HISTORICAL DWELLING CERTIFICATE OF INSURANCE (2)
Inc.
34296-1138
COMPANIES AFFORDING COVERAGE
"
INSURED
Clearwater Historical Society,
P. O. Box 175
Clearwater, Fl. 33517
COMPANY A
LETTER St. Paul Fire & Harine Ins. Co.
COMPANY B
LETTER
I~PANY C
LETTER
COMPANY 0
LETTER
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COMPANY E
LETTER
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THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MA Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
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TYPE OF INSURANCE
POLICY NUMBER
POLICY ErFECTIVE POliCY E XPIAA liON LIABILITY LIMITS IN T.HOUSANDS .'
DA TE (MMIOOlYY) DA TE (MM/DDIYY) EACH AGGREGATE ;~.
OCCURRENCE
BODIL Y
INJURY $ $
PROPERTY
DAMAGE $ $
1/20/87 1/20/88
BI & PO $500
COMBINED
GENERAL LIABILITY
X COMPREHENSIVE FORM
PREMISES/OPERA liONS
UNOERGROUt,D
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDEIH Cm,TRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
609 NC 9272
PERSONAL INJURY $
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV PASS.)
ALL OWNED AUTOS (~~7JRpl~~N)
X HIRED AUTOS
X NON.OWNED AUTOS
GARAGE LIABILITY
609 NC 9272
1/20/87
1/20/88
BOOllY
II~JURY
(PER PERSON) $
&~OllY
INJURY
(PER ACCIOHlT) $
PROPERTY
DAMAGE $
BI & PO
COMBINED
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BI & PO
COMBINED
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
(EACH ACCIDENT)
(DISEASE,PDlICY LIMIT) ifi.:
(DISEASE.EACH EMPLOYEE) ;~
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Add'l Insured:
City of Clearwater
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Historical Dwelling Loc:
1350 S. Greenwood Ave.
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City of Clearwater
P. O. Box 4748
J, Clearwater, Fl. 335'18
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RECEJV~n
JUN 28 LUI
crt'L CLEH1(
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