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.
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Long & Co.. Inc
SGA-ll.B AVlhorl"'(fti tall"
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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
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(813) 535-1755