CERTIFICATE OF INSURANCE (053)
REVISED
ROGER BOUCHARD INSURANCE, INC.
P.O. Box 6090
Clearwater, FL 33518
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
R.E. PURCELL CONSTRUCTION CO., INC.
P.O. Box 217
Ozona, FL 33560
COMPANY A
LEnCR Northbrook Property & Casualty Ins.Co.
~~NY B American Guarantee & Liability Ins.Co.,
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 PER,.AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONSOFSUCHPOLICfES.- ". .... ............ ......" 'u' . .. . . ... .... ..
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDNY) DATE (MMIODIYY) EACH
OCCURRENCE AGGREGAT
GENERAL LIABILITY RECEIVE BODILY $ $
COMPREHENSIVE FORM INJURY
X
PREMISES/OPERATIONS PROPERTY $ $
UNDERGROUND 12/31/84 12/31/85 DAMAGE
~0lllCK~~~~ BPP0151631
PRODUCTS/COMPLETED OPERATIONS ,q 16 Igg~
BI & PO $500, $500,
CONTRACTUAL COMBINED
INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY 1JIIrf CLEEK ' PERSONAL INJURY $500,
X l'l--r,-,,,,,, Fnrm rr.:T,
AUTOMOBILE LIABILITY BODILY $ 500,
INJURY
ANY AUTO CA0151632 12/31/84 12/31/85 (PER PERSON)
X ALL OWNED AUTOS (PRIV, PASS,) BODILY
INJURY $500,
X ALL OWNED AUTOS (OTHER THAN) (PER ACCIDEt-IT)
PRIV, PASS,
X HIRED AUTOS PROPERTY $100,
X NON-OWNED AUTOS DAMAGE
GARAGE LIABILITY BI & PO $
COMBINED
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
WC6900057
1/1/85
1/1/86
81 & PO
COMoiNELI
EXCESS LIABILITY
UMBRELLA FORM,
OTHER THAN UMBRELLA FORM
UEL030891Q
12/31/84 2/31/85
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlSPECIAL ITEMS