CERTIFICATE OF INSURANCE (019)
ROGER BOUCHARD INSURANCE, INC.
POBOX 6090
CLEARWATER, FLORIDA 33518
COMPANIES AFFORDING COVERAGES
IOWA NATIONAL MUTUAL INS. CO.
COMPAN'
LEHEIl
A
B
C
o
E
FLORIDA CONSTRUCTION
COMPANY
LEHER
U. S. FIRE INSURANCE COMPANY
..
NAME AND~DDI'ESS Of. INSUr11 '
SUNCOAST PAVING, INC.
ROUTE 1 BOX 222
ANCLOTE ROAD
TARPON SPRINGS, FLORIDA 33589
COMPANY
I En ER
COMPANY
LETTER
This is to certify that policies of msurance 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 perm;I'i,TI'1eimtlt!l1'1~lI~rM!'l by the policies described herein is subject to all the
terms, exclusions and conditions of such policies.
TYPI: OF INSUflM,.. POL.ICY NUMBER
I'OLICY
i:XP111A 1101'1 DATI:
limits of Liability in Thousands (000)
.-,--- E AC H I ^G(:-R.~G-"^-T c
1..OC;CURFi'EI'1CI: u._.__., "'- on"
GENERAL L1ABILlTy~~i
A []a COMPf11:HENSIVE FOP\' TO BE ASSIGNED
5a PREMISES.C'PEr,,'.!
D DPLOSION f,NI)
HAZARD
D UNDERGF10lJNIJ 1,1,/:..,
I.J PRODUCTS/COMPL I: IT!
LJQ OPERATIONS HAU"")
[]a CONTRACTUAL INSlJRAr,Cc
D BROAD FOF1M PI,OPFflT
. DAMAGE
[]a IN!J[YI:NDENT CONrHAC roP~ CiTY CLE
[]a PEIlSONAL INJURY
! $ 300,
,
$ 300,
BODILY IN-'"PY
04/02/84-
04/02/85
PROPERTY !lAMMi, I 100,
+---
I
,
100,
BODilY INJURY AN!)
f'WJF'ERTY DAMAC;E
COMBINE!:
PEf~SON~L INJURY
A ~ COMPREHENSIVE FOF1M
[XI OWNFO
5a HIF1ED
5a NON.OWNED
-~[]a I~:~R~~I: ~(~::ILlTY
[J OTHEH THAN UMEHF. '.:
FORM
C]WORKERS' COMPENSATION
and
-IEMPlOY~;~;~IABllITY
1
BODILY INJURY
(EACH PFFlSON,
$ 500,
500,
04/02/84-
04/02/85
TO BE ASSIGNED
BODILY INJURY
(EACH ACCIDENT)
PROPERI Y L'I,MAGE
BODilY INJURY /,'.0
PROPERTY IlAMA.GE
COMBINUJ
BOIlIl.Y INILJFiY AN[)
04/02/84-
04/02/85
5233219992
f:'HOPE RT'i Ut,M,l\CE
C OMHINU'
7-18-1934
12/31/83-
12/31/84
OPERA T IONS/IOCA T IONSNEH ICL ES
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the Issuing com-
pany Will endeavor to Fllall -3.0- days written notice to the below named certificate holder, but failure to
mail suc" notice shall Impose no obligation or liability of allY kind upon the company.
N/',M [ 1\ ND ,ADDRESS ur: c ~ FF WI,' ,:. -- F ~~(h 1-: l ~~
ROGER O. BOUCHARD
CITY OF CLEARWATER
POBOX 4748
CLEARWATER FL 33518