BUSINESS OWNERS POLICY RENEWAL CERTIFICATE AND INVOICE
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--,- ~---- I BUSINESSOWNERS POLICY I
}rl~~~.!l"H~[!J.:lIJ.1L RENEWAL CERTIFICATE
. ATTACH THIS CERTIFICATE TO YOUR POLICY.
~D 0 THE OHIO CASUALTY INSURANCE COMPANY
The Ohio Casualty Group D. AMERICAN FIRE AND CASUALTY COMPANY
il WEST AMERICAN INSURANCE COMPANY
of Insurance Companies
136 North Third Street, HamiltoR, Ohio 45025
References in the. policy to "the Company" or "this Company"
mean the Company designated above by the letter X,
In consideration of the premium, the policy designated below is renewed for the policy period stated below, subject to all its terms except
as otherwisE specified herein.' . ,
Policy Number JIPW 11 .1 71 Renewal Premium $ 1SO."
Named InsurerltmJ.a IlaPbD'P "~p .. "'~t7 St.,l..
Mailing Address 2~ Catu.",AJ' .lW41.
TO~~o,o~tc~~:: Cleuntor. 1'1. "S1,
,county, St:!t~L,
Zip'C'ode)
P I' P . d F 1L.4ft._.t T .......'!!W'" GJI:! Beginning and ending at 12 noon Standard Time (12:01 A,M, In
o ICY eno: rom: ~~~.7 , .0:..... __ __ California and Oregon) at the Address of the Insured stated above,
IN WITNESS WHEREOF, this Company has executed and attested these pre-
sents; but this certificate shall not be valid unless countersigned by a
duly authorized Agent of the Company.
Countersigned at Cl.~t..."
this ~ll day of Ira"".. 19___
~....y~,-" I~. 1M.
Date Issued 1-30-85 1jr/*,-_ Authorized Agent
~ ~ ht4.1.C'~'__
President
CITY iOf":C~~~~~r~~
, ", " ,l \! Secretary
MARe'l 1985 f L B ,~tl5 it \ ~
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"50 INVOICE
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BURKE-LEHMAN INSURANCE, INC.
HOMEOWNERS . AUTO . COMMERCiAl · LIFE
2173 N,E. COACHMAN ROAD
CLEARWATER, FLORIDA 33575
TELEPHONE (813) 441-4914
,to '
11
ACCOUNT
I
HARBOH BAHBER 8( BE(.%UTV ::nVdE
L~:::::.::3
25 CAUSEWAY BLVD.
CLEARWATER BCH. FL. 33515
L
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NAME
INSURED
PLEASE DETACH AND RETURN WITH REMITTANCE
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3-20-85/861IBPW174171
OWNER::; POL I CY
P A \ 0 1"lAR 1 8 1985
PREMIUMS DUE AND PAYABLE ON EFFECTIVE DATE OF POLICY
Please examine the polIcies listed above and notify us immediately II any corrections are necessary. Any
NOTE policy not wanted must be relurned promptly for cancellation: otherwise an earned premium will be charged
by the Insurance Company lor the time it was In for-ceo
.
DATE
,. ... <::> [
AMOUNT REMITIED ~~() L-@
PREMIUM
CHARGE CREDIT
"1} .I. :.~I \ , ,. (: ~ )
BURK&LEHMANINSURANC&INC
2173 N.E. COACHMAN ROAD
CLEARWATER, FLORIDA 33575
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