CERTIFICATE OF INSURANCE (100)
~ 'H" e,""""" " '''o,i~~~!~~'~!~A~O~ !N~' ~~ ~O~'~~"GH" OM 'H' e,"""",, HOW'"
~ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED''!lY THE POLICIES LISTED BELOW
I ADDRESS OF AGENCY
JSEPH U.
01 SWANN
iAMPA, FL
COMPANY A
LETTER U . S . F. ~ G.
COMPANY B
LETTER
COMPANY C
LETTER
~~~::"NY D [JTC J DJWR OTF [JAE
COMPANY E ......IET
LETTER OW J S DrUM [JG s [Jc G
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force a[!h4!tf\IJlJl, UObwltl1lltal!iOihgllT1Y rEfillt'ment, term or con.
dition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded 1S'.,tl'1'Iil pbntteS'desdibe/l nllrein is subject to
all the terms, exclusions and conditions of such policies,
MOORE,
AVE
INC.
COMPANIES AFFORDING COVERAGES
33606
S ~ E CONTRACTORS
14561 58TH STREET
CLEARWATER, FL
INC
NORTH
FCC I - S I F
PUBUC WORKSOr:Pl.
(813)251-2699
lAME AND ADDRESS OF INSURED
33520
COMPANY
LETTER
POLICY NUMBER
JlI. n s
TYPE OF INSURANCE
EACH
OCCURRENCE
AGGREGAT
PREMISES-OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETEO
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PROPERTY DAMAGE
$
-'. 500,
$
$
-500,
COMPREHENSIVE FORM
MP056627967
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11/01/86' / ,"nv:,;::,';(L~, -
L ~ .,
\ l\UG 4
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,!rY
.., ,.
~, ,'! .~,
. I',
000,
$
500/
, ~: 1
t. ~ ,~',
BOOIL Y INJURY AND
PROPERTY DAMAGE
COMBIr.ED
$
$
PERSONAL INJURY
, . ~
~.~:,.i :\
,,,:; 7" ..;_~ ;':vnf
PERSONAL INJURY
$
~jOO
B
.nd
EMPLOYER'S LIABILITY
OTHER
7941
11/01/86
BODIL Y INJURY
(EACH PERSON}
BODILY INJURY
lEACH OCCURRENCE}
$
BAP067092201
11/01/86
PROPERTY DAMAGE
$ 250,
BOOI L Y INJURY AND
PROPERTY DAMAGE
COMBINED
CEP064851402
11/01/86
BODIL Y INJURY AND
PROPERTY OAMAGE
COMBINED
$
WORKER'S COMPENSATION
ESC'A~rO~'A1'~~!!I!t~crES CURLEW ROAD PUMPING STAT ION INTERIM FACILITY.
*ENGINEERS ~ ARCHITECTS: BRILEY-WILD ~ ASSOC. INC., INCLUDED AS ADDIL INSURE I
*CERTIFICATE HOLDER INCLUDED AS ADDITIONAL INSURED
Cancellation: Should any of the above des'3ijed policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail 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
P.O. BOX 4748
CLEARWATER/
'^'iJl"~/
I JOSEPH
-y7 c..;-,/L.(r-.j...... '::J
U MOORE INb-/ CR
CITY OF CLEARWATER
AUTHORIZED REPRESENTATIVE