CERTIFICATE OF INSURANCE (107)
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. MISSOURI AVE. 90X 6090
CLEARWATER # FL 33518
INSURED
Suncoast P.vinq Inc
900 Anclote Road
Tarpon SP)-; n9$
33589
COMPANIES AFFORDING COVERAGE
COMPANY A INSURANCE
LETTER MASSACHUSETSS BAY
COMPANY B
LETTER FeCI
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 INDICA TED.
'NO'fWf'fHSTANOIN6ANY'R~UIfU!MI!NT, TI!I'IM Oft l...ONDITIONOF'ANY CONTflACTOR-OTHEROOCUMENT wtTH lfESPECT TO' WH'CHTHISCERTIFICATEMAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
COMPREHENSIVE FORM
PREMISES/OPERA liONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
DRaAII FORM CGL
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV PASS,)
ALL OWNED AUTOS (~~~JRpl~~N)
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
OTHER
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
DATE IMMIDOIYY) DATE (MMIDDIYY) EACH
OCCURRENCE
12/09/86 BODILY
11/09/86 INJURY $ $
PROPERTY
DAMAGE $ $
BI & PD $ $
COMBINED SOOt
PERSONAL INJURY $ SOOt
BODILY
11/09/86 12/09/86 INJURY $
(PER PERSONI
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED $ 500t
BI & PD $
COMBINED
02314514
BASOS847
7181934
1/01/86 12/31/86
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
CITY OF CLEARWATER
P.O BOX 4740
CLEARWATER# FL 33518