CERTIFICATE OF INSURANCE (3)
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LIFE & CAStJ-A.-l~
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RECEIVED
NOV 6 1975
CITY: ATTORNEY
To
10 The A:tna Casualty and Surety C.......a..,
o The Standard Fire Insurance Company
Hartford, Connecticut
RECEIVED
NOV 6 1975
C'ITY OF CLEARWATER
p. O. BOX 4748
CLEARWATER, FLORIDA 33518
Cl'Iy CLE~,
Date 11/4/75
Gf"t1emen, This is to certify that insu,ance policies subject 10 the" ""ms. conditions and exciuSions. a'e at P'OSent in ""ce
in the Company indicated above.
Name of Insured Ross Yacht Service J Inc 0
279 Windward Passage
COvering Clearwa ter J 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
In event of cancellation,
Nritten notice will be given to the party
o whom this certificate is addrElSSed,
::;C-5194) 1-73
POLICY NO,
EFFECTIVE EXP/RA TION
23AL201446 9/30/75 9/30/76
"
.000 $ 300 ,000
.000 $ 300 .000 23AL201446 /30~75 9~30'76
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,000 $ .000
.000 $ .000
ADDIT IONAL N~ .~(8l1RED ENllORSE
THE CITY OF C~RlI'ATER ATTACIlED
I" RODGERS ,& C
;!Ji<<; By
1~1 ,"
Authorized Representative
r"AT ____
~
'fhi!: .(', ;"I:'~'\l.~I,~lil~~:: .I~h 'in~ur;u'n' r>:; i. ;>;{
of th" p"'"'Y d;1llllg to till followmg:
'.IIY the provi3ion3
. - -----...,
t
CU~'lPHFtlENSIVE GENERAL J.1.'\OI LITi." INSURANCE
miNERS I L.l\..'\!DLORlJS I AND TEN.~l\lTS 1 LIABILITY
INSURANCE
ENDORSEHENT G-110 "REVISED II
ADDITIONAL INSURED
(State or political Subdivisions-Permits)
It is agreed that the "pe:z;sons 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 insurance applies only with respect to operations performec.
by or on behalf of the named insured for which the state or
-political siibdi vi-sion-has---j;ssuea -apermi t.--
2. The insurance does not apply to bodily injury or property damase
(eil.) arising out of operations performed for the state or
municipality, or
(b) included within the completed operations hazard.
.,.
SCHEDULE
Designation of state or political Subdivision:
/
RbC
~, 'E:IVED
NOV 6 L/~
CITy"., .
. A.TTORNE:Y
RECEIVEt)
NOli
6 1975
ell)--
, Cl.E:~
II-::-:-
CITY OF CLEARWATER
COMPLETE THIS ONI.Y WH&!f ZNOO~S!tM&l'tT IS JSSUZI) SUBS'SQUSJft' TO THS ORIGINAL POLleY
Policy N..ftOtboov
Ef(.ctive Dale
or K,,"..._.....
Ezpi,.lioot Pate
Di."i.t.Jn4i.. Produc.... . or JOoli" D...Io.u.eot
Rodgers & Cummings, Inc. 9/30/76 11/4/75
23AL201446
This endorsement forms a p3rt of the above numbered policy and i$ subject to all of the provisions of said policy
not specifically modified hereby.
,
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Mr. Jamell L. Carnett
RodgeI'll & Cununinga. Inc.
P. O. Box 6600
Clearwater. Florida 3351$
Re: ROils Yacht S.rvlce, l~t.
Deal' Mr. Garnett:
I
October 30, 1975
Plea.e rofer to your 1."01' of SeptaQlber 26. 1975, directed
to the City of Cl..rwat~l'.provlcUn. a C('Iftlflcate of Insurance
covering the permit graated Roaa Yacht Service. tne.
In reviewing the Certlflcat:e of Ina,uranee. I do not note any section
governing the property damage portioD of the liability Insurance
required in paralraph 6 ot.the permit. Roa. YachtServlee. IDe..
wa. required to provide a Pllnlmurn of Flve Thouaand Dollar.
<<$5.000.00) property da~..lnauraDce. and, in addtUon,One
Hundred ThouaaAd DoUal'.:, 1$100. 000.00) peraonallnJury liability
coveraie to any olle pera.or Thr..; HWldred Thou.and Dollars
($300.000. 00) for anyone ..currence.
Could, you pleaa. pr..tcIe, 'beelty ~.clearwater with a Certificate
coveriD. the prope..t,,"..epol\tloD aa required by the paragraph
rel.red to berein. " .
Thank you 101' your eoc,tper,:.Uon.
",- .t
:,1, City C1e'ikj
-fl.. 111III1 '111I11i 1 I
'111'-
" .",..
V ory truly your..
Thomas A. Bustin
City Attorney
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