CERTIFICATE OF INSURANCE (115)
1/06/87
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,
ROGER BOUCHARD INSURANCE, INC.
301 SO~ MISSOUfU A\,.IE, BOX ~.090
CLEAR~tA TER ,. FL 335:L B
COMPANIES AFFORDING COVERAGE
33::i89
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
AUTO OWNERS INSURANCE COMPANY
INSURED
F ~JUA
Sunc:o,;ts.t F'avi n9 Inc
800 ATlctt\te Road
Tarpon Sp)" i \'\9S
FCCI
. ,r'
, ....
-~.... I....~'~
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N MED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING. ANY REQUIREMENT.I.!'ER!'l OR ~ONDJTION OF ANY CONTRACT OR QIHER DQClJMEN'L)VITHl!.~IQW.H!CI:l THIS C.ERTIFICAIElMY
----sElSSUEOORYAY PCRTAIN,lHClNSUHAiIICEAFFORDED,.y TtfC'pOLlc~rSCRlBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
DATE (MMlDO/YY) DATE (MM/DD/YY) EACH
OCCURRENCE AGGREGATE
GENERAL LIABILITY BODILY
X COMPREHENSIVE FORM UNDER BINnER 12/31/86 12/31/807 INJURY $ $
X PREMISES/OPERATIONS PROPERTY
UNDERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
X PRODUCTS/COMPLETED OPERATIONS
X CONTRACTUAL BI & PD $ $
COMBINED
X INDEPENDENT CONTRACTORS 500t
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY PERSONAL INJURY $
X BROs:!jIl FORM GGL
AUTOMOBILE LIABILITY BODILY
12/31/86 INJURY $
ANY AUTO UNDER BINDER 12/31/87 (PER PERSON)
ALL OWNED AUTOS (PRIV. PASS) BODILY
ALL OWNED AUTOS (OTHER THAN) INJURY $
PRIV. PASS, (PER ACCIDENT)
X HIRED AUTOS PROPERTY
X NON-OWNED AUTOS DAMAGE $
GARAGE LIABILITY
BI & PD
X PPT/SMALL VEI-l. COMBINED $ 500,
EX.CI:~S J.lABILlTY
UMBRELLA FORM g~t~~ED $ $
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION $100,. (EACH ACCIDENT)
AND 7-18-1934 1/(11.187 :1.2/:1)1/87 $500, (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY $100, (DISEASE-EACH EMPLOYEE
OTHER
DUMP T"'tJC~<S UNDER Bn.mER 12/31/86 :l2/31/87 BI 100/300
PD 100
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLESlSPECIAL ITEMS
CITY OF CLEARWATER
P..O BOX 4740
GLEAR{..tA TEr-:.~ FL 33518