CERTIFICATE OF INSURANCE (067)
9-24-85
ML Rodgers & Currmings Insurance Ins.
P. O. Box 5148
Clearwater, Fl. 33518
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,
INSURED
COMPANIES AFFORDING COVERAGE
COMPANY A South Carolina Insurance Co.
LETTER
COMPANY B Planet InsuranceR E eEl V
LETTER
COMPANY C
LETTER Scottsdale Ins.
COMPANY D SEP 30 1985
LETTER FCCI
COMPANY E
LETTER
Terra Excavating, Inc.
l3400 Pine Street
Largo, Fl. 33540
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ICY ATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTiVE
DATE IMMIODNY)
POLICY EXPIRATION
DATE (MM/DD/YY)
----------
EACH
OCCURRENCE
BODIL Y
INJURY $ $
PROPERTY
DAMAGE $ $
BI & PD $ $ 500
COMBINED 500
GENERAL LIABILITY
X COMPREHENSIVE FORM
X PREMISES/OPERATIONS
UNOERGROUND
EXPLOSION & COLLAPSE HAZARD
X PRODUCTS/COMPLETED OPERATIONS
X CONTRACTUAL
X INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
SMP 44 88 095
7-l5-85
7-l5-86
AUTOMOBILE LIABILITY
X ANY AUTO
X ALL OWNED AUTOS (PRIV PASS,)
X ALL OWNED AUTOS (~~~JRpl~~N)
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE LIABILITY
EBO 5021 14
7-l-85
7-l-86
PERSONAL INJURY $
BODILY
INJURY $
(f'tR f'tRSON)
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED $ 500
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
UNB Ol1838
7-l6-85
7-l5-86
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY
4601
l-l-85
l-l-86
$
$
$
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Additional Insured: City of Clearwater
JOB: l2l5 Railroad Avenue, Clearwater,
, )
City of Clearwater
lO S. Missouri Avenue
Clearwater, Fl. 33515
j