CERTIFICATE OF LIABILITY INSURANCE (2) DATE:IMNVDDPYYYY)
CERTIFICATE OF LIABILITY INSURANCE
12112(2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 policyjiesj must have ADDITIONAL.INSURED provisions or be endorsed,
If S IBROGATION 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 NAME: $t9crry SMet _.
Lancaster Insurance Inc PHONE (727)461-3704AJCNo: (727)441-3298
APC No Ext):
510 Druid Rd E.,Ste.#C ADDRESS: strerry landiis.corn
P 0 80x.2656 INSURER(S)AFFORDING COVERAGE MAIC 0
Clearwater FL 33757 INSURER A: AutoOwners Agency#12-0253-00 18988
INSURED INSURER B ___...
Clearwater Shuffleboard Club INSURER
19201 Calumet St INSURER D:
INSURER E-
Clearwater FL 33755-1813 INSURERF.
COVERAGES CERTIFICATE NUMBER: CLIB5409696 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR ZITHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM'S,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
rA
_ TYPE OF INSURANCE In D WV.. POLICY NUMBER MM DPYYYFr A9Md41]PYYYY CYERF LIMITS
X COMMERCIAL GE'NERAL.LJABILITY EACH OCCURRENCE S 1,000,000
CLAIMS-MALS �OCCUR PREMISES Eaocxvrrrenet: 3 50,000
MED EXP(Anyone person) S 5,000
Y 20540898 1211312018 12113/2019 PERSONAL 6 ADV INJURY S 1,000,000
GEty L AGGREGATE LIMIT APPLIES PE.R, CE NEPAL AGGREGATE $ 2,000,000
POLICY E T 1:1 LOC PRODUCTS-CC MPnP AGG 5 1,00D,000
OTHER: INADJ s
AUTOMOBILE LIABILITY COMBINED Sd..:.. ELIMIT 'a 1.,00'0,000
Ea acdowr _ r,
ANY AUTO BODILY INJURY(Par person)
OWNED 'SCHEDULED Y [20540898 1241312018 12JI 12019 BODILY INJURY(Per ar enl) S
AUTOS ONLY AUTOS
HIRED NON-WNEp PRr 'ERTY L`1AIilIAGE
AUTOS ONLY AUTOS ONLY r"9eraC.Gd9n1
s
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAR Id CLAKS-MADE AGGREGATE 'S
DED I I RETENTION 5 5'
WORKERS COMPENSATION I PER LITH.
AND EMPLOYErt'S'LIABILITY Y 1 NSTATUTE ER _..�
ANY PROPRIETOFUPARTNERIEXECI TIVE L. N I A E M EACH ACCIDENT 5
OFFICERNE MOE R EXCLUDE
(mandalnry in NH) E.C..DISEASE-EA EMPLOYEE ,1
el 9e*.deY 'Ue
[DESCRIPTION OF OPERATIONS 4®rpw' E.I.-DISEASE•POLICY UMIT 3
DESCRIPTION Or OPERATIONS i LOCATIONS f VEHICLES(ACORO 101,Additional Remarks Schedule,rney 4e attactwet If more*gave Is ferlutred)
City of Clearwater Is named as Addtional Insured with respect to the General Lialbity and Autry Liahitity
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.
7016 N Missouri Ave
AUTHORIZED-REFRESENTA`IVE
Clearwater FL 33758r o- f
iti88 2015 ACORD CORPORATION, All rights reserved.
AC ORD 25(201640 3) The ACORN name and logo are registered marks pf ACORD
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