INSURANCE CERTIFICATE (15)
\, I
: f'
--
1~!!!!!:,IIIIIfi_l_""""'n"''':~::;':
t~~FER'S NO RIGH+~ '3~~~TA~ ~E~f1~Ig:tTl?'HOrDER. THIS c~~~l~
Hllb Rogal & Hamilton Company DOES NOTAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BVTHE
P O. Box 23968 POLICIES BELOW.
Tampa, FL 33623 R E C E l"tZ D COMPANIES AFFORDING COVERAGE
813-289-6386 SEP 3 0 1993
INSURED
~II T
. -,,"..
"'... "
COIof'ANV A
LEIlER Mo n tic e I I 0 Ins. CO
COt.f'ANV B
LEIlER .
COIof'ANV C
LE IlER
COIof'ANV 0
LEIlER
Suncoast Beach & Pool
Se rv Ice, I nc
2270 Citrus Valley Circle
Palm Harbor
FL 33563 m~~NV E
9.R~~~A~l~~;iWti}m::':::mjm::;itWifj:m:M}M::}tIlitW:tM:mHtt:j;li@H::Miq::bIIWmm;:j'j:}@i::'rIIm::,mtrr:i;Il:r::::',nrr;Mmmi:::Imi":tiiI:;::rm:m:mir'tr::m:mMMtlN:tl\\%lU%UMmmUl"
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE lISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA T EO.. NOT WIT HST ANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLMENT WIT H RESPECT TO WHICH THIS
CERTlFICA TE MAY BE ISSUED OR MAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
CO
LTl
POlICY unOTlV\!: POlICY !XPIRATIO~
DAT! (MM/OO/VY) DAT! (MWoo/W)
TVPEOf INSURANCE
POLICY NUMIll!R
celERAl.L1ABILITY
-
A _ ClJv1PREHENSIVE FOPM
X PREMISES/OPERA liONS
~ UNDERGROUND
_ ExPLOSION 8. COllAPSE HAZARD
~ PRODUCTS/ClJv1PlmD OPER.
'-- CONTRACTUAL
'-- INDEPENDENT CONTRAC TORS
_ BROAD FOPM PROPERTY DAMAGE
PERSONAL INJURY
AUTOMOBR.! LIABILITY
-
ANY AUTO
- All OWNED AUIOS (Priv. p....)
-
_ All OWNED AUTOS (8:rv~rp~~;n)
_ HIRED AUTOS
_ NON-OWNED AUTOS
GARAGE lIABIlI TY
-
BODILY INJURY OCC.
BODILY INJURY AGG.
PROPERTy DAMAGE OCC.
PROPER TY DAMAGE AGO.
BI 8. PO ClJv1BINED OCC.
BI 8. PO ClJv1BINEO AGG.
PERSONAL INJURY AGG.
ML264320
11/07/92
11/07193
LIMITS
$
$
$
$
$
$
$
500000
500000
~ i ~ ~; Hi ~ ~ ~ ~; W; i; H;; ~ ~H; 1 HW H n 11 ~H i; i ~ n~;! ~ H~ ~ 1 H; n ~ 1 H l H H W!i;1 ~ H
~; ~ l; ~ ~ ~ ~! j ~ 1 ~ j 1 ~ ~ ~ ~ ~; ~ 1~ 1 ~!!~!~ ~; 1 ~! i ;~~ 1;1 ~ i ~; i!~;;; ill;;! 1!!~! ~~~ i ~ i!!; 1! i;;; ~ ~
BODILY INJURY $
IPer person)
BODILY INJURY $
(Per aeeidenll
PROPERTY DAMAGE $
BODILY INJURY & $
PROPERTY DAMAGE
ClJv1BINED
EACH OCCURRENCE $
AGGREGAIE $
ItXCI!SS LlAOlLlTY
h LMBREllA FOPM
'-1 OTHER THAi'! LMBRHl.\ FORM
WORKER'S COMPENSATION
AND
!IoFlOY!RS'LIABILITY
j ~; ~;!;~; ~ ~! ~!;;;; ~ ~; ~ ~~; H ~ ~ H; ~; H H~ m H; ~ ~; H ~ ~ j m ~ ~ HH ~ H ~ ~H m ~ ~ H H W ~
ISlA TUIORY LIMITS
EACH ACCIDENT
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
OTHER
j ~~;;~ l ~ ~~ ~;; ~ ~~ !~~~ 1 i;;~ ~~j; f ~1 ~~~; i
DfOSCRlPTION Of OPERATIONSIL%'ijll!ff'vpttl')"~C'tJRT~ I L & RENT ALlRET A I L OPERAT IONS
400 MlndlllY Ave., Cleuwlter, FI 34630
Certifl~lte H"ld,.. it thnwn!Ot Addition.1 In'turll!ld
%;;f6!!m%~r!::!}9M?M,}}:::{:}::}:::t}}:::::':m::::::t"::::::::{:::::i{m:::'f}},::{':{:::}t:::':m:m:'::;::'::::,:::t9!~9fH+.~[!9~f:}}}:{:}:::m:::::m::f::::}:':?!:}::::!::m::::}f!:::!::::':':m:{{::::{,}::!:;:::;::::,}::::::!,:::m:{:;:::;::t:!{,:::m!:,m:::;:::;::'}:'!::!'::::::!ii}
tt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
1m EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
:::.:.:: MAIL ----19DAYSWRIT TENNOTlCE TO THECERTlFICA TE HOLDERNAMEDTO THE
City of Clearw.ter )m: LEFT.BUTFAIlURETOMAILSUCHNOTlCESHALLMPOSENOOBlIGAlIONOR
Equ i t II IJP Ho te I DBA ;::::!: LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTSOR REPRESENT A liVES.
Holld.y Inn Surfside :::'?
. . :':':':: AUT70RIZfOD RI!PRl!SfONTATIVe:
B~~i;~;_WiJ!i~i~~~&1l~~'m
'V
U
./ ..
I~ r 1,
( ~...\'
~~ J