcJ 727-442-7695 E-MAIL Clearwater FL 33759-3925AP DRESS; SCVeteZarQbbpineIIas.com _ INSURER(S)AFFORDING COVERAGE I NAIC#.' INSURERA:Southern-Owners Insurance Company INSURED CLEAG1OL-01 IN SUR ER8 FFVA Mutual Insurance Co. 11"7385 Clearwater Golf Associates, Inc. rw 1875 Airport Drive INSURER C ....... Clearwater FL 33765 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:338554231 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 I I IN 21=0: IY CLAIMS.. _ _ Y _ LTTYPE OF INSURANCE IADDLISUBRPOLICY MMUCYEYYM6ID6YYYYI LIMITSR i A I X COMMERCIAL GENERAL LIABILITY Y 20115551 6117!2018 611712019 EACH OCCURRENCE 1,ODO,000 UAMAr.=TO_RENTED D CLAIMS MADE X 'I 1 OCCUR PREMISES MED EXP(Any one person) 1$10,000 PERSONAL&ADV INJURY SI.OLM _ S 2i __.'_' LGEN'L AGGREGATE LIMIT PPLIESPER: GENERAL AGGREGATE S2,0 POLICY PRO- LOC PRODUCTS-GO MPIOP AG OTHER: A AUTOMOBILE LIABILITY I i20115551 611712018 611712019 COMBINED SINGLE LIMITS 1.000.000 )-1--,------ — . ANYAUTO ........... BODILY INJURY(Per person) OWNED SCHEDULED DILY INJURY(Per acadent)!$ AUTOS ONLY AUTOS I BO HIRED '_X f NON-OWNED r PROPERTYtl)AMAGF is AUTOS ONLY AUTOS ONLY Per acciden, PIP$10,000 is UMBRELLA LIAR iOCCUR i i I EACH OCCURRENCE EXCESS LtAB CLAIMS MADE( AGGREGATE is DEC RETENTIONS is i WORKERS COMPENSATION WC84000161062015A 311712018 311712019 X PER 0TH- AND EMPLOYERS'LIABILITY YIN 1TUTS ER ANYPROPRIETOPJPARTNEP,fEXECUTIVE _""'DOG ! I OFFICERJMEMBEREXCI_UQED? ❑ NIA (Mandatory In NH) I El.DISEASE EA EMPLOYEE!$700.909 If yes,describe under DESCRIPTION Of OPERATIONS below E.L.DISEASE-POLICY LIMIT iS500,000 A Liquor LiaNlity 201 15551.... 6117f2018 611712019 Each Occurrence i 1 000 0x70 Aggregate 1,004,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additionai 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 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater PO Box 4748 Clearwater FL 33758 AUTHORIZED REPRESENTATIVE Oc: 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD .........* o.........ON 0 ACC)RE) EVIDENCE OF PROPERTY INSURANCE DATE IMMIDI)IYYYY) '%� 6118f2018 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST, AGENCY PHONE COMPANY Brown&Brown Insurance-Clearwater Scottsdale Insurance Company 83 Park Place Blvd- Suite 101 Clearwater,FL 33759-3925 -E-,M 727-442-7695 bbpinellas.com AppR Ess:scvetezar@ CODE: SUB COD AGENCY CU -sj-QMER1D-&---.-......... INSURED LOAN NUMBER POLICY NUMBER Clearwater Golf Associates,Inc. 1875 Airport Drive CPS2890865 Clearwater,FL 33765 EFFECTIVE DATE I EXPIRATION DATE CONTINUED UNTIL 0611712018 06117/2019 TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATIONMESCRIPTION Bldg 1:1875 Airport Drive,Clearwater,FL 33765 Clubhouse Bldg 2:1875 Airport Drive,Clearwater,FL 33765 Storage Facility Bldg 3:1875 Airport Drive,Clearwater,FL 33765 Golf Cart Storage Building Bldg 4:1875 Airport Drive,Clearwater,FL 33765 Pump House THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE 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, COVERAGE INFORMATION PERILS INSURED BASIC BROAD X SPECIAL COVERAGE PERILS I FORMS .......... AMOUNT O€INSURANCE DEDUCTIBLE Building I Building-Excludes Wind 1267,900 2,500 Contents-Excludes Wind 1 !131,250 2,500 Building 2 1 Building-Excludes VVInd 197,400 2,500 Contents-Excludes VMnd 115,750 2,500 Building 3 Building-Excludes Wind 214,300 12,500 Contents-Excludes VVind15,000 12,500 Building 4 1 Pump House-Excludes Wind ;5,000 12,500 Machinery/Equipment-Excludes Wind 125,000 i2.500 Replacement Cost;80%Coinsurance REMARKS(including Special Conditions) City of Clearwater is listed as Additional Insured with regard to General Liability If required by written contract. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAME AND ADDRESS ADDITIONAL INSURED LENDER'S LOSS PAYABLE LOSS PAYEE MORTGAGEE ILOAN# City of Clearwater PO Box 4748 Clearwater FL 33758 UTHORLZED I REPRESENTAT &,-77 4q,� ACORD 27(2016103) kOc 1993.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD