MEMO AND CERTIFICATE OF INSURANCE
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FROM: Risk Management
COPIES:
SUBJECT: Certificate of Insurance
DATE: 7- eM - &i9
CITY IF CLEARWATER
Interdepartment Correspondence Sheet
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Attached certificate of Insurance meets lease specifications, with following
exceptions:
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SEP 28 1988
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13080 S BELCHER RD, H I EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PUiICIES B[LOW.
LARGO, FL 1
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COMPAN1ES AFFORDING COVlRAGE
ZIP CODE 34646
COMPANY L~TTER A
fJ:TNA
COMPANY LETTER B
INSURED
TERRY TSAFATINOS
1144 - 81ST STREff
BROOKLYN, NY
CO('iPAi'~Y
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COMPANY LETTER D
ZIP rnJlE 1122r:
COMPANY lETTER E
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COVERAGES
THE; IS TO CEF:TIn THAT pourlES OF INSURANCE LISTED BELOW tlAljE DI:TN JSt.;(ifJi TU Tiif INf;iWEIi (H'lliED MilNE FDr: THF F'DU[:!
f;i~F:I.OD _ IrjpIC~ ~~D I. _~QTWI :(t!3T~r1D !~Q. ~NY _.f:C~~~I~r:~!1~~I ~ I fEE:P,.. Of:. .~~Cit:~j!I:I!G~~~ ~}l~r,~~ti/ j~J~N:!~hf~LX=-, i.)lj r.;:'} r~Fb::- !~:P;~':ii~~ft~T. ;~~i~,-i~):. ,r,~~~~~F~E:r :r~~.i
wHICH IHJ~ CEF,IItlL.HTE Mfil !:iE 1~:-;UtD UI\ ['Ifil rEr;If-i!I~, Irk It~~,UKHi'I,t Hrrt1i',j.C!.l BI ifi':. 10L1\.1:::.;:; V:::'OL.r,J,!:>i::.l< herd:J.. .l;:' ~Uh'r.LI
TO ALL THE T~RMS! EXCLUSIONS, AND CONDITIUNS OF SJCH rOl.ICIES.
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TYPE OF IN;-;tiRANCE
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DESCRIPTI{lN OF OPER~TIONS!LUCATIONS/VEHICLES!RESTRrCl.JUNS!Sr'EC):AL ITEMS
=======================~===~====~====~===~======~=~~======~~~~=.==~==~====~==~~::~=~~~:::~-_..,~~~~~=~=~::~=~~~~=~:=~~~~=~~~==_.._----
CERTIFICATE HOLDER
CANCELLATIUN
CITY OF CLEARWA1'ER
~IW\B8~N~%~~NT
CLEAR~~lE~6D~L34618
~Op~H..:~i.-,~Nl ~ QC TH~~.f:r.!Q\)t
~'iKH!lUN DR!t !h~KtUr ~
WRI'fTEN NOTICE T0 TH~
TO NA r i_ :.3 U C;..i ;'~DT
UPON Ti~E COMPAN)','
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AUT~iDF~ ZEn f.~Ef'~~ESE:NT A T 1 VE