CERTIFICATES OF INSURANCE
INSERT _. ~
~~~~A~~ - - - - ~O_N1' !li~~T~ - Il'lE~ ~r- ~2~ ~!..i,; c~l.d the ;;m-;a;yl - - - - - - -1- - - - - - - - - - - - -
CERTIFICATE OF INSURANCE
NAMED INSURED AND ADDRESS
'The Four Suns, Inc.
332 Gulf View Blvd.
Clearwater Beach, Fla. 33515
and
Palm Pavilion of Clearwater, Inc.
LIO Bay Esplanade
Clearwater Beach, Fla. 33515
I
The company hereby states that it has issued to the in-
sured named herein a policy or policies of insurance
providing the types of insurance and limits of liability
set forth herein. This certificate of insurance neither
affirmatively nor negatively amends, extends or alters
the coverage afforded by the policies scheduled here-
in. It is furnished as a matter of information only, confers
no rights upon the holder and is issued with the under-
standing that the rights and liabilities of the parties will
be governed by the original policy or policies as they
may be lawfully amended by endorsement from time
to time.
..J
TYPE OF INSURANCE
(Indicate by "X" In Bax)
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
LIMITS OF LIABILITY
BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY
o Comprehensive Automobile Liability
o
XJ Comprehensive General Liability
o Manufacturers' and
Contractors' Liability
o Owners', landlords' and
Tenants' Liability
D Contractual liability
L6734628
4/1/75
4/1/76
$ each $ each
person occurrence
$ each
occurrence
each 50,000. each
$300,000. occurrence $ occurrence
$300,000. og9regote $ 50,000. ogg regate
. REeE! ED
D
D
.R 25 1975
$
each
occurrence
BROAD FORM
EXCESS LIABILITY
arT ' ,;:::-.1K
oggregote-products-completed operations
Subject to self-insured retoined limit and underlying insurance described
in the policy.
WORKMEN.r '"
COMPENSATION ...." I
WC2046607
4/1/75
4/1/76
Coverage afforded in accordance with the Workmen's Compensation Law ~ the States
specified in subdivision {oj below and the Occupational Disease law, if any, of such States,
unless otherwise stated in subdivision (b) below.
EMPLOYERS' LIABILITY
(a)
(bl
COVERAGE B-EMPLOYEES SUBJECT TO COMPENSATION LAW
(Unless otherwise stated, the policy
number, effective and expiration dotes
are the some as those shown for work-
men's compensation insurance)
$100 000.
COVERAGE B-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW
INJURY BY ACCIDENT
INJURY BY DISEASE
$
$
each
employee $
each
accident $
each
employee
aggregate
{each state I
MEDICAL $
eac
employee
REMARKS
State of Florida
Additional Named Insured:
Howard G. Hamilton (OWner of Corporation)
This certificate is issued at the request of the person or organization named below and the company will mail to such person or organization,
at the address shown, notice of cancellation and, where possible, notice of any material change in any of the described policies.
I,
Clty
Post Office
Clearwater,
LAttention:
of Clearwater
Box 4748
Florida
-,
PRINTii"D IN U.S:f.. /)
I c..r - ()DQ - ,f-.
33518
Ci ty Clerk
.J
LIAS. 16165
INSERT ~ - I I ~
~~~~AWy - - R.fg!f~~611VUJ- INS.LT~' _C.9~~-;'e~ c-;;Ued the ~m-;;a;YI - - - - - - - - - - - :. - - - - - - - - -
CERTIFICATE OF INSURANCE
JUN 20 1974
NAMED INSURED AND ADDRESS
I The Four Suns, Inc. I
332 Gulf View Boulevard
Clearwater Beach, FL 33515
and
Palm Pavilion of Clearwater, Inc.
L 10 Bay Esplanade ~
Clearwater Beach, FL 33515
The company hereby states that it has issued to the in-
sured named herein a policy or policies of insurance
providing the types of insurance and limits of liability
set forth herein. This certificate of insurance neither
affirmatively nor negatively amends, extends or alters
the coverage afforded by the policies scheduled here-
in. It is furnished as a matter of information only, confers
no rights upon the holder and is issued with the under-
standing that the rights and liabilities of the parties will
be governed by the original policy or policies as they
may be lawfully amended by endorsement from time
to time.
CITY CLERK
o
$
$
LIMITS OF LIABILITY
BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY
each each
person occurrence
each
occurrence
TYPE OF INSURANCE
(Indicate by "X" In Ba.)
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
[J Comprehensive Automobile Liability
Xi Comprehensive General liability
o Manufacturers' and
Contractors' Liability
o Owners', landlords' and
Tenants' Liability
[J Contractual liability
L6431115
4/1/74
4/1/75
300,000.
each
occurrence
$ 50,000.
each
occurrence
$ 300,000.
aggregate
$ 50,000.
aggregate
o
o
each
occurrence
BROAD FORM
EXCESS LIABILITY
aggregate-products-completed operations
Subiect to self-insured retained limit and underlying insurance described
in the policy.
WORKMEN'S
COMPENSATION
Coverage afforded in accordance with the Workmen's Compensation Law of the States
specified in subdivision (0) below and the Occupational Disease law, if any, of such States,
unless otherwise stated in subdivision (b) below.
WC2043708
4/1/74
4/1/75
(a)
(b)
COVERAGE B-EMPLOYEES SUBJECT TO COMPENSATION LAW
EMPLOYERS' LIABILITY
"
"
"
(Unless otherwise stated, the policy
number. effective and expiration dotes
are the same as those shown for work~
men's compensation insurance)
o
COVERAGE B-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW
INJURY BY ACCIDENT
INJURY BY DISEASE
$
$
each
employee $
each
accident $
each
employee
aggregate
(each state)
MEDICAL $
eac
empioyee
REMARKS
State of Florida
Additional Named Insured:
Howard G. Hamilton
(Owner of Corporation)
This Certificate voids and su ercedes reviousl issued Certificate.
This certificate is issued at the request of the person or organization named below and the company will mail to such person or organization,
at the address shown, notice o.f cancellation and, where possible, notice of any material change in any of the described policies.
I -,
City of Clearwater
Post Office Box 4748
Clearwater, FL 33517 dw
L Attention: City Clerk ~
PRINTED IN U.S.A.
LIAS. 16185
INSERT ~ - ~ t .
NAME OF CONTINENTAL INSURAN. CO~PANY.
COMPANY - - - - - - - - - - - - - - - - - - - _ - - - - - (H-;;e'i,; c;jled ,; -;m-;a;y) - - - - - - -I- - - - - - - - - - - - - -
CERTIFICATE OF INSURANCE
NAMED INSURED AND ADDRESS
rThe Four Suns, Inc.
332 Gulf View Blvd.
Clearwater Beach, Fla. 33515
and
Palm Pavilion of Clearwater, Inc.
10 Bay Esplanade
LClearwater Beach, Florida 33515
--,
The company hereby states that it has issued to the in-
sured named herein a policy or policies of insurance
providing the types of insurance and limits of liability
set forth herein. This certificate of insurance neither
affirmatively nor negatively amends. extends or alters
the coverage afforded by the policies scheduled here-
in. It is furnished as a matter of information only, confers
no rights upon the holder and is issued with the under-
standing that the rights and liabilities of the parties will
be governed by the original policy or policies as they
may be lawfully amended by endorsement from time
to time.
..J
TYPE OF INSURANCE POLICY EFFECTIVE EXPIRATION
(Indicate by "X" In Box) NUMBER DATE DATE
o Comprehensive Automobile liability
0
XI Comprehensive General liability
o Manufacturers' and L64l7450 4/1/73 4/1/74
Contractors' liability
o Owners', Landlords' and
Tenants' liability
o Contractual Liability
0
0
WORKMEN'S WC4676664 4/1/73 4/1/74
COMPENSATION
EMPLOYERS' LIABILITY
" " "
(Unless otherwise stated, the policy
number, effective and expiration dates
are the same ns those shown for work.
men's compensation insurance)
$
$
LIMITS OF LIABILITY
BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY
~~~~on $ ~~~~rrence
each
occurrence
$300,000.
each
person
$
50,000.
each
occurrence
$ 300,000.
each
occurrence
$
50,000.
aggregate
$300,000.
aggregate
Coverage afforded in accordance with the Workmen's Compensation law of the States
specifled in subdivision (a) below and the Occupational Disease law, if any, of such States;
unless otherwise stated in subdivision (b) below.
(a)
(b)
COVERAGE a-EMPLOYEES SUBJECT TO COMPENSATION LAW
$100 000.
COVERAGE a-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW
$
$
INJURY BY ACCIDENT
each
employee $
each
accident $
MEDICAL $
INJURY BY DISEASE
eac
employee
aggregate
(each state I
eac
employee
REMARKS
State of Florida
Additional Named Insured:
Howard G.-Hamilton (OWner of Corporation)
RECEIVQ),
MAY 1 1973
CITy (;'1 ~
This certificate is issued at the request of the person or organization named below and the company will mail to such person or organization,
at the address shown, notice of cancellation and, where possible, notice of any material change in any of the described policies.
rcity of Clearwater
Post Office Box 4748
Clearwater, Florida 33518
-,
L
..J
PRINTED IN U.S.A.
L1AB. 1618Q
INSERT - ~ . Rfr;t:,vED
~~~~A~Y_ _ _ _ _ _ gc;N_Tj:B~I1T.M_Il1.PQIIAN... - CF1.!_c.9M~~X - -- --- - --- -- t.- - - - -- -_.~<~.~---
. / _ ! I - (Herein called the campany)
JUN 12 1972
CERTIFICATE OF INSURANCE
CiTY CJ.ERJt
NAMED INSURED AND ADDRESS
f.The Four Suns, Inc.
332 Gulf View Blvd.
Clearwater Beach, Fla. 33515
.a:o.d
Palm Pav1110n of Clearwater, Inc.
10 Bay Esplanade
LClearwater Beach, Florida 33515
--,
The company hereby states that it has issued to the in-
sured named herein a policy or policies of insurance
providing the types of insurance and limits of liability
set forth herein. This certificate of insurance neither
affirmatively nor negatively amends, extends or alters
the coverage afforded by the policies scheduled here-
in. It is furnished as a matter of information only, confers
no rights upon the holder and is issued with the under-
standing that the rights and liabilities of the parties will
be governed by the original policy or policies as they
may be lawfully amended by endorsement from time
to time.
.J
o
$
$
LIMITS OF LIABILITY
BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY
~~~~on $ g~~~rrence
each
occurrence
TYPE OF INSURANCE
(Indicate by "X" In Box)
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
o Comprehensive Automobile Liability
IX Comprehensive General Liability
o Manufacturers' and
Contractors' Liability
o Owners', landlords' and
Tenants' liability
L4285276
4/1/72
4/1/73
$ 300,000.
each
person
$50,000.
each
occurrence
o Contractual Liability
$ 300,000.
each
occurrence
$50,000.
aggregate
o
o
$300,000.
aggregate
Coverage afforded in accordance with the Workmen's Compensation Law of the States
specifled in subdivision {o} below and the Occupational Disease Law, if any, of such States,
unless otherwise stated in subdivisian (b) below.
WORKMEN'S
COMPENSATION
WCll16916
4/1/72
4/1/73
(a)
(b)
COVERAGE B-EMPLOYEES SUBJECT TO COMPENSATION LAW
$100,000.
COVERAGE B-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW
EMPLOYERS' LIABILITY
"
"
"
(Unless otherwise stoted, the policy
number, effective and expiration dotes
are the same CIS those shown for work-
men's compensation insurance)
$
$
INJURY BY ACCIDENT
eoch
employee $
each
occident $
MEDICAL $
INJURY BY DISEASE
eac
employee
aggregate
leoch statel
eac
employee
REMARKS
State of Florida
Additional Named Insured:
Howard G. H.alU,i,it.PJ;l.. '<"
(Owner of Corporation)
This certit'4-.~~t~ ,v:tl"l'a.s and supercedes previously issued Certificate.
') ~1
~,'\\ ~
This certificate is issued ?(t..,tJJe.J~ue of the person or organization named below and the company will mail to such person or organization,
at the address shown, notM~of cancellation and, where possible, notice of any material change in any of the described policies.
I
City of Clearwater
Post Office Box 4748
Clearwater, Florida 33517
-,
L
.J
PRINTED IN U.S.A.
L1AB. 161BQ
INSERT . " . . .
~~~~A~Y_ _ _ _ _ _ --T _ .f~~1:.iE~r.!.t.?.! _~n~~~C!.n2~ _~o!!lEC!.n'y___ - - -- --1- - - - - _"!~ft~E.D__
- - ~ (Herein called the company)-
,MAV 19 1972
Ql"X .CUm(
CERTIFICATE OF INSURANCE
NAMED INSURED AND ADDRESS
~he Four Suns, Inc.
332 Gulf View Blvd.
Clearwater Beach, Fla. 33515
and
Palm Pavilion of Clearwater,
qO Bay Esplanade, Clearwater
The company he(eby states that it has issued to the in-
sured named herein a policy or policies of insurance
providing the types of insurance and limits of 'liability
set forth herein. This certificate of insurance neither
-, affirmatively nor negatively amends, extends or alters
the coverage afforded by the policies scheduled here-
in. It is furnished as a matter of information only, confers
no rights upon the holder and is issued with the under-
standing that the rights and liabilities of the parties will
be governed by the original policy or policies as they
may be lawfully amended by endorsement from time
__I to time.
FTa.
Inc.
Bch . ,
o
IX Comprehensive General LIability
o Manufacturers' and
Contractors' Liability
o Owners', landlords' and
Tenants' Liability
o Cantractuol Liability
$
$
LIMITS OF LIABILITY
BODILY INJURY LIABILITY PROPERTY DAMAGE LIABILITY
~~~~on $ ~~~~rrence
each
occurrence
TYPE OF INSURANCE
(Indicate by "XU In Box)
POLICY
NUMBER
EFFECTIVE
DATE
EXPIRATION
DATE
o Comprehensive Automobile Liability
L4285ll6
4/1/72
4/1/73
$ 100,000.
each
person
$10,000.
each
occurrence
$300,000.
each
occurrence
$25,000.
aggregate
o
o
$ 300,000.
aggregate
Coverage afforded in accordance with the Workmen's Compensation Law of the States
specifled in subdivision (a) below and the Occupational Disease Law, if any, of such States;
unless otherwise stated in subdivision (bl below.
WORKMEN'S
COMPENSATION
WCll169l6
4/1/72
4/1/73
(a)
(b)
COVERAGE B-EMPLOYEES SUBJECT TO COMPENSATION LAW
$100,000.
COVERAGE B-EMPLOYEES NOT SUBJECT TO COMPENSATION LAW
EMPLOYERS' LIABILITY
"
"
"
{Unless otherwise, stated, .the policy
number, effective and expiration dates
are the same (1$ those shown for work4
men's compensation Insurance)
$
$
INJURY BY ACCIDENT
each
employee $
each
occident $
MEDICAL $
INJURY BY DISEASE
eac
employee
aggregate
(each slatel
eac
employee
REMARKS
Sate of Florida
Additional Named Insured:
Howard G. Hami,l~!'f:-i~"r~h"~~p Ci-f.! ~...,,;..,,.~i"",i<"I'f_i:~,,~'HI._,;,I~Hf~""'-"c,~ :..i,.,.;,--,.,'~~L:.I;- 'ff.;-J,'~~iI.IH"Oq."-~-----'
(OWner of Corporation)
This certificate is issued at the request of the person or organization named below and the company will mail to such person or organization,
at the address shown, notice of cancellation and, where possible, notice of any material change in any of the described policies.
r
City of Clearwater
Post Office Box 4748
Clearwater, Florida 33517
-,
L
.J
PRINTED IN U.S.A.
L1AB. 1618Q
'CEkl'flU.l~Qf~UaANCE few' ,^u' ",,-
_ _ 4 'ANSI'S cn'\' FIRE & MARINE INS. CO Kansas ("y "
NAMEAND ADDRESS OflNSURED The Four suns. InO. Palm Pavilion of CFlleaa.~a3t3e5rl'5' ~nc.'.
332 Gulf VieW Blvd. 10 Bay ESplanade
Cle~ater.Bcb.. Fla. 33515 Cle~ater Bob..
Thl' ,.";11,, .ho' ,h, poll';" 01 10'''0.'' d,'"'''''' hel~ ho"' .... I~",d o.d '" I. '0"" Th, ,.,,,0." oll"d"" I, 001, ~;Ih ,.,p'"
'" ,h. h",,,d' l.dI"''''' b, ,p.,;II, II~I.. o. IIoblll" 000 I, "bi'" '" 011 ,h. w~, 0' ,h. poll" 000 ..d""""'." h~l.g "..,00" '" 'ho~
,~,,"g" " ,,,h poll';" ". ".~I"" " ",,,,,..d_dO,' 00"" .111 he ~oll"" '" .h, port, '" .ho~ ,hi, ,.,,;11"" " I~"""
<h" ,...tlI~" o' I...~'~ .,I.h.' ,.,_,".1, " _w.... ....00.. ....00' ., ....~ .he ~-.... ........ h, ,,11<1" i"ol~''''
beloW.
\
.,NAME AND ADDRESS OF PARrY iO
WHOM iHIS CERilFICAiE is iSSUED
, "FCJ:'JVs:t)
LOCAnON AND DESCRIPTION Of OPERATIONS TO WHICH THIS CERTIfiCATE DESCRlPnON Of CONTRACTS SPEClflCALl V COVER
APPLIES TUAL LIMITS SHOWN BELOW
r-CitY of Clearwater
1>. o. BOX 4748
Clearwater, Florida 33517
L
At tn: Mr. Robert 1,Nhi tehead
APR 8 lS71
~
NiRAC-
state of Florida
Additional Named Insured:
Howard G. Hamilton
(owner of corporation)
EXPLANAiORY NOiES'.
, ," 0.0.' , ,I "," "0" '0< ,,'''' ,,,I"" ""' ,,""'" ,,0'" coo""" .. ,......' '" >>, '"" ~
, t.". ,,,, ".", "eo"., """" ,. ",d'" ",,'"'' I '" ,....,"' """"" ",,' ,"'"0""'" ,,"" "'" ~",""" .. ,..",00' ,,, >>, eo,.., P"" ~
COVERAGES AND LIMITS OF L1A81L1TY
80Dll Y INJURY
AGGREGATE
PROPERTY DAMAGE
EACH OCCURRENCE AGGREGATE
HAZARD
COVE REI
POLICY
NUM8ER
EXPIRATION
DATE
EACH. PERSON
EACH OCCURRENCE
$ 10,000. $ 25,000.
PREMISE
OPERA \Ie
MFC l3225C
$ $ $
$ $ $
" " " " $300,000.
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $ $
EACH OCCURRENCE AGGREGATE
$ CSL
As provided by ,he workmen's compensa'ion LoW of 'he SIO,e(S) of
4/1/72
$100,000. $300,000.
owners/ Con
Protective L
$
Contractual
\Controct.
scribed (
$
"
completed I
& Products
"
$
OW
AU10N
HI
AU101
NON
AU1(
01HE
$
SELF INSURED RETENTION
CSL $
Florida
'I
COI
MFC l3225D
4/1/72
u? OJ~
l
DA1E SIGNED
4/7/71 vca
Form 10209 ":i:' (ReV. 6-68)
,or
J....
I
..
,. unl:
MllllTlOI ~t,! I: :<:[1 ::Hl
I ·
leu II [f u It j II 'I, j II (l'l t~ ,; t:
...:ors: -'llj~:1 ';I(Jd !r.:S <"1!Ch 1n".lHlncr ;11", j'; -!d~',r,' II i
sf th..'
'" :
Clli,II'llillfIlSIIJ[" i;CiFiI
I.I! Ii Iii i '( 1!!:;lIlilllILE
1.'MllliJ"lliiili:I';' JII'II I:liI, I, ',llllii;' I.Idlllll V ill:;IIilMIU
IIllilll!';', : :\ilillilllll':' :,Iil, 111::iiiIIIV I,Jllln!'.i:!:1
" ~' !, l', ), r
l~ffectivr.
].;').,'~-7()
(12:011'\. M" ~;L!'I\Llfd tilllt~'i
101111:: ;] pMi "f l"liiey 1110.
1\lV'C J
~.'! '::)
,}''''
~? ~>
C7;.?
".:,:,] 10
'1'lllul Pav:i.l:i.on ot' Cli::U'\/ill":r-,, Inc. and '1','
Ii'nt"
n,1
Inc"
Inr;urn.ncl~
.\/'nghi;"
,t'l l'ersLll1 or nrr'anilation:
i ~
';"IL .n'j ,I: .1lnntilton
.il.:r,',:dt!,:1I
'11",. "I'''I:,I."IS l!l~lIIr.d" plovision is anwnde'd to include ;]s all illsurell tlie pei snll or orr.al1i'{~ ,'" i"~Wi' ,( cI[)OVf', [lid only willi rr'>fwc, to
Iii,ildil'/ i,II::illl: l1ull1l
L,) Iii': iillJIIi:ial cord rill of IlIcl1;]lIted il1sured or
(II) pl",II",":; ,wlncd, rn~lintiiined 01 controlled byllim wilde said prrll1iscs ;]1" ICilsed to (II ill:i:I!!,i:,,: h'! ilre insured,
fh" 1,1::\11:,11(;" iJli"rd,'dliy tbls endorsemenl dnes not apply 10 stlllctural ali,:lillioll;;, new "nll::".' Illll dllr: ,'llIillilloli "IJI'liiliol1s Ilerle",,:,..d liv n:
101 ::."dP,''''ilJli or illI:;illil:llillll.
. ~,u ..,.,
:t;)~J'),.'(() .TC/~h
if :~J nl_L~ :'-'1..: Ii
. -
~~fNS FALts p
GROUP '~:,.~
Gle.ns Fall......,"_ ..
I
CERTIFICATE OF INSURANCE
~:ENS F:LlS INSURANCE COMPANY, Glens Falls, N.Y.
KANSAS CITY FIRE & MARINE INS, CO" Kansos City, Mo.
Four Suns, Inc.
332 Gulf View Blvd.
Clearwater,Beh., Fla.
33515
!Palm Pavilion of
10 Bay Esplanade
Clearwater Beh.,
Clearwater,
Inc.
Fla.
33515
This certifies that the policies of insurance described below have been issued and are in force, The insurance afforded is only with respecf
to the hazards indicated by specific limits of liability and is subject to 011 the terms of the policy and endorsements having reference to those
coverages, If such policies are canceled or restricted_days notice will be moiled to the party to whom this certificate is issued.
This certificate of insurance neither affirmatively or negatively amends. extends or alters the coverage afforded by policies indicated
below.
!City of Clearwater, Florida
P. O. Box 4748
Clearwater, Florida 33515
~ttn:
I
~ NAME AND ADDRESS OF PARTY TO
WHOM THIS CERTIFICATE IS ISSUED
Mr. Gerald Weimer
~
LOCATION AND DESCRIPTION OF OPERATIONS TO WHICH THIS CERTIFICATE DESCRIPTION OF CONiRACTS SPECIFICALL Y COVERED SUBJECT TO CONTRAC-
APPLIES TUAL LIMITS SHOWN BELOW
State of Florida
Additional Named Insured:
Howard G. Hamilton
(Owner of Corporation)
EXPLANATORY NOTES:
I. CSL meons a single limi' for bodily injury and property damoge combined as defined in the policy.
2. Excess liability applies excess of specific underlying general liability and automobile liability insurance as described in the excess policy.
COVERAGES AND LIMITS OF LIABILITY
POLICY EXPIRATION BODIL Y INJURY PROPERTY DAMAGE HAZARDS
NUMBER DATE COVERED
EACH PERSON EACH OCCURRENCE AGGREGATE EACH OCCURRENCE AGGREGATE
MFC l3225C 4/1/71 slOO, 000. $300, 000. $10,000. 25,000. PREMISES-
$ OPERATIONS
Owners! Contractors
$ $ $ $ Protective Liability
Contractual Liability
(Contracts Oe-
$ $ $ $ SUi bed above)
Completed Operations
II II " .. $300,000. $ II " & Products liability
$ $
OWNED
$ $ $ AU10MOBllES
HIRED
$ $ $ AUTOMOBilES
NON-OWNED
$ $ $ AUTOMOBilES
01HER (SPEeIFY)
$ $ $ $ $
EACH OCCURRENCE AGGREGATE SELF INSURED RETENTION
EXCESS
liABILITY
$ eSl $ CSl $
MFC13225D 4/1/71 As provided by 'he Workmen's Compensation law of the Sto'e(s) of Flor ida
WORKMEN'S
COMPENSATIONS
DATE SIGNED
12/10/70 vea
Form 10209 ~:~:o (Rev, 6-6B)