CERTIFICATE OF INSURANCE (3)
THE VEGHTE AGENCY
Post Office Box 1560
Clearwater, FL 33517
COMPANIES AFFORDING COVERAGES
NAME AND ADDRESS OF INSURED
f~~~~NY A Reliance Insurance Company
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER CIIT ., .._
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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.
Palm P~vilion of Clearwater,
and the Four SUns, Inc.
10 Bay Esplanade
Clearwater Beach, FL
Inc.
JUN13
1975
.
TYPE OF INSURANCE
POLICY NUMBER
PO lICY
EXPIRATION DATE
Limits of Liability in Thousands
EACH
OCCURRENCE
GENERAL LIABILITY
A ~ COMPREHENSIVE FORM FM 1009202
~PREMISES-OPERATIONS
o ,EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
~ PRODUCTS/COMPLETED
OPERATIONS HAZARD
DCONTRACTUAL INSURANCE
o BROAD, FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTOIlS
~ PEIlSONAL INJURY
4/1/80
BODILY INJURY
PROPERTY DAMAGE
BODll Y INJUIlY AND
PIlOPERTY DAMAGE $
COMBINED
PERSONAL INJURY
AUTOMOBILE LIABILITY
A ~ COMPIlEHENSIVEFORM
~ OWNED
KI HIRED
KJ NON.OWNED
ZA 1009204
4/1/80
BODII Y INJUFY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROFtRTY DAMAGE
COMBINED
$ 250
$ 300
$ 100
EXCESS LIABILITY
A ~ UMBRELLA FOIlM
o OTHER THAN UMBRELLA
FORM
A WORKERS'COMPENSATlON ZC 1009207
ZU 1009203
4/1/80
BODll Y INJURY AND
PllOl'EIlTY DAMAGE
COMBINErJ
and
EMPLOYERS' LIABILITY
OTHER
4/1/80
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
State of Florida
Additional Named Insared:
Howard G. Hamilton
Cancellation: Should any of the above descri~d policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder. but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER'
City of Clearwater
Post Office Box 4748
Clearwater, FL 33518
Attn:
CityClerk
/Cj-o