CERTIFICATE OF INSURANCE
PRODUCERd ,,',', dd"ddddddddddd'''dddddd,,,,,,,,,,,,,,,,,,,n,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 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.
UNCOAST
.0. BOX
AMPA FL
INS ASSOC INC
22668
33622-26~ ~ ~ ~ ~ W ~
COMPANIES AFFORDING COVERAG~
I ' .. ,~,
. MPANY A SECURITY INS HARTFORD if
ETTER
AMPA BAY
NGINEERING, INC
18167 U S 19, N RISK MANAGEME
UITE 550
LEARWATER, FL 34624
FIRE AND MARl
tl.~
MUTUkL'
.r I)
INSURED
COMPANY B NORTH BROOK NATIONAL INS
lETTER
MPANY D AMERICAN MANUFACTURERS
lETTER
COMPANY E
lETTER
?:
PPt"'M)~)~~)))):m:mmm~~~~!~:m:mmmmm::mm:m:m:mm:mmmmm:m:mmmm~mmmm::m~m:):::m::):::::::m::))t:):::m:m::m:m::mmm:::m:m:::m:m:t:::::::::::::f:::::tm):m:::t::m:m)::~m)m:m::!m:~m):tm:m:tttm:t:::::::mmt:::::::):::::m:i::i::m:m:m:m::::::im:::i:!:mm:!!::m:m:m::::::mm:~::::m:m:iH:i::mmi)mm::i!mt:i~:m~
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICAtE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDmONS OF SUCH POUCIES, UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
POLICY EFFECTIVE POLICY EXPIRA TIO
TYPE OF INSURANCE
POlICYNUMBER
LIMITS
RP06642429
GENERAL AGGREGATE $ 2 000
PRODUCTS-COMP/OP AGG, $ 2 000
PERSONAl&AD~INJURY $ 1 000
EACH OCCURRENCE $ 1 000
FIRE DAMAGE (Anyone fire) $ 1 000
M ED, EXP, (Anyone person) $
OM MERCIAl GENERAlllABllI
lAIMS MADE[1L]OCCUR,
OWNER'S & CONTRACTOR'S PROT
CA0602046
COMBINED SINGLE
liMIT
BODilY INJURY
(Per person)
BODilY INJURY
$ 1 000 000
All OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
$
(Per accident)
$
PROPERTY DAMAGE
WORKER'S COMPENSATION
AND
-- -
EMPLOYERS' LIABILITY
3CQ609206-06
EACH OCCURRENCE
1 000 00
"""~1..Q"QQ.,,1.,PQ,'"
........"'.........,...................
........................................
................................................................................
................................................................................
...........................,....................'...............................
.......................................
RP06642429
UMBRELLA FORM
OTHERTHANUMBREllAFORM
mH~ROF LIABILITY
CLAIMS MADE
PL89219001
1 000
DISEASE-POLICY lIM~ 1~0
DISEASE-EACHEM-PlOYEE $ 1()o 0
06/30/94 06/30/95 $1,000,000 PER
CLAIM & AGGREGATE
DESCRIPTION OF OPERATIONS/lOCATIONS/VEHIClES/SPEClAlITEMS
aTE: CERTIFICATE HOLDER IS ADDITIONAL INSURED WITH RESPECTS TO GENERAL
lABILITY & AUTO LIABILITY ONLY.
H ,:~U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
'AR 2 3 19db EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
CITY OF CLEARWA TE.i.~ vfl MAIL...3.0...- DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE
A TTN ETHEL, RISK ~l'(LeRi( ~::::~i: LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
POBOX 4748 CEPD,: F ANY KIND UPON THE COMPANY, ITSA'GEN'I'8"OR'EPRESENTATIVES,
CLEARWATER FL 34618 :::::::: AUT OR REPRESENTATIVE Z
.:':':': ~ ,,'
iQQijp~~~(li.l.ijif~~~!~:~~~:~~~~~~~~~~~:~~~:~~:::::~::r:::~:~:~~::~::~~r:~::~~::::::~:::~~::~~~~~~~~:~:~::::~:::::~:~::::::~:::~~~:::i:~~::::~::::::~~::i:r~~r~~~::riiitr~~~:~~~~:~~:~~:~::~~~:~:~:~~:~::::~~:::~::::II~~:t:~~~~~~~~~;~~~~~~~~~:~~~:~~~~~i~I:~~~:~~~t~:~~:~::~::~~~::::~~:::~:~:~:~:::~:~:~:::~::::~:~:~:t)@~ii~pgMm'9N~j~
{!zZ1 t!&L