CERTIFICATE OF INSURANCE (3)
Insures the 'oIlowlng poliCYhold;t~r ~~ -CO~~~ge~-F~ted ~~:
Name or policyhOlder
. _.- _......~._... .....m t-
Address ot pOlicyholder
LocatiOn 0' operatIOns
POBOX 3025
Description ot operations PUB LIS f'I ER
The poliCieS liSted below have, been issuoo to the poficyholder for the policy periods shown. The in8ur8l1C8 described in these polldes is subj8ct 10 all the term
exeluslons, and conditions of those policies. Ttle limits ot IlablUty shown may have been reduced by any paid claims.
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effectiw Date : Expiration Date
UMITS Of liABILITY
(at beginning of policy periOCl)
BODILY INJURY AND
PROPERTY DAMAGE
Compreherlslve :
.9.0.~.BL::~U .8.0::,.2.. .r...... ..J?~~!~~..~~l!~y.... ..... .... ..8./ 2/. 95_____.....L... 81 2l9.0.. ...__.
This Insurara Includes: D Products - Compl9ted Operations
o Contractual Uablllty
o Underground HaZard Coverage
o Pursonallnjury
o Advertl&lng Injury
D ExploSion Hazard Coverage
D CoIlapee Hazard Coverage
o General Aggr'egate Unlit appIiaa to each project
o
o
POLICY NUMBER
EXCESS LIABILITY
D Umbflllh.'l
o other
POLICY PERIOD
EUtctl". Data ExptratlOI'l Data
Wcners' CompensatiOn
and Employers L1ablllty
TYPE OF INSURANCE
POLICY PERIOD
E"ectlve Date Expiration Data
Name and Address ot Certificate Holder
CITV Of CLEARWATER
25 CAUSEWAY BLVD
C:EARWATER, FL '34636
~.~ R40v.12.11 _..v,s-^-
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Al~ G 3
t,., I"
;'"," 'J
Cj.rl'~:'~4.l~"": ~;.(I.
Each Occurr8OCtl
General Aggregate
Products - Completed
Operatlon8 Aggregate
$
$
$ 600 000
$
$
$
BODILY INJURY AND PROPERTY DAMAG
(CombIned Single Urnlt)
$
$
Each Oo;;vr(EIOCIiI
AQQRlQ8te
Port 1 STATUTORY
Par'! 2 80DlL Y INJURY
EachAocIdent
Disease Each Employee
DIMaM - Policy UmIt
L1MIT$ OF UAIIILITV
(at ~lnnlng of policy period)
If any of the doocribed poIlclea are canceled betore
expiration date. State Farm will try to mall a wrttten notice
the certlf~te holder - -.. days belOl'e cancellation,
oowev6f, WfI fail to mail such notice, no obligation or Ila
'w tate Fa Ite agente OJ. re
tlv".
l1llo
.-.'. ~ S""'Il
RUGGIE~1214
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