CERTIFICATE OF INSURANCE (037)
BAYLIS' INSURANCE
P.O. Box 150506
ORLANDO" FLORIDA
COMPANIES AFFORDING COVERAGES
~i\~'~~lNY A \'!EST AMER I CAN I NSURANCE Co.
f!\~li~lNY B. FCC I SELF I NSURERS FUND
::~:.~:: ~- ___u_ --~ r ~~~'\-
~~)~~;~Y -En -- ---f\ ~\'u
LET1[H - V
This is to certify that policies of insurance listed below have been issued ~o the insured named aboy(,a;,darein forceat this time:-r\joiWlu1~i,;,,'(ii,;i) ,
01 any contract or other document with respect to which this certifica'e may be issued or may pertarn, the insurance afforded by fhl' pr:iic',,; ri:
terms, exclusions and conditions of such policies.
COMI'^Nl' ~
'Lf'HH IYPlOF INSURANI I POI.ICYNUMBUI
---- --- ------------- ----
. GENERAL LIABILITY
AGENCY"
INC.
32853
INSIJflfll
THARP PLUMBING SYSTEMS"
2677 MERCY DRIVE
ORLANDO" FLORIDA
INC.
32808
t,:-:rn or cOildiho,-!
!;, ~\lJt;iect to a!llh~':
PUl H:V
fXl'IHAIION IIAII
~__._L.in;lt'~OfLi,'t"lity in
^(;(,Pf.(.f\l f
RECEIVED
3-1-86
,
----'r--'-'-- --
HnUll_" InH.Jii'r
L
I
,
, 300
$ 100
A
5(J COMPHlHENSIVE fORM
I)(] f'HfMI';ES---OPfRATIONS
CJ rXI'LOSION AND COllAPSE
.. . HAZARD
~ IINDEflGHOUND HAZARD
~ I'HODUCTSiCOMPLET[D
. OpmATIONS HAZAHD
~ CONTH^C r lJAL INSUllANCE
KJ 1lllOAD fOHM PHOI'FRT'I
DAMAGE
K1INDFPfNDf NT CONTIIAC TORS
lKJ f'fRSONAL INJURY
XPO 193694
PH()P['f~'1 '( [lM/;\(~!
100
AUTOMOBILE LIABILITY
, DEe 24 1&<J"1
I
(CITY CLER~
I $
._---___J
lJOOIL Y INJUHY ANU
Pf"OP[RTY DAMAGf
COMfllNfU
Pt RSONAI
!N.,IUHY
A
KJ COMPf<[HfNSIVl
[J OWNED
XJ H lI!fD
XJ NON.OWNED
I~O['ll.Y ir'LJURy
(f AC H P! HSUN',
$250
500
fORM
XA!'J 193694
3-1-86
HODILY 1~~.Ji.lR'r'
lEACH M;C!c)f'IHi
PPOP[R r y ()t~MI\(~[
BODILY IN.JUr-1Y M.J:-'
PPOPFHl '-( r)M.~/q
EXCESS LIABILITY
o UMBRELLA FOHM
[J OTHER THAN UMHHfLLA
FORM
UODIL y !~L!ur,:'f
f1f.:OPr.f,I') i)M,..1:,,'~C
IWORKERS' COMPENSATION
cd'-B- .. -- - c----jmd- --1144-0Q
EMPLOYERS' LIABILITY
OTHER
I
~I ..,-.---- .--.-.--..-..,.....--..
1"" -., 0l::
.. ;i;..f~~-=-e-;;r
(-c.Mrlir~t'r'\
DESCRIPTION OF OPERATIONS/LOCATIDNSNEHICLES
""'-....
~, .i.>_ ~
'""
Cancellation: Should any of the above des'Jr,i.Ped policies be cancelled before the expiration date thereof, the issuing corn.
pany will endeavor to mail ...:2.ll- 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 OF CLEARWATER
112 S. OSCEOLA AVE.
CLEARWATER" FLORIDA
33516