CERTIFICATE OF INSURANCE POLICY NUMBERS 709NA0802 609NA2622
THE 51: PAUL
! f'J SUR A NeE CO rvl PA N IE 5
ST. .tUL FIRE AND MARINE INSURANCE COtANY
ST. PAUL MERCURY INSURANCE COMPANY
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Sen''''f} yalJ ,1'0111'1.1 Ihe- worlo
CERTIFICATE OF INSURANCE
UEe 17 1911'
~ary CLERK
This is to certify that the following policies, subject to the terms, conditions and exclusions have been issued by
this Company.
The Company will mail to the party to whom this Certificate is issued a record of any material change in or can-
cellation of said policy or policies but takes no responsibility for failure to do so.
NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED:
.
Eity ofl Clea.s:wa.ter
Ity Clerks Uttlce
CleiLrwater, Florida
Attn: Mrs. Bell
.
.
.
NAME AND ADDRESS OF INSURED
TY PE OF
i~5URANCE &
POLICY NO.
WORKMEN'S
i.OMPENSATION
Field Hotel Corporation DBA
CJecuwaier. PQint 1-l'llton
7b ::>. Gulfvlew,'B vd., Clearwater Beach,
DATE ' I
EFFECTIVE EXPIRATION
Flori da
LIMITS OF LIABILITY
! STATUTORY - in conformance with the Compensation Law of the State of:
AUTOMOBILE
LIABILITY
11-12-72! Stc:ltu!~rl' - $100,000
I BODILY INJURY
Frson ! Each Occurrence
, I
,-"---,,,'--1-
Each Person Each
PROPERTY DAMAGE
Aggregate E ac h Occurrence Aggregate
Ii
t
709NA0802 11-12-71
PUBLIC
LiABILITY
Each
609NA2622
C6mpre ens.
General Liab
609NA2622
$500,000
'I
I $1,000,000 iingle Limits B dily Injury anl~ Property Dam ge
, , I
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, ..,i-\HKS:
This CERTIFICATE OF INSURANCE neither affirmatively or negatively amends, extends or alters the coverage
,lI-dled by these policies.
"[,,,0 December 14, 1971
~r
By
Na~t\Cr~&J~t~n~
, \.
1\11'5.1 (:01 J\l'\'. ~-(l.s Printed in U. S. A.