CERTIFICATE OF INSUANCE (11)
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',...rdejIOrtlllent ColTftpondence Sheet
Prepared Form
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COPIES:
SUBJECt :
DATE:
Elizabeth Haes.k~r.Al,UJ~. City
Sue Lamkin, A.i.~~:'Cl~,;i~.."k
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In'surance C~~~J.!~.t.; ',; . .
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ROUTE TO:
Initial 6
Forward
Hay 19, 1983
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3.______________. ----------------(
,1>''':'1:',
) S~EMEt
) DRAFT REPLY FOR MYS~GN+~
( ) PREPARE JOINT REPORT,
) FOR LEGAL PREPARATION
) FOR CLEARANCE
) NEED APPROVAL OF ______n________________
) ESTIMATE COST
KIoR NECESSARY ACTION
) FOR IMMEDIATE ACTION
( ) DRAFTLEm'R FOR A_i)A
) INVESTIGATE AND REPORT
) HANDLE TO COMPLETION
) CLEAR WITH ALL AGENCIES CONCERNED
) EXPECT REPLY _ - _ - - _ __ - - - - - - - - - - __ - - __ - 0 ' -
) MAY I COMMENT ON THIS?
) FOR YOUR INFORMATION
( Xl FOR YOUR FILES
) FOR YOUR SIGNATURE
) RETURN
) JOB ACCOMPLISHED
l REPLY 'DIIlECTl,.Y TO COUf$,POMMNT;SEND Copy TO THIS OFFICE
) CONTACT CORRESPONDPfTrREPORT ACTION TAKEN TO THIS OFFICE
) SUBMIT YOUllECOMMfN~TtON$ORCOMNINTS IN WRITINC
( ) PREPARE ROUGHSKO'CH' .,:
REMARKS:
We are, enCl, os, ,1" n, ,8" ',:1\, ',,','.,' ~",." ,,;, :L,,~&,',' Uf, 0, '~, ?pia., of ins urance certificate for
The, Colony Ltd.lqc.-e.d. ,..~ 421-429 Cleveland Street. Please note
thec.rtific..:.1.~:~,.~; '~~ J:une 9,,1983.
: "\"0' .
We.1:ill have notr.o~ivad ~y insurance oertificate for Lucho.s.
, .
.
(Signotllre)
Susan Stephenson
(Position Title I
II.' Iii
The Veghte Agency
P.O. Box 1560
Clearwater, Florida 33517
COMPANIES AFFORDING COVERAGES
The Colony Ltd.
Stiff & Brauer
33 North Ft. Harrison
Clearwater, Florida 33515
COMPANY A
LETTER
COMPANY B
LETTER
COMPA NY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
Ro al Insurance
NAME AND ADDRESS OF INSURED
MAY 16 1983
CITY CLERK
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time, Notwithstanding any requirement, term orwndition
of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the
terms, exclusions and conditions of such policies,
TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
A o COMPREHENSIVE FORM PYR 13 34 04
o PREMISES-OPERATIONS
o EXloLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
o PRODUCTS/COMPLETED
OPERATIONS HAZARD
o CONTRACTUAL INSURANCE
o BROAD FORM PROPERTY
DAMAGE
o INDEPENDENT CONTRACTORS
o PERSONAL INJURY
AUTOMOBILE LIABILITY
o COMPflEHENSIVE FORM
DOWNED
o H I RED
o NON-OWNED
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
A Property PYR 13 34 04
POUCY
EXPIRATION DATE
Limits of Liability in Thousands ( 00)
EACH
OCCURRENCE
BODILY INJURY
6 / 9 /8 3
PROPERTY DAMAGE
$
$
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$ 1,000 $
pm,~ONAL INJURY $
BODIL Y INJURY $
(EACH PERSON)
BODILY INJURY $
(EACH ACCIDENT)
PROPERTY DAMAGE $
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
'-',>
6 / 9 /8 3
, $650,000.
DESCRIPTION OF OPERATIONS/LOCATfONSNEHICLES
Location of premises: 421-29 Cleveland Street
/
i'
C) ,
Cancellation: Should any of the above dest;;ribed 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
City Clerk
P.O. Box 4748
Clearwater, Flroida 3351-
Att: Sue