CERTIFICATE OF INSURANCE (078)
TYPE: OF INSURANCE POLICY NUMBER POLICY
EXPIRATION DATE
GENERAL LIABILITY
BODilY INJURY $ $
[] COMPREHENSIVE FORM
A []PREMISES-oPERATlONS PROPERTY DAMAGE $ $
o EXPLOSION AND COllAPSE XPO 19 36 94 03/01/87
HAZARD
[2a .UNDERGROUND HAZARD
[2a PRODUCTS/cOMPlETED
OPERATIONS HAZARD BODll Y INJURY AND
[2a CONTRACTUAL INSURANCE PROPERTY DAMAGE $ 500 $ 500
[2aBROAD FORM PROPERTY COMBINED
DAMAGE
[2a INDEPENDENT CONTRACTORS
G.<l PERSONAL INJURY PERSONAL INJURY $
AUTOMOBILE LIABILITY BODilY INJURY $
[XI COMPREHENSIVE FORM (EACH PERSON)
BODILY INJURY
A [XI OWNED XAW 19 36 94 03/01/87 (EACH ACCIDENT)
[X] HIRED PROPERTY DAMAGE
[X] NON-DWNED BODll Y INJURY AND 500
PROPERTY DAMAGE $
COMBINED
EXCESS LIABILITY
BODll Y INJURY AND
[XJ UMBREllA FORM PROPERTY DAMAGE $1,000
o OTHER THAN UMBREllA XEO 19 36 94 03/01/87 COMBINED
FORM
and 1144-00 12/31/86
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/lOCATlONSNEHIClES
Cancellation: Should any of the above described policies be cancelled before .the expiration date thereof, the issuing com-
pany will endeavor to mail -lO- 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 any,
NAME AND ADDRESS OF CERTIFICATE HOLDER
City of Clearwater
112 S. Osceola Ave,
Clearwater, FI 33516