CERTIFICATE OF INSURANCE (13)
Lancaster Insurance Inc
POBox 2856
Clearwater, FL 33517
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
COMPANY B
INSURED LETTER
Robert J Burnside CLU & Assoc Inc COMPANY C
LETTER
319 South Garden Ave
Clearwater, FL 33516 COMPANY D
LETTER
COMPANY E
LETTER
Hartford Insurance Co of the Southeast
D
R
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F~~LII5'l>~ DICA TED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T. \1,Hlt:H ~RTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE MS, EXCLUSIONS, AND CONDI,
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE
POLICY NUMBER
-1--------
POLlC'f f:Fi-1CT!VE POLlC'i
DATE IMM/DD!YY) DATE
UABILlTY LIMITS IN THOUSANDS
OCCQ~~~NCE AGGREGATE
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDE\iT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
2lSBAPH1587
12/25/85
12/25/86
BODILY
INJURY
$
$
PROPERlY
DAMAGE
$
$
BI & PD
COMBINED
$1,000, $1,000,
PERSONAL INJURY $
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV PASS.)
ALL OWNED AUTOS (OTHER THAN. )
PRIV. PASS
HIRED AUTOS
NON,OWNED AUTOS
GARAGE LIABILITY
$
$
PROPERTY
DAMAGE $
BI & PD
COMBINED $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
g6t~~ED $
$
STATUTORY
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
(EACH ACCIDENT)
(DISEASE,POLiCY LIMIT)
(DISEASE,EACH EMPLOYEE)
OTHER
,___1__,_____
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Additional insured endorsement to: City of Clearwater
City of Clearwater
POBox 4748
Clearwater, FL 33518