CERTIFICATE OF INSURANCE POLICY NUMBER 02-CC-546564-5
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CERTIFICATE OF INSURANCE ==-IL______~______ ---~~~~E DATE
03./16/98
THIS CERTIFICATE ISSUED AS MATTER OF INFOR-
MATION ONLY AND CONFERS NO RIGHTS UPON THE
CERTIFICATE HOLDER; IT DOES NOT AMEND, EX-
TEND OR ALTER COVERAGE AFFORDED BY THE POL-
ICIES BELOW. COMPANIES AFFORDING COVERAGE:
COMPANY
LETTER A AMERICAN STATES INSURANCE COMPANY
COMPANY
LETTER B
COMPANY
LETTER C
. COMPANY
LETTER 0
COMPANY
LETTER E
THIS CERTIFIES THAT INSURANCE POLICIES BELOW HAVE BEEN ISSUED TO THE ABOVE
INSURED FOR POLICY PERIOD INDICATED.. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CONDITION OF ANY CONTRACT OR DOCUMENT WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE HEREIN IS SUBJECT TO ALL TERMS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INS POLICY NUMBER EFF DATE EXP DATE
A GENERAL LIABILITY 02-CC-546564-5 01/20/98 01/20/99
X COMMERCIAL GENERAL LIABILITY
CL MADE XOCCUR.
OWNER'S & CONTRACTORS PROTECTIVE
PRODUCER
WH ALLEN & ASSOC, INC.
P. O. BOX 1138
DUNEDIN, FL 34697 1138
INSURED
CLEARWA'rER lUS'rORICAL SOCIE'l!Y,ntC.
PO BOX 175
CLEARWA'rER, FL 34617
AUTOMOBILE LIAB
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -m^lNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA
WORKERS' COMPEN-
SATION AND
EMPLOYERS' LIABILITY
OTHER
LIMITS
GEN AGGREG. $
PR-CMP/OP AG $
PERS&ADV INJ $
EA OCCURR. S
FIRE DAMAGE $
MED. EXPENSE $
COMBINED $
SINGLE LIMIT
BODILY INJ. $
(PER PERSON)
BODILY INJ. $
(PER ACCIDENT)
PROPERTY $
DAMAGE
EA OCCURR. $
AGGREGATE $
500,000
500,000
500,000
500,000
100,000
10,000
FORM
STATUTORY LIMITS
EA ACCIDENT $
DIS-POL LIM. $
DIS-EA EMPLY $
DESCRIPTIon OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
LOCATION: 1350 S. GREENWOOD AVENUE, CLEARWATER, FLORIDA
CITY OF CLEA.~WATER IS NAMED AS ADDITIONAL INSURED
CERTIFICATE HOLDER ============--===
CITY OF CLEARWATER
P.O. BOX 4748
CLEARW~TER, FL 34618
ATTENTION: DEBRA RICHTER
ADMINISTRATIVE SUPPORT
HANAGEn I
CANCELLATION -
SHOULD ABOVE POLICIES BE CANCELLED BEFORE
EXPIRATION DATE, COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO CERTIFICATE
HOLDER (AT LEFT); FAILURE TO MAIL NOTICE
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES. AUTHORIZED REPRESENTATIVE:
WK. ALLEN & ASSOC., INC.
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FORM 25-5 (7/90)