The URL can be used to link to this page

CERTIFICATE OF INSURANCE (113) TO" " "",.." '"" po'''''''' """po, ,,,,,d ...~. b~' PO," "",d ",.. ,"""d "m,d ."'" "d ." io w"., "" "10' N,..".."od'" '" """,10 0< ",10 0< oood"iOO " ",000""'" "", d",m,"' ."b """, ".b"b .." ,,",,"'" 10" b' "",d 0< m.Y po,"'"'''' ,",,"0" .H"d,d bY .eo ,,'''''' d"" bod ",,10 " "bi'" " ." ... ",10' ",",""' "d oood""'" " ",b po"'.' c.nc.'Io'lon' ShO,'d anY 01 'he ab"e desClibed ,ol\c,es be ca"eHed be,,,e ,he e"i"';oo da.e ....eol, ,.. "'," '00 elld..'" " mail ~ day' ..il,ellllO"ce " ... belO. ",med ,e."Ii".e holde" b" Iall"e '0 mail ",h lloli. '0" lIO obl\.a"'" 0' I\abil'" 01 allY killd "", ,.. "m,allY NAME AND ADDRESS OF CERilFICAiE KOLOER city Clearwater p. o. BOX 4148 CLearwater FL 33519 H'.ClRO 25 ('.79\ +, ~. , I COplmercial General Liability Insurance A.meDdment .a.:uve, 12/31/86 WHO IS 1;NSURED ADDITIONAL INSURED-VENDORS D&SlONATXD v~DOa .Aa p.e: .~a Oil U.la v1a:!:l ch.. ~aAY DESIONATXD PB.ODUC'1'S .Aa pel:' "~ Oil 111- V1a:A en. ~&Q1 -n.. WHO IS LN~URED pnwia.i.o.a U. '.....n..4--d to ~ .. aA iDaurai Uw peDOIl or orp.aU.aUaa ~ ~ .. Y8Ddar. bue. ONY with ~pea to bodlly 1aJ~ or pnfM'd7 d.Juaq. ~ oue. 01 &.h4I diaUibucJ,a,o or.ale 1D the ~ couae 01. ~~. bu..u- ol,~ ~ A_IIV.'~ blMow: BUT 1. No aw:h penc.a or orga.ni1aUG4 da&i~tad .. . vacd.cr 1a &4 " inawwd wit.b ~ t.a: .. &41 u~ w~r.y wautb..ocUad by you; b. aAY phr-ical I:W ~.....I~..I ch&np 1D Lha form cl r.ha pmdUd'. mAda iDtaAUc4&lly by tha v..ndor; Co I"Ipackiq. unI-a WJpacX.ed ~y lar thai put'POM cl iD.IIp-< i.... ci.a.moAaln.Lioa. CMLin.Ir I:W t.ha .wb.Li.WUaIl ol pll.l'r..a 1&Ad-- buouuctian froa1 tha ........I....i.W'W ..,Q ~ "9---"'--:f IA &.b.I ~ ~'.i~~ d. damonAtnlUDu. buuJlatioa. ~iciq or r-paU- operatLc.c.&. u.o.pc. auch os-atiaAa performed ., .&.boa ~'. ~ ill Cf'n.."-w. with tha u.1e 01 t,.b. produa; .. produ.cu whic:h. altar disLributioa or aale by you haw bee4 1II~ 0Jr ,..I.hat.--i cr_ u..asd.. ~..,a. cmuinar. ~.I:W ~ 01. aA'J ~ ~ cr aub............ by cr foi chi ~. t:JI t aA1 raiIura to m.aka .u.c:h ina~.;nn.. adjua(.meau. r-u or IIM'V~ .. the veadD&" haa ~ to mab ar a.ormally ~ 1.0 mak.e ill tha u.u.&1 COW'M 01 b...i-- 1D e<.....-~;oa with tha diauibuUaa or..u. 01. t.ba ~ :. mu- Uuu.raAC8 doea DO' apply to &AY pono4 or crv"i....,inn. U iaaunId. from whom you have -.cqu.ind au.cll. ptOdu.cu or &Q)" ~~ part. or c:caf.ll.i..aM. ea~ [Qc.a. ~pa'V~ or <~. _;..i ft I 8UC!l pn:ad.ud.L . ,I !o .. J-.4~ All u&.h.w c..rnw &ad. amdiuoa,a rwn&i.a UAdtanpci N~rwd l~ La...l Inc.. .~l Pu1iq Numb.: ~15-74-l:Z ProduCM: C.U~Q'U~ &ad lU.ack. - , tC . . =},..s~... . . CHLJ<<O- r ! .~!~~~:6::~~~f~~::~ :=7:7:i~:-:";~~~ '.~;'~::: c...,~.,:;~,:~_:"~.:: '-..;~=f "~"\''''~~'~~~J~::;Jo':~~~~':"?,''._':.