CERTIFICATE OF INSURANCE (14)
Lancaster Insurance Inc
POBox 2856
Clearwater, fL 33517
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOlDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGe AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
INSURED
Robert J Burnside CLU & Assoc Inc
319 South Garden Ave
Clearwater, FL 33516
COMPANY A
LETTER Hartford Insurance
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPlRA TlON LIABILITY LIMITS IN THOUSANDS
POLICY NUMBER DATE (MM/DDIYY) DATE (MMIDOIYY) EACH
OCCURRENCE
GENERAL LIABILITY BOOIL Y
COMPREHENSIVE FORM 21SBAPH1587 12/25/86 12/25/87 INJURY $ $
PREMISEs/OPERATIONS PROPERTY
UNDERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
PRODUCTs/COMPLETED OPERATIONS
CONTRACTUAL BI & PO $ 1,000 $ 1,000
COMBINED
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAl INJURY PERSONAL INJURY $
AUTOMOBILE LIABILITY mLY
ANY AUTO INJJRY $
(Pl'R Pl'RSONI
AlL OWNED AUTOS (PRN. PASS) IlIDL Y
AlL OWNED AUTOS (OTHER THAN) I/Wf( $
PRIV PASS. (Pl'R AaD'NT)
HIRED AUTOS PROPERTY
NON-DWNED AUTOS DAMAGE $
GARAGE LIABILITY
BI & PD
COMBINED $
._--,-~~
EXCESS LIABILITY
UMBRELLA FORM BI & PD $
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND (EACH ACCIDENT)
EMPLOYERS' LIABILITY (DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
OTHER All Ri sk
Property
21SBAPH1587 12/25/86 12/25/87
DESCRIPTION OF OPERA TlONSlLOCA TlONSNEHICLESlSPECIAL ITEMS
Additional Insured Endorsement to: City of Clearwater, FL
Mortgage clause to: First Florida Bank- Clearwater, FL
City of
POBox 4748
Clearwater, FL
33518