CERTIFICATE OF INSURANCE
Burke-Lehman Insurance, Inc.
2173N.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 AL TEA THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
Excelsior
INSURED
M. Alfred Gregory dba
Marina Gift Souveniers
75 Causeway Blvd.
Clearwater, Florida 33515
COMPANY B
LETTER
COMPANY C
LETTER
MAR 29
COMPANY D
LETTER
. ,
E
1.
THIS IS TO CERTIFY THAT 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 CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE
POLICY NUMBER POlICY EFFECTIVE POLICY EXPIRATION
OA TE (MMlDD/YY) DATE (MMIOO/YY)
BODILY $ $
Being Issued 3-14-85 3-14-86 INJURY
PROPERTY $ $
DAMAGE
BI & PO $ 300 SBOO
COMBINED
RECEI\TED
GENERAL LIABILITY
X COMPREHENSIVE FORM
X PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
X PRODUCTs/COMPLETED OPERATIONS
X CONTRACTUAL
X INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
PERSONAL INJURY SBOO
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS.)
ALL OWNED AUTOS (OTHER THAN)
PRIV, PASS,
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
APR 1 1985
BOOIL Y
INJURY $
(PER PERSONI
BODILY
INJURY $
(PER ACCIllENT)
CITY CT "C'nK
~~~~~~TY $
~~t:~ED $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
~~t,:~ED$
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
(EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESfSPECIAL ITEMS
copy to: Harbormaster
Clearwater Marina
25 Causeway Blvd.
City Clerk
Clearwater City Hall
P.O. Box 4748
Clearwater, Florida 33518
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION,. DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAlL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUNIZED REPRI];>.ENTATI~ A
~u.u,.A /<., /4.A.A./~
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