CERTIFICATE OF INSURANCE
THE VEGHTE AGENCY
P.O. Box 1560
Clearwater, FL
COMPANIES AFFORDING COVERAGES
33517
COMPANY
LETTER
A
B
C
o
E
The St. Paul Companies
Aetna Insurance Company
COMPANY
LETTER
NAME AND ADDRESS OF INSURED
Palm Pavilion of Clearwater,
and the Four Suns, Inc.
10 Bay Esplanade
Clearwater Beach, Florida
Inc.
COMPANY
LETTER
COMPANY
LETTER
1.] J~~
CI."I>.._
This IS to certify that policies of Insurance listed below have been Issued to the Insured named above antl'aret'lforce at this time.
COMPANY .._-+ r-- --- ~~~~-_._.- .F- .--'= ~~~! Lia_bilit~~ousands (000)
LETTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION [lATF =E fAI H ~GGRLGArE
.- UCCeJRRENCf '
GENERAL lIABllrrv- . ~----_.- .'--r - ~~DIL Y IN~~~Y-- -- $; O~ -~-- $--- *
[3 COMPREHENSIVE FORM I CG-S7 ~9''''~'''-~'~'--''''-- tT/i8..' T . , ..,
[J PI1EMISES-OPERATIONS I'ROPERTY DAMAGE $ 50, .. j. $ 50,
o EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZArID -_._._n___. __~___._. _..__
~ PRODUCTS/COMPL [fEC1
OPERATIONS HAZARD BOlllL Y INJURY AND I
o CONTRACTUAL INSURANCE F'ROPERTY DAMAGE
o BRg:3A~~RM F'ROPERTY _COMBINED._....._..I_
o INDEPENDENT CONTRACTORS _ _ _..._....____
COMPANY
LETTER
A
$
PERSONAL INJURY
COMPREHENSIVE F0I1M
[iI OWNED
[1g HIRED
~ NON.OWNED
CG 57 99 67
4/1/78
-Applies to Products/Completed
Operations Hazard.
.---. ~.--... ---~-~-------nr-----'------'-' ------.--..-
HODliYINJURY $ 300
(LAUI PERSON) ,
bODILY INJUllY $ 300,
rEACH OCCURHFNCE)
A
EXCESS LIABILITY
F'10PEiiTY DAMAGE 50,
W)[)I'.Y INJURY AND
HilJPERTY DAMAGE
.__.COMBINED
B
rn UMBRELLA FORM
o OTHERTHAN UMBRELLA
FORM
509 XB 1758
4/1/78
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
A
WORKERS' COMPENSATION
and
_ EI\llf'LQyERS' LIABILITY
OTHER
WC 15 36 42
4/1/78
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
State of Florida
Additional Named Insured:
Howard G. Hamil ton - ~ 'I (.......:?" '1"2.--
Cancellation: Should any of the above desCr.i5ed policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mall ~ 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 Clearwate~
Post Office Box 4748
Clearwater, Florida 33518
DATE ISSUED:
6/10/77
Atten:
City Clerk