INSURANCE CERTIFICATE ENGINEERED RECYCLING SYSTEMS INC. (3)
~
-s;~ ",'"
4(tH. .uS\"~
STAl(: AUTOMOBILE MUTUAL
IItSURANCE COMPANY
- OF COLUMBUS. OHIO
l:ate
CERTIFICATE OF INSURANCE
9/20/78
Revised
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 notified in writing in the manner pro.
vided in the policy. Ten llOl days' notice wUl be given unless otherwise indicated herein:
Name & Address Of Party To Whom This Certificate Is Issued Name & Address of Insured
"ITY nF ' , n..~ TN"
,-
PO Box 4748 2575 Harn Blvd. ...rt
Clearwater, FL Clearwater, FL ~'t.C~X' ~'
\<:1:11)
Business of Insured
Location of Operations or Premises
Engineered Farming
State Road 5BO (North of), Clearwal-er, FL
<<"" ,I.)
,cIrJ
.'
TYPE OF INSURANCE LIMITS OF LIABILITY PO~~~~ . EXPIRATION
NUMBER OATE
Workmen's Compensation As provided by law of the State of
IIZI Designates Insurance Afforded or Hazard $ EACH OCCURRENCE""
Excluded) Bodily Injury Liability and $ AGGREGATE""
D Multl.Peril Property Damage liability ""Total Limit for Bodily Injury and Prop-
erty Damage Liability combined
Excluding Completed
L ~ ""'...~,. }" Operations and
G I
EA General liability Products Liability $ 300 000 EACH OCCURRENCE GA939l97 9/20/79
NB o Owners', landlords' and Tenants' Liability Bodily Injury liability $ 300 000 AGGREGAH:
E I D Excluding Structural Alterations
RL
A I o Manufacturers' and Contractors' Liability
L T D Excluding independent Contractors Property Damage $ 50,000
Y EACH OCCURRENCE
D Contractual Liability Liability $ 50,000 AGGREGATE
D Completed Operations and Products Liability
ADDITIONAL INSURED: CITY OF CL I'ARWATER
o Comprehensive Automobile liability Bodily Injury Liability $ EACH PERSON
AL o Basic Automobile liability $ EACH OCCURRENCE
U I
TA Properly Damage Liability $ EACH OCCURRENCE
OB Automobile(s) Specified Below $ EACH PERSON
MI Bodily Injury Liability
OL $ EACH OCCURRENCE
BI Property Damage liability $ EACH OCCURRENCE
IT
Ly
E
AUTO Automobile[s) Specified Below
P Encumbrance-loss is payable as interest may appear to the IACV Actual Cash Value)
HO named insured and: (See reverse side) Car No. Comprehensive Collision Fire Theft
YA $ Deductible $ $ $ $
SM Loss Payee-Name $
I A
CG Address
AE
L
S Car No. Year of Model Trade Name Body Type Serial, Motor or Iden-tification No.
C
AH c,
UE I " ~
I
TO ",,::> :" \ " ~4'
OU , \
L '17 t i.j'
E \ nv' )
, / "U tNr: fg~ J~
tJ ",,'7 e;/-' ,
/ A(lttiorlzed ~;pntatlve
j
,'"
C~ "'..:.J-.....-
SGA-I1-B
,/
,..2.