CERTIFICATE OF INSURANCE (084)
ROGER BOUCHARD INSURANCE,. INC.
301 SO. MISSOURI AVE, BOX 6090
CL.EARWATEF~,. FL 33518
INSURED
R E PURCELL CONSTRUCTION
PO BOX 217
OZONA
34265
3/20/86
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TION 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
COMPANY A
LETTER NORTHBROOK RTY AND
COMPANY B 1 V 'J:W '
LETTER F L 0 ro i d a Cons h- uc:.t ion C"tfJ:)et- c: e
COMPANY C
LETTER
COMPANY D 1986
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT "OLlCIES 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 INSURANCEAFPORDED BYTHE.POt.ICIES DESCRIBED HEREIN IS SUBJecT TO ALL THE-TERMS,-EXCt:USIONS,ANDCONDI.
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
GENERAL LIABILITY
X COMPREHENSIVE FORM
X PREMISES/OPERATIONS
UNDERGROUND
X EXPLOSION & COLLAPSE HAZARD
X PRODUCTS/COMPLETED OPERATIONS
X CONTRACTUAL
X INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
X BROAD FORM CGI
AUTOMOBILE LIABILITY
ANY AUTO
X ALL OWNED AUTOS (PRIV. PASS,)
X ALL OWNED AUTOS (~~7JHpl~~N)
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE L1ABI L1TY
BPP0151631
CA0151632
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
8802
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CITY OF CLEARWATER
P.O. BOX 4748
CL.EARWATER,. FL 33518
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
OA TE (MM/OOIYY) OATE (MM/OOIYY) EACH
OCCURRENCE
BODILY
2/03/86 12/31/86 INJURY $ $
PROPERTY
DAMAGE $ $
BI & PD $
COMBINED
1,.000,
PERSONAL INJURY
BODILY
INJURY $
12/31/85 12/31/86 (PER PERSON)
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED :Ill,. 000,
~-.__. ---- ""..- .-
~6t~~ED $
STATUTORY
$100, (EACH ACCIDENT)
1/01/86 12/31/86 $500,. (DISEASE-POLICY LIMIT)
$100,. (DISEASE-EACH EMPLOYE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE