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INSURANCE CERTIFICATE ENGINEERED RECYCLING SYSTEMS INC. STA"ij: AUTOMOBILE MUTUAL II'ISURANCE COMPANY , OF COLUMBUS, OHIO tate CERTIFICATE OF 10/20/76 INSURANCE This certifies that the State Automobile Mutual Insurance Company has issued, to the insured named herein, policies of insurance which provide coverage as indicated below. Such policies are subject to the provisions, conditions and limitations contained therein. In the event of cancelation of any policy described below in the schedule, the party to whom this certificate is issued will be nRiEJii:'lliI~fITg:in the manner pro. vided in the policy. Ten (10) days' notice will be given unless otherwise indicated herein: OCT ' Name & Address Of Party To Whom This Certificate Is Issued Name & Address of Insured Cit of Clearwater En ineered Rec c1ig Inc. P.O. Box 4748 2575 Ham Blvd. Clearwater Florida Clearwater Florida Business of Insured location of Operations or Premises Engineered Farming State Road ~SO (North ot) Clearwater, Flor~da TYPE OF INSURANCE LIMITS OF LIABILITY POLICY EXPIRATION NUMBER DATE Workmen's Compensation As provided by law of fhe State of HZ] Designates Insurance Afforded or Hazard $ EACH OCCURRENCE~ Excluded) Bodily Injury Liability and $ AGGREGATE* D ~""'"' } Properly Damage Liability * Total Limit for Bodily Injury ond Prop- erty Damage Liability combined Excluding Completed L iiI. Comprehensive [jj Operations and G I EA General Liability Products Liability $ 300,000. EACH OCCURRENCE NB o Owners', landlords' and Tenants' Liability Bodily Injury liability $100 ,000 AGGREGATl:: ;A899048 9/20/77 E I RL o Excluding Structural Alterations A I o Manufacturers' and Contractors' Liability l T o Excluding Independent Contractors Property Damage $ 50,000. Y EACH OCCURRENCE o Confractual Liability Liability $ 50 000. AGGREGATE o Completed Operations and Products liability Additional Insured; Cit v of C1earwat ar AL o Comprehensive Automobile Liability Bodily Injury Liability $ EACH PERSON U I D Basic Automobile Liability $ EACH OCCURRENCE TA Property Damage Liability $ EACH OCCURRENCE OB Automobilets) Specified Below $ EACH PERSON MI Bodily Injury Liability Ol $ EACH OCCURRENCE B I Property Damage Liability $ EACH OCCURRENCE IT Ly E AUTO Automobile(sl Specified Below P Encumbrance-Loss is payable -as interest may appear to the IACV-Actual Cash Value) NO named insured and: (See reverse side) Car No. Comprehensive Collision Fire Theft YA $ Deductible $ $ $ $ SM Loss Payee-Name $ I A C G Address AE L S Car No. Year of Model Trade Name Body Type Serial, Motor or Identification No. C AN UE TO OU C) \\ L r-II E f( , V ~. 'V \~rl Ft' Long & Co.. Inc SGA-ll.B AVlhorl"'(fti tall" , ~ -,If" i J October 12, 1976 Engineered Recycling Systems, Inc. 2575 narn Boulevard Clearwater, Florida 33516 Gentlemen: Reference is made to the agreement between your firm and the City of Clearwater for environmental manaee- ment and monitoring at the liortheast Sewage Spray Irrigation Fields. Under the terms of this agreement you are required to furnish the City with a certificate of insurance covering this uctivity, with the City to be named as additional insured. It will be appreciated if you will take immediate action to provide this office with the required insurance certificate, at which time we will mail your copy of the agreement. Very truly yours, R. G. Whitehead, CMC Ci ty Clerk 51 be; !1r. ;'like Paroby I I -"';'-~- ENGINEEAEDReCYCLlN"G SYSTEMS, INC. 2575 Harn Boulevard Clearwater, Florida 33516 200ct~b,eT. 1976. ---'=.",,..." Mr.R. G. Whitehead, CMC . . City-Cle.TIt ~".Qf,~.r.V{l!.j;8:r_ __ '_, __ _., P. O:-Box 4748 ' ' ..., Clearwater",F'la. '33518. Dear Mr. Whitehead: In accordance with your letter of QctQbieT i2, 1976, please be advi-sed thaLour ins,urance agent:Long, & Co., is forwarding directly to you OUT certificate ofil:lSuT~.!lee~ We tru!lt that it will meet with your -approval and wish 1;0 acl.~th.atwe are looking forward to working . wi-th-the City QfClea:rwater ,on this project. . As you are aware, our contraGt with the city requires that we pay $10 per month for. use of the Spray Irrigation Fi,eld. Please advise us where we should maUour check so we can begin doing so on . receipt of our signedconl:ract. -.---~", - _." ..v::;p~~ M. J. GAYLOR, P. E. President MJG/dfg, ;Y "':'~ . '[vAl' - '. ' .. 0.." _)f\ I\b M'~~~~~/ ., -(It> ~ '. , .- ~ ;~, '- (813) 535-1755