CERTIFICATE OF INSURANCE (038)
CERTIFICATE OF INSURANCE EFFECTIVE DATE
_1 1... OF CERTIFIC.. ATE
. ALL Si .1\ r tIN SUR I\.\J C t CIJ '4 PAN '{ Home Office, Northbrook, J ,';J 4, l'~ 8 5
Illinois, hereby certifies thatthe following insurance is in force:
POLICYHOLDER POLICY NUMBER
ROBERT RODESHIER DdA
PORTABLE ~ELJI~; SPLTS J 49 316277 J7/ll
13625 LESLI~ JKIVE
HUDSON FL 33j61
POLICY PERIOD
At
12:01 A.M.
J UL 11, 19 B4fi~~dard
TO
JUL 11, 19a5
R E eEl V E,D
The person ororganization designated below is described in the policy as:
CITY OF CLEAR~ATER
PO BOX 474~
CLEAR~ATER FL 33518
JAM 21 &5
@ LIENHOLDER
. (Loss Payable Clause)
X ADDITIONAL
INTERESTED PARTY
CLEJUCwILLIAM C SHERWOOO
CITY
I
J
,
To the named Loss Payee and Additional Interested Party:
This policy, as respects the interest of the loss payee and additional Interested party named on the
reverse side hereof, may be cancelled by the Company during the policy period by giving such person
ororganl~atlon 10 days written notice at its last address known tothe Company.
Coverages designated below a re afforded foreach described vehicle:
76 ~ORU f25J I F25JK~56a91
lIABILITY 330,000 EA. ACCIUENT
I
See reverse side for provision concerning Lienholderand Additional Interested Party.
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage
afforded by the policy referred to above.
BU1380 PRINTED IN USA
---
Atlanta Commercial Territorial Office
P. O. Box 4027
Atlanta, GeorQia 30302
- --.
.<~ ".j "-
/\' "'. ,.-\
(:i' ~.~\ J~'
\ I:, J.~N,.
"..-
----..---'
;;~;::j ),~:~~<'::2,(,~:::~~71t:~:~ .~_
'i. ,'~' hr":'r' ./'::~' " ~i~.' \~).r~.
-k 1'" I ,!
J !l )'~~' : ~-;, ~ ~t;T"~ ~ J d
", "",:.?i., f:i. '/'(! I ,r(J
: .'. /-'f, ;""~ Ii ", V.>
.,~i:~;~~ft-~-~.~.
AIIBIBhr .
~
~