CORRECTED CERTIFICATE OF INSURANCE
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TO:
FROM:
COPIES:
Elizabeth Haeseker, Asst. City Man gel"
]tOUTE TO:
Initial 6-
Forward
Sue Lamkin, Asst. City Clerk
DATE:
July 12, 1983
1.._________. ______ __.___ _________.(
2.__._____ .._______ __ _____ _ _ ________(
3._______________ ________________(
SU'JECT: Corrected Insurance CertificateI'
) S,E ME
(. ) DJtAFT REPLY FOR MY SIGNATURE
( ) PREPARE JOINT REPORT
) FOR LEGAL PREPARATION
( ) FOR CLEARANCE
) NEED APPROVAL OF u__u__u_____u_u___
) ESTIMATE COST
X FOR NECESSARY ACTION
) FOR IMMEDIATE ACTION
( l DRAFT LETTE-R FOR AGENDA
) INVESTICA TE AN D REPORT
) HANDLE TO COMPLETION
) CLEAR WITH ALL AGENCIES CONCERNED
) EXPECT REPLY u_u _u _ _ __ __ _ _ __ __ U h__ ._
) MAY I COMMENT ON THIS?
) FOR YOUR INFORMATION
k FOR YOUR FILES
) FOR YOUR SIGNATURE
) RETURN
) JOB ACCOMPLISHED
r
) REPLY DIRECTLY TO CORRESPONDENT; SEND Copy TO THIS OFFICE
( ) CONTACT CORRESPONDENT; REPORT ACTION TAKEN TO THIS OFFICE
) SUBMIT YOUR RECOMMENDATIONS OR COMMENTS IN WRITING
( ) PREPARE ROUGH SKETCH
REMARKS:
The enclosed Certificat., of Insurance is a corrected copy replacing
the one fol" the The Col.y ~ent to you last week.
(Signoture)
Secretary
(Position Title)
The Veg~te Agency
P.O. Box 1560
Clearwater, FL 33517
COMPANIES AFFORDING COVERAGES
The Colqny LTD
33 N. Fort Harrison
Clearwater, FL 33515
COMPANY A
LETTER
COMPANY B
LE TTER
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
Royal Insurance
NAME AND ADDRESS OF INSURED
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 or condition
of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance aHorded by the policies described herein is subject to all the
terms, exclusions and conditions of such policies.
TY PE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
A. [XJ COMPREHENSIVE FORM PYR13404
o PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
H AZA RD
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 COMPREHENSIVE mRM
DOWNED
o H I RED
o NON-OWNED
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
WORKERS' COMPENSATION
---.----.----,------------- -,--------"- -- - -, -- .----.----
and
EMPLOYERS'L1ABILlTY
OTHER
A. Property PYR133404
PO LlCY
EXPIRATION DATE
Limits of Liability in Thousands (000)
OCC~~~~NCE AGGREGATE
BODILY INJURY
6/9/84
PROPERTY DAMAGE
$
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$1,000. $
PERSONAL INJURY
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
BODILY INJURY AND
PROPERTY DAMAGE $
COMBINED
6/9/84
$650,000.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
Re: 421 - 29 Cleveland St., Clearwater
Additional insured: City of Clearwater
Cancellation: Should any of the above descrf(jd 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, FL
DATE ISSUED:
7 /1/83
33518
Jack Rice