CERTIFICATE OF INSURANCE (5)
COMPANIES AFFORDING COVERAGES
Quality Insurance Services, Inc.
119 E. Ogden Avenue
Hinsdale, Ill. 60521
COMPANY A
LETTER S t
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
Paul Fire & Marine Ins. Co.
NAME AN D ADDRESS OF INSURED
U. S. Home Corporation
One Countryside Office Park
P. O. Box 5000
Clearwater, Florida 33518
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time.
Limits of Liability in Thousands (000)
oCC~~~~NCE AGGREGAfE
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
GENERAL LIABILITY
o COMPREHENSiVE FORM
o PREMISES..-OPERATIONS
o EXPLOSION AND COLLAPSE
H AZA RD
o UNDERGROUND HAZARD
o PRODUCTS/COMPLETED
OPERATIONS HAZARD
o CONTRACTuAL INSURANCE
o BROAD FORM PROPERTY I
DAMAGE
o INDEPENDENT CONTRACTORS
o PERSONAL INJURY
BODILY INJURY
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBiNED
$
AUTOMOBILE LIABILITY
o COMPREHENSIVE FORM
o ;~NED
o H I RED
o NON.OWNED
l12JG8262
1_ l1ll!~l(
BODILY INJURY
(EACH PERSON) $
BODILY INJURY
(EACH ACCIDENT)
EXCESS LIABILITY
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
OWNED PROPERTY
BUILDER'S RISK
A
366MP1768
366MP1768
ntil Canc
ntil Canc
Per Schedule
5 000 000 Per
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
Coverage and Deductible as per M.O.P. policy
Cancellation: Should any of the above des<J~ed policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail _ 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. Send cancellation
notice to the City of Clearwater, registered mail at the below address.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
City of Clearwater
Department of Community Developmen
Mr. J0e McFate
P.O. Box 4748
Cl
DATE ISSUED:
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AUTHORIZED REPRESENTATIVE
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