CERTIFICATE OF INSURANCE (5)
. CERTIFTCATE OF TNSIlRANCE 10/15/97
i-~nnU~t~-~___LL_-____---~----~---------------------T--TRTS-CtRTIFIC~Tt-IS-IsSUrO-~S-~-H~i.r~-OF-INFORH~TIUN-ONIY-~O~CrrRFrRS---T
! MOORE AND MOORE INSURANC I ) NO RIGHTS UPON THE CERTIFICATE HOL R. THIS CERTIFICATE DOES NOT AMEND, )
, - _ EXTEND OR ALTER THE COVERAGE AFFORD BY THE POLICIES BELOW. I
\ 601 8th Avenue West \ ------------------------------------:.'------___________---------------------1
\ Palmetto, FL I I
: 34221-5115 I COMPANIES AFFORDING COVERAGE :
1 PHONE941-722-3238 I
1______-----------------------------------------------"___________________________________________________________________________1
!I INSURED (-~~~~~~~_~~~~~~_~___~~~~~'?~~ it - <;-- --- -TCft-rnt -_____l
! ~~~~~~~~~~~l ~~~n U1~;m:mm:L:::::::::::::: i::::::::::::]::OOl::j: l!tt :::::!
I 33556 ! COMPANY LETTER D )
1 ,___________________________________ ____ ______ ____ _____
I ! COMPANY LETTER E CITY O.F CLEi~iWATE~, I
\) COVERAGES (:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::: ~~~~ofPJJllMt~r_____ :::::\
: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY I
: PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO I
: WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO I
1 ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. lIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :
"______---------------------------------------------------------------------------------------------------------------------------,
) CO! TYPE OF INSURANCE ; POLICY NUMBER I POLICY EFF ; POLICY EXP; ALL LIMITS IN THOUSANDS )
,LTRI I \ DATE I DATE \ I
1___1______-------------------------- ____________________________ ______________ ______________ _________________________________1
,! Ii GENERAL LIABILITY ! )! )_~~~~~~~_~~~~~~~~~___I~?_~____I!
il A!I [X) COMMERCIAL GEN LIABILITY (01 CC 635794 7 f1/19/97 (11/19/98 L~~~~~=~~~~~~~~_~~~:J~_?~~___J
) ) [] [] CLAIMS MADE t<] OCC. ) ! I ) _~~~~~_~_~~~~~_~~~~~~! ~?_<!~un!
! I [] OWNER'S & CONTRACTORS I I I I EACH OCCURRENCE 11000 l
I \ PROTECTIVE \ \ \ \ _____________________ \ ___________
II " I I I I FIRE DAMAGE I I
I I [] I I I I (ANY ONE FIRE) I 50 I
II \ \ \ \ \ _____________________ \ ___________ \
" II [] I 1 1 I MEDICAL EXPENSE 1 I
! ! I I I I (ANY ONE PERSON) \ 5 I
1---1--------------------------______1______----------____________\______________1______________1_____________________ ___________
! I AUTOMOBILE LIAB I I I I CSL I I
, 1 I I I 1_____________________1___________1
I: \ ANY AUTO I I \ \ BODILY INJURY \ \
\:: ~~~E~~~~~ ~~t~~ ( (( (-~~~~-~~~~~~~-------- (----------- \
:' HIRED AUTOS I I I 1 BODILY INJURY I I
: \ NON-OWNED AUTOS \ \ ISTRATIO~ \ (PER ACCIDENT) \ \
I I GARAGE LIABILITY I ENGINEERING ADMIN ,_____________________1___________'
\ \ I \ \ \ \ \
"---I--------------------------------I------------1j~--{3~-I~l~~Ye--~~I--------------I-~~~~~~~!------------~-----------1
) )EXC~rR1lL}~O~~ILITY) 0 ~ti g ~~ ) g ~~AF ~ ~ ); EACH OCC; AGGREGATE )
lr-l--+~' - "'___.m \---O-C1t1ilF\-D EN-\I~ Q-~--- _-In 1____ --~---_~_+
(---(------~~~:~-~~~~-~~~~~~~~-~~~~--(--------~----~-~~-(-15-~--~~\--------------(-STATUT~RY--------~--------------(
I I WORKERS' COMP I I 1- I EACH ACC I
I I AND I COPIES:: L I DISEASE-POLICY LIMIT I
! I EMPLOYERS' LIAB I ALE: I I DISEASE -EACH EMPLOYEE I
1___1______--------------------______1______----------____________1______________1______________1_________________________________1
\ \ OTHER \ I \ \ II
I I I I I I I'
II " \ \ \ \ "
,,---~--------------------------------~---------------------_______~______________~______________~___________----------------______1
i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHIClES/SPECIAl ITEMS \
Certificate holder is also additional insured as it pertains to:
: Part of the Southeast 1/4 of Section 19, Township 27 South, Range 17 East :
I Hillsborough County, Florida_ I
, I
\) CERTIFICATE HOLDER (-------------------------------) CANCELLATION (------------------------------------------------------------1
I ------------------------------- ------------------------------------------------------______1
I : SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- 1
l City of Clearwater : PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 \
I At tn: Mr - Ea r I Sa r ret t : DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLD R NAMED TO THE ,UT I
I P - 0 - Box 4748 : FAILURE TO MAIL SUCH NOlI~E-SHALt IMPESE ATION OR L BILI OF I
i ~t~: ~~ · FL ~ - A~;~oi;;;o~:;;Ri;;NTm-- Y ,- ~:~-~~~ ~:;-~ -~..~~~~- IU;'~~;iU!---L -- i
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