CERTIFICATE OF INSURANCE (12)
The Vegh~e Agency
P.O. Box 1560
Clearwater, FL 33517
COMPANIES AFFORDING COVERAGES
I
,
f.J-'~"-1_~_
COMFANV
LETrfR
A
B
C
o
E
COMPA~ '
LEn ER
American Econom
Ins. Co.
COMFA~'
L fTTER
NAME AND ADDRESS OF INSURED
The Colo~y, LTD
c/o Stiff & Brauer
33 Noruh Fort Harrison
Clearwater, FL 33515
COMP,u.I\'y
IF FEil
COMPANY
LETTER
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~I(~!Jl. t~tr c
of any contract or other document with respect to which this certificate may be issued or may pertam, the insurance afforded by the policies descr~ l'eteiIJis ~'
terms, exclusions and conditions of such policies,
limits of liability in Thousands (000)
EACH I .----,
OCCURRENCE
"'Y-PE OF INSURANCE
POLICY NUMBER
1'0 L1CY
,'"PIRATION DAfE
COMPANY
LETTER
GENERAL LIABILITY
For>llY INJL!I,Y
A.
GCOMPREHENSIVE FORM
o PREMISES-OPERATIONS
o EXPLOSION 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
02-BP-044463-1
6/9/85
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$1,000,
PERSONAl INJUli'f
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
DOWNED
o HIRED
o NON,OWNED
BODILY INJURY
(EACH PIRS')'"
BODILY INJURY
(EACH ACCIDEN'[ I
PROPEfHY DfI.MA,CjF
BODILY INJlJliY AND
PROPERTY DAMAGFC
COMBINED
$
EXCESS LIABILITY
o UMBHFCLLA FORM
o OTHEHTHAN UMBRELLA
FOflM
BODilY INJURY AND
PROPFRTY DAMAGE
COMBINED
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
Property
02-BO-044463-1
6/9/84
$650,000. Building
A.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
Fire Legal Liability $50,000.
Medical Payments $i,OOO. Each Person $10,000. Each Accident
Money and Securities $10,000. On Premises $2,000. Off Premises
Loss of Income - Actual Loss Sustained Not exceeding 12 Consecutive Months
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ...l.O...- 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 HOLDEH
Clearwater City Clerk's Office
P.O. Box 448
Clearwater, FL 33518
Attn: Susan
DATE ISSUED:
\
Jack Rice