CERTIFICATE OF INSURANCE (045)
COMEGYS INSURANCE AGENCY
1005 1st Avenue North
St. Petersburg, FL 3370
INSURED
T.C. Structures Inc
12405 - 49th St.
Clearwater, FL
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 BEl-OW, '
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER CNA
COMPANY B West American Insur~j: ~~ I V
LETTER
COMPANY C To be assigned
LETTER
COMPANY D MAR 4 198~
LETTER
THI.SJS TO CERTIFY TttATPOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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
GENERAL LIABILITY
A X COMPREHENSIVE FORM
PREMISEs/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
X PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
X INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
X 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
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
POLICY NUMBER
CCP022194247
ACW9646349
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
OATE (MWOOIYY) OATE (MMIDOIYY) EACH AGGREGATE
OCCURRENCE
BODILY $300 $300
INJURY
3-14-84 3-14-8 PROPERTY $ 50 $ 50
DAMAGE
BI & PO $ $
COMBINED
PERSONAL INJURY $
BODILY $
INJURY
(PfR PfRSONI
4-28-84 4-28-8 ILY
INJURY $
(PfR ACCIDENT)
PROPERTY $
DAMAGE
BI & PO $25
COMBINED
BI & PO $
'. COMBINED
Binder #KD0214572
(EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/SPECIAL ITEMS
City of Clearwater
PoBox 4748
Clearwater, FL 33518
2-17-85