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CERTIFICATE OF INSURANCE (9) cf~~~Y ~ American Druggists Ins. Co. COMPANY B LETTER COMPANY C LETTER COMPA~Y 0 LETTER COMPANY E ,llr'I"TV, CLERK. LETTER LlIo'.&.&~" 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 1his 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. AIM Insurance Agency P. O. Box 4985 Clearwater, FL 33518 NAME AND ADDRESS OF INSURED Emil M?rquardt, Trustee 519 Cleveland Street Clearwater, FL 33515 COMPANY LETTER TYPE OF INSURANCE GENERAL LIABILITY A o COMPREHENSIVE FORM [X] 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 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 COMPANIES AFFORDING COVERAGES POLICY NUMBER POLICY EXPIRATION DATE limits of liability in Thousands (0 0) OCC~~~~NCE AGGREGATE PP901664 12-10-80 BODILY INJURY PROPERTY DAMAGE $ $ BODILY INJURY AND PROPERTY DAMAGE COMBINED $ 500 $ 500 PEflSONAi~ INJURY $ BODILY INJURY lEACH PERSON) BODILY INJURY (EACH ACCIDENT) f'ROPERTY DAMAGE BOOILY INJURY AND PROPERTY DAMAGE COMBINED $ $ BODILY INJURY AND PROPERTY DAMAGE COMBINED $ City of Clearwater is named as co-insured for the liability on the buildings at the described locations which extend to the curb of the premises. THIS VOIDS AND SUPERCEDES PREVIOUS CERTIFICATE OF 3-6-80 Cancellation: Should any of the above desc[lfed 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' DATE ISSUED~ 5-12-80 City of Clearwater P. O. Box 4748 Clearwater, FL 33518 Attention: Denise Cowdrick AIM In~urance Agency P. O. Box 4985 Clearwater, FL 33518 COMPANIES AFFORDING COVERAGES COMPANY LETTER A B C o E o American Druggists COMPANY LETTER NAME AND ADDRESS OF INSURED COMPANY LETTER Tillie'O'Too1es Jazz Emporium Decade, Inc dba & Emil Marquardt, Trustee 519 Cleveland Street COMPANY LETTER COMPANY LETTER , This;s to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. IYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION DATE Limits of Liability in Thousands (000) EACH OCCURRENCE AGGREGATE GENERAL LIABILITY A o COMPREHENSIVE FORM IKJ PREMISES-OPERATIONS o EXPLOSION AND COLLAPSE HAZARD 0' UNDERGROUND HAZARD o PRODUCTS/COMPLETED OPERATIONS HAZARD o CONTRACTUAL INSURANCE o BROAD FORM PROPERTY DAMAGE o INDePENDENT CONTRACTORS o f'ERSONAL INJURv PP90l664 12-10-80 BODILY INJURY PROPERTY DAMAGE BODILY INJURY ANll PROPERTY DAMAGE COMBINED 500 $ 500 EXCESS LIABILITY --~ ---------L------------~ I i I 1- I -~-----_f ~-- PER'30NAL INJURY I BODILY INJURY : (E ACH PERSON) I , BODILY INJURY i I (EACH ACCIDENT) i I f'ROPERTY DAMAGE ~IL Y INJUI1Y AND -- PROPfRTY DM~AGE COMBINFo!L___ -----------'---r AUTOMOBILE LIABILITY [J COMPREHENSIVE FUq',' , DOWNED ' o HIRED o NON-OWNED o UMBRELLA FORM o OTHER THAN UMBRELLA FORM liO[lILY INJURY AND PROPERlY flAMAGf_ COMBINED WORKERS' COMPENSATION and EMPLOYERS' LIABILITY OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES City of Clearwater is named as co-insured for the liability on the buildings at the described locations which extends to the curb of the premises. Cancellation: Should any of the above descriaed 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 City of Clearwater p. O. Box 4748 Clearwater, FL 33518 Attention: Denise Cowdrick DATE ISSUED, 3-6-80 to 'eJ; r;,~~ AUTHORIZED REPRESENTATIVE ).