CERTIFICATE OF LIABILITY INSURANCE (7)
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP IDVG I DATE (MMIDDNVYV)
CI.EAR17 08/10/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FI. 33757-2456
Phone: 727-461-6044 Fax: 727-442-7695 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American Econ~ Ins. Co. 19690
INSURER B: l"PYll. Mut.u.l InlNranc. COIIIpany 10385
Clearwater Golf Associates Inc INSURER c:
1875 Airport Drive INSURER D:
Clearwater PI. 33765
INSURER e"
COVERAGES
THE POLICIES OF INsURANce LISTED BELOW HAVE BEEN Issuec TO THE INSURED NAMEDAElOVE FDA THE POLlCY PERJOO INClCATED. M)TWrrHSTANOINQ
ANY REQUIREMENT. TEAM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY, PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO AU THE TERMS, EXCLUSIONS ANOCONOlTIONS OF SUCH
POliCIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR DO'l POUCY EffECTIVE PDUCY EXPIRATION
LTR NSAD TYPE OF INSURANCE PDUCY NUMBER DATE(MMIIlI>VY) DATE (MM/DDlYYI UMITS
GENERAL LIABILITY EACH OCCURRENCE . 1000000
- DAMAGE TO RENTED
A X X COMMERCIAL GENERAL LIABILITY 02CB:07957840 06/17/07 06/17/08 PREMISES (Ea ooourence) . 200000
- =:J CLAIMS MADE [!] OCCUR
MED EXP (Any one pereon) . 10000
-
X I.iquor I.iability PERSONAL & ADV INJURY . 1000000
-
GENEAAlAGGAEGATE . 2000000
-
GEN.L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMP/OP AGG . 2000000
I POLICY npRO- nLOC
JEeT
AUTOMOEltLE LIABILITY COMElINED SINGLE LIMIT
. 1000000
A ~ ...= 02CE07957840 06/17/07 06/17/08 (Eaaooldent)
ALL OWNED AUTOS BODILY INJURY
.
t SCHEDULED AUTOS (PerperBOn)
-
X HIRED AUTOS BODILY INJURY
(Peraooldenl) .
X NON-OWNED AUTOS
-
- PROPERlY DAMAGE .
(Peraocldenl)
GARAGE liABILITY AUTO ONLY - EA ACCIDENT .
~ ANY AUTO OTHER THAN EA ACe .
AUTO ONLY: AGG .
EXCESSi\JMBRELLA LIABtLITY EACH OCCURRENCE .
=:J OCCUR D CLAIMS MADE AGGREGATE .
.
~ DEDUCTIBLE .
RI;TENTION . .
X IT~~:~ I Ion-\-
WORKERS COMPENSATION AND ER
EMPLOYEAS' LIAElIUTY 03/17/07 03/17/08 . 100000
B 0016106 E.L EACH ACCIDENT
ANY PROPRIETOR/PARTNEFVEXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L DISEASE. EA EMPLOYEE . 100000
II yell. dellCnbe under . 500000
SPECIAL PROVISIONS below E.L otSEASE - POLICY LIMIT
OTHER
RECEIVED
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCWSIONS ADDED BY ENDORSEMENT 'SPECIAL PROVISIONS
City of Clearwater is listed as Additional Insured with regard to General AUG 14 2007
I.iability.
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
CERTIFICATE HOLDER
CANCELLATION
ClTOF-8
SHOULD ANY OF THE ABOVE DEBCRtBED POLICIES BE CANCELLED BEFORE THE EXPlRATlON
DATE THEREOf, THE 198UING INSURER W1U ENDEAVOR TO MAIL
30
DAVS WRITTEN
NOTICE TO THE CERTIFICATE HOlDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 SHALL
City of Clearwater
PO Box 4748
Clearwater PI. 33758
IMPOSE NO OBUOATlON OR UABtUTY OF ANY KIND UPON THE INSUFlER, ITS AGENTS OR
REPRESENTATIVES.
AUTHOA~~
' / /-,LJl -o..,--r.
ACORD 25 (2001/08)