INSURANCE AND MEMO (3)
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TO:
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SUBJECT:
DATE:
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C I T Y 0 F C LEA R W ATE R
Interdepartment Correspondence Sheet
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- St. Petersburg Junior College
Lucille Williams, City Clerk
Proof of Insurance
Ream Wilson, Director, Parks and Recreation
April 26, 1~82
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Attached is a Certifi,cate of Insurance from St. Petersburg
Junior College which should be atta.ched to our Joint Utilization
Agreements. Please contact me if you have any questions.
RW:pp
At tachment
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Gallaghe~ Bassett Insurance
3118 Gulf to Bay Boulevard
Clearwater, Florida 33515
Service
COMPANIES AFFORDING COVERAGES
COMPANY A
LETTER
COMPANY B
LETTER
NAME AND ADDRESS OF INSURED
COMPANY C
st. Petersburg Junior College LETTER
Fla. Comm. ColI Risk Mgt. Consortium COMPANY 0
Santa Fe Community College LETTER
P.o. Box 1530 COMPANY E
Gainesville Florida 32602 LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time, 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 conditions of such policies.
ualified self insured
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits of Liability in Thousands (
EACH
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY
Ii] COMPREHENSIVE FORM
[X] PREMISES,-OPERATIONS
[iJ EXPLOSION AND COLLAPSE
H AZA RD
[Xl UNDERGROUND HAZARD
[Xl PRODUCTS/COMPLETED
OPERATIONS HAZARD
[Xl CONTRACTUAL INSURANCE
[Xl BROAD FORM PROPERTY
DAMAGE
[Xl INDEPENDENT CONTRACTORS
[Xl PERSONAL INJURY
self insurer as per
State of Florida Statute
Chapter 768.28, as amended
10/1/81, and 111.07
3/1/83
PROPERTY DAMAGE
$
BODILY INJURY ANC'
PROPERTY DAMAGE
C0MBINED
PERSONAL INJURY
$
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON,OWNED
BODILY INJURY
(EAC H PERSON)
BODILY INJURY
(EACH ACCIDENT)
$
PROPEpTY,lAMAGE
BODIL- Y INJURY (-\NO
PROPERTY DAMAGe
COMBINED
EXCESS LIABILITY
BODll Y INJURY "NE)
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
"ROPlRn DAMAGE
COMBINED
WORKERS' COMPENSATION
and
EMPLOYERS'L1ABILlTY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
PURPOSE:
Use of recreational facilities by St. Petersburg Junior College
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail --3.0.- days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND .ADDRESS OF CERTIFICATE HOLDER:
City of Clearwater
Parks and Recreation Department
P.O. Box 4748
Clearwater, Fl 33518
DATE ISSUED: