CERTIFICATE OF INSURANCE SMP 444 52 89
::-CNA/insurance I
CERTIFICATE OF INSURANCE
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The Policy identified below by a policy number is in force on the date of Certificate Issuance. Insurance is afforded only with respect to those coverages for which a
specific limit of liability has been entered and is subject to all the terms of the Policy having reference thereto including for Umbrella Excess Third Party Liability
Insurance a provision requiring the maintenance of underlying insurance or self insurance. Nothing herein contained shall modify any provision of said Policy.
In the event of cancellation of the Policy the Company issuing said Policy will make all reasonable effort to send notice of cancellation to the Certificate Holder at the
address shown herein, but the Company assumes no responsibility for any mistake or for failure to give such notice.
RECFIVFO
NAME AND ADDRESS OF INSURED
FIELD HOTEL CORPORATION DBA
STATLER HILTON INN
715 S. GULFVIEW BLVD., CLEARWATER BEACH,
NAME AND ADDRESS OF CERTIFICATE HOLDER
r-eITY OF CLEARWATER, FLORIDA
LICENSE DEPT.
CLEARWATER, FLORIDA
L
FLA.
"FEB 24 1970
DATE OF CERTIFICATE ISSUANCE:
~lTY CLERK
COVERAGES
Bodily Injury Liability
Property Damage Liability
odily Injury and Property
Damage Liability Combined
Uninsured Motorists
Bodily Injury Liability
Property Damage Liability
Bodily Injury and Property
Damage Liability Combined
Bodily Injury Liability
Property Damage Liability
I
1-29-70
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NABERS CR"AttWz6d ~pr3I"fEft
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INC.
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TYPE OF INSURANCE IS DESIGNATED BELOW
THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE HOLDER
LIMITS OF LIABILITY
EACH OCCURRENCE
OJ Continental Casualty Company
[3] Transportation Insurance Company
EACH PERSON
AGGREGATE
A. Statutory Statutory locations:
B. Bodily Injury $ t
The Excess Insuror's Limit of Liability is (Complete one)
(a) $ in excess of a Retained Limit
(b) Up to $ in excess of a Retained Limit
and in excess of various underlying Insuror's Limits of Liability
t each Accident
I~
Complete below, by designating company by number in the box and entering policy number and expiration date in the sections corresponding to the type of insurance
indicated above.
I. 0 Comprehensive Automobile Liability
o Schedule Automobihi Liability
X Non-owned & Hired Aut
o Protection Against Uninsured Motorists
II. lJ Comprehensive General Liability
DOwners', landlords' and Tenants' liability
o
o Manufacturers' and Contractors' liability
o Owner's and Contractor's Protective Liability
o Beauticians' Malpractice liability
III. 0
IV. 0 Workmen's Compensation
Employers' Liability
V. 0 Umbrella Excess Third Party Liability
I. SMP 444 52 89 II. SMP 444 52 89 III. Policy Number
[I] 11-12-71 OJ 11-12-71 0 Policy Expiration
IV. V. VI. Policy Number
0 0 0 Policy Expiration
m National Fire Insurance Company of Hartford
m Transcontinental Insurance Company
m American Casualty Company of Reading, Pa.
m Valley Forge Insurance Company
G.32343-G