CERTIFICATE OF INSURANCE (2)
Pr10DUCER
Burke-Lehman Insurance, Inc.
2173 N.E. Coachman Road
Clearwater, Florida 33575
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.
COMPANIES AFFORDING COVERAGE
f~~~~NY A Seibels lirifcli: E I V E D
COMPANY B
INSURED LETTER
M. Alfred Gregory dba COMPANY C
Marina Gift Souveniers LETTER
75 Causeway Blvd. COMPANY D
Clearwater, Florida 33515 LETTER
COMPANY E
LETTER
MAR 11 1986
CITY CLERK
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD INDIC~TED.
IWTW1THSrAlmJ~IG ANY REQUII'IEMENT, TERM OR CONDITION OF ANY CONTRi~CT OR (iT nEI~ Dl)CUME1n WITH RESPr.;CT TO \il:,Cf-[ ILL ;;E:; i";j,C,,, n,: i\!ill.t
(~E ISSUED ,)R MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Al.L THE rERMS, EXGL.USION':" AND CO!~DI-
TIONS OF SUCH POLICIES.
}~_~l~::~~~,~;;~,~~~R,':~(-C-~+ B~1~~(;:-:::~~~~~-~6~;I.. ~~4 _~~~''''r~;~~:'~ft~~"~
r~~j PREMm,S/OPERft,TIONS tf'F10~CRrY $ ---------+_~I !__m.___h-,-___
;-- UNDERGFIOUND I1AMAGE $ $
~~ EXc'LOStON & COLLAPS!' HAZf\RlJ f
~ :~:~~MP(EfW ,p,""""s ,~6t:~m $1 ,~~-o ~:~--:-~;;-~
~ IINDEPENlJENT CONTRACTORS rl ____ __ ____ --J~
! X1 BROAD fORM PROPERTY DAMA.GE I
---trt:~::N~:::'UTym -+ m n ..~t:RSONAC","U"u~ .... ....
l ANY AUT 0 r:~I~R~ERSO~1! $
~:11 ALL ()W~JED AUTOS (PRiV PASS.) ~IV~~ --------
I ALL OWNED AUTOS (OTHER THN,') I' (PER~CCIDENTi $
>-_. 'PRIV, PASS
, HIRED AUTOS
i
I
I
i BI & PD
J COMBINED
~---------------: =--------- --------+--
NON-OWNED AUTOS
GARAGE L.IABIL ITY
PROPERTY
DAMAGE
$
SXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
- --------------
I WORKERS' COMPENSATION
I AND
, EMPLOYERS' LIABILITY
~St~~ED $
$
STATUTORY
II lEACH ACCIDE'H)
$ IDISFASEPOLlCv LIMIT)
.', ' ' $----------~D1:;:ASEEACr ErH(lYEE)
J__.~____.____..l
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
copy to: Harbormaster
Clearwater Marina
City Clerk
Clearwater City Hall
r.te. Box 4748
Clearwater, Florida 33518
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