CERTIFICATE OF INSURANCE (2)
I I
Aviation Insurance Agency
INCORPORATED
Palm Beach (407) 884-2826
4440 P.G.A. Boulevard
Palm Beach Gardens, Florida 334l0-6575
FaCllmUa (407) 828-19n
September 5, 1991
Re: Suncoast Aviation, Inc.
I
L...,.,,~.
~E~ - ~
City Manager
City of Clearwater
P. O. Box 4748
Clearwater, Florida 34618-4748
Dear Sir/Madam:
We have enclosed aCertifi~ate of Insurance certifying Workers'
Compensation Insurance co~erages in full force and effect for the
captioned Insured.
We trust you will find this in order.
Sincerely,
AVIATION INSURANCE AGENCY, INC.
/i.~e (--/1!L~~~~
:Sandra Phillips ;7
sp/
Enclosure
cc: Mr. R. Emshoff, Suncoast Aviation, Inc.
Liberty Mutual
:ef:r.f:lVED
SEP 0 9 1991
CITY ClE~K
At~ttlll."
ISSUE DATE (MM/DD/YY)
09/05/91
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
'I'
: '
PRODUCER
Aviation Insurance Agency, Inc.
4440 P.G.A. Boulevard, Suite 308
Palm Beach Gardens, Florida 33410
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
Liberty Mutual
INSURED
~~~~Y B
Suncoast Aviation, Inc. dba
Suncoast Air Center
4630 Douglas Street
Tampa, Florida 33614
COMPANY C
LETTER
COMPANY D
LETTER
,,.~'tif~C!l.,,,,
~~I'~~~i?-'~"- :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
~~T~~NY E
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
CLAIMS MADE
OCCUR.
GENERAL AGGREGATE $
PRODUCTS.COMP/OP AGG, $
PERSONAL & ADV, INJURY $
$
$
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
WCl-351-234762-011
OS/21/92
$
OWNER'S & CONTRACTOR'S PROT,
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
$
$
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
A
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
OS/21/91
EACH ACCIDENT
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
1,000,000
1,000,000
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSIVEHICLES/SPECIAL ITEMS
LOCATION COVERED: 1000 Hercules Avenue, Clearwater, Florida
i~~~IHY;:
,.. ..', >.~ -- -, ",
~: :_;~;:~~: t?~ H~- ~~ ~,; ~,,;
iQ_~A;TJ.
City Manager, City of Clearwater
P. O. Box 4748
Clearwater, Florida 34618-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL.-30..- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED R~SENTATlVE
~g..,~~-
:->_;~_ -,;;(,-t~~m~t.{}-;../..i- -':~;- ~
@ACORD CORPORATIOH1tt90