CERTIFICATE OF INSURANCE (3)
TO:
Susan Stephenson, Documents and Records
CITyfOF
In~l'depart
Manag<\r
CLEARWATER
or espondence Sheet
"
I
FROM:
Elizabeth S. Haeseker, Assistant City Manager
COPIES:
SUBJEC~ Car1oue1 Garden & Improvement
Agreement March 6, 1981
DATE: April 22, 1986
In the above-referenced agreement, the Car1oue1 people are to
provide us with $500,000.00 worth of insurance to cover their
entrance monuments.
Enclosed is the original of the most recent insurance certificate.
Enc.
RECEIVED
APR 23 1986
CITY ClERK
��ertificate of Insurance APR 2i'sas
THIS CERTIFICATE IS ISSUE- +5 A MATTER OF INFORMATION ONLY AND CONFERS NC LIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
NAME AND ADDRESS OF AGENCY
CONDOi i ME=EK INC
121 1 COURT ST
(CLL = RW TER FL 33516
,
COMPANIES AFFORDING COVERAGES
COMPANY 1- t
LETTER ST PAUL FIRE
RE
COMPANY B
LETTER
NAME AND ADDRESS OF INSURED
!.. RI....c:vEL._ GARDEN ::. IMPROVEMENT
VE:MENT
BOX 3442
CLE I...11•5:W,A 1 E R
FL
:33515
COMPANY C
LETTER
COMPANY
LETTER ,
COMPANY E
LETTER
This is to certify that 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.
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EFFECTIVE DATE
POLICY
EXPIRATION DATE
Limits of Liability in Thousand[OOTJ)
EACH
OCCURRENCE
AGGREGATE
(y
--_
-
A
'
-
A
i
J
A4
GENERAL
LIABILITY I±•
COMPREHENSIVE FORM -•
PREMISES/OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS
CONTRACTUAL
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PERSONAL INJURY
i/_)'-D,TI"I8`JC] 7i
rl c: ep t i on date
fy j 1 O / 86
4/10/86
4/10/R7
BODILY INJURY
PROPERTY DAMAGE
--
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
_- -_
500
_- --
PERSONAL INJURY
1
a^y
-,
I
a
.a
AUTOMOBILE
LIABILITY
COMPREHENSIVE FORM
OWNED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
-
BODILY INJURY
(PER PERSON)
BODILY INJURY
(PER ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
I
2
a
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTYCOMBINED DAMAGE
a
WORKER'S COMPENSATION
and
EMPLOYERSLIABILITY
STATUTORY
EACH ACCIDENT)
=
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES S E A ••),TEM.-•
�.� � � �1F CI E".t=1RWi'.:1..1..1-:R IS NAMED AS i=1 h:: t:t :i: "i" I I.�jP.IE=';
a:NSuRE:D AS RESPECTS TO THE Di::::lrOR(.TIVE:
COLUMNS
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company
will endeavor to mail "- days written notice to the below named certificate holder, but failure to mail
such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.
NAME AND ADDRESS OF CERTIFICATE HOLDER
CITY OF Ci_EA f -,f( l'.ER
i TTN ELIZABETH HAE:. i•:E.R
2 0 BOX 4748
CL..EIAi WA T ER FL 3„::.517
8-:4 25
ISSUE DATE
Apr.l..I. 17, 1581. 2
/(
AUTHORIZED REPRESENTATIV,
JOHN H