CERTIFICATE OF INSURANCE (2)
WEST COAST INSURORS, INC.
4535 Central Ave.
St. Petersburg, Fl. 33713
COMPANY
LETTER
COMPANIES AFFORDING COVERAGES
ITY ~LERK
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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
NAME AND ADDRESS OF INSURED
Clearwater High
Inc.
C/O Don Hacker
540 S. Hercules,
COMPANY
LETTE R
School Band Boosters Assoc.
COMPANY
LETTER
Clearwater, Fl. 33516
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
GENERAL LIABILITY
A
~ COMPREHENSIVE FORM
o PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
H AZA RD
o UNDERGROUND HAZARD
o PRODUCTS/COMPLETED
OPERATIONS HAZARD
o CONTRACTUAL INSURANCE
o BROAD FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
o PERSONAL INJURY
CG118252
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON~OWNED
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
A
B
C
o
E
POLICY
EXPIRATION DATE
Aetna Insurance Company
,
FEB 12
1980
Limits of Liability in Thousands (
OCC~~~~NCE AGGREGATE
10/31/80
BODILY INJURY $
300
PROPERTY DAMAGE $
50
$
SODIL Y INJURY AND
PROPERTY DAMAGE $
COMBINED
$
PERSONAL INJURY
$
BODILY INJURY
IEAC H PERSON)
SODIL Y INJURY
(EACH ACCIDENT)
F'ROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany 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.
NAME AND ADDRESS OF CERTIFICATE HOLDER
Additional Insured
City of Clearwater
P.O. Box 4748
Clearwater, Fl. 33518
DATE ISSUED:
2/11/80
WEST COAST INSURORS, INC.
I
,
February 1, 1980
Mr. Merwyn Hassell, President
Clearwater High School Band Boosters
1679 Drew Street
Clearwater, Fla. 33515
Dear Mr. Hassell:
The parking management agreement between the City of
Clearwater and the Clearwater High School Band Boosters
requires that you furnish evidence of insurance, with the
City listed as an additional insured.
Please send the required certificate of insurance to
this office at your earliest convenience.
Yours,tttAo/.1
Lucille Williams
City Clerk
LW/dc