CERTIFICATE OF INSURANCE (2)
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LIFE & CASUALTY
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a The '€tna Casualty and Surety Company
o The Standard Fire Insurance Company
Hartford, Connecticut
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1976
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Date 11 / 4 / 7 6
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33518
To
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G?ntlemen: This is to certify that insurance policies, subject to their terms, conditions and exclusions, are at present in force
in the Company indicated above.
Name of Insured Ross Yacht Service, Inc.
279 Windward Passage
Covering Clearwa ter, Florida 33515
KIND OF INSURANCE
Workmen's Compensation
Manufacturers' & Contractors'
Bodily Injury Liability
Property Damage Liability
Owners' or Contractors'
Protective
Bodily Injury Liability
Property Damage Liability
Comprehensive Automobile
Bodily Injury Liability
Property Damage Liability
Comprehensive General
Bodily Injury Liability
Property Damage Liability
Bodily Injury Liability
Property Damage Liability
POLICY NO.
EFFECTIVE EXPIRATION
23AL203679 9/30/76 9/30/77
,000 $
300
300
,000
23AL203679 9/30/76
/30/77
,000
,000 $
,000 $ ,000
,000 $
,000
In event of cancellation,
written notice will be given to the party
to whom this certificate is addressed.
ADDITIONAL NAMED INSURED ENDORSEME
THE CITY OF CLEARWATER ATTACHED.
By
(CC-5194) 1-73
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CAT, 273562
PRINTED IN U.S.A.
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GllO
(Ed, ]-66)
This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.
(The following information is required only when this endorsement is issued subsequent to preparation of policy.)
Endorsement effective 9/30/76 Policy No. 2 3AL 203679 Endorsement No,
Named Insured Ross Yacht Service,Inc.
Additional Premium $ r NCLUDED
Cou ntersigned by
(Authorized Representative)
This endorsement modifies such insurance as is aHorded by the, provisions of the policy relating to the following:
'. '., " . -
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS AND CONTRACTORS LIABILITY INSURANCE
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY INSURANCE
OWNERS, LAND1.0RDS AND TENANTS' LiABii.iTY iNSURANCE
ADDITIONAL INSURED
(state or Political Subdivisiol1$-Permits)
It is agreed that the "Persons Insured" provision includes as an insured any state or political subdivision thereof designated in the Schedule below, subject
to the following additional provisions:
1, The insuran<;eapplies only with respect to operations performed by or on behalf of the named insured for which the state or political subdivision
has issued a permit
2, The insurance does not apply to bodily injury or property damace
(3) arising out of operations performed forthe state or municipality, or
(b)' included within the completed operatitlftS hazard.
3, If the Property Damage Liability Coverage is not otherwise afforded, such insurance shall nevertheless apply wit~ respect to operations performed
by or on behalf of the named insured for which such permit has been issued stJbject to th,e limits of liability stated herBin.
.
SCHEDULE
Designation of Stat. or Political Subdivision: CITY OF CLEARWATER
Limits of Property Damage Liability
$ 300,000 each occurrence
$ 300,000 aurqate
Annual Premium . $
GllO (Ed. ]-66)