CERTIFICATE OF INSURANCE (6)
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NORTH1VESTERN NATIONAL INlsuRANCE GROUP
HOME OFFI~: 731 NORTH JACKSON STREET · MILWAUKEE. WISCONSIN 53201
(1) NORTHWESTERN NATIONAL INSURANCE COMPANY OF MILWAUKEE, WISCONSIN
(2) NORTHWESTERN NATIONAL CASUALTY COMPANY (3) UNIVERSAL REINSURANCE CORPORATION
(4) OREGON AUTOMOBILE INSURANCE COMPANY n\':CEc,-~f~tJ
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CERTIFICATE OF INSURANCE
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This is to Certify, that policies in the name of
~l""l CLE.f\.l(.,
NAMED' U. S. HOME CORPORATION AND ITS WHOLLY OWNED I
INSURED SUBSIDIARIES including Highland Lakes
and 11 77 West Loop South' Division and
ADDRESS P.O. Box 2863 William Wallace
L-Houston, TX 77001 ~
are in 'orce at the date hereo', sublect to all 0' their provisions, terms and conditions, and have been issued by the company indicated, as 'ollows:
THIS CERTIFICATE OF INSURANCE NEITHER
AFFIRMATIVELY NOR NEGATIVELX AMENDS,
EXTENDS OR ALTERS THE COVERAGE AF.
FORDED BY ANY POLICY DESCRIBED HEREIN,
CO KINO OF POLICY POLICY LIMITS OF LIABILITY
NO. INSURANCE NUMBER PERIOD BOOIL Y INJURY PROPERTY DAMAGE
.
I WORKMEN'S COMPENSATION WC 576993 (All Eft, 11/1/79 Provided by Workmen's NIL
AND States) Exp. 11/1/80 Compensation Law-State 0' nopolistic
2 EMPLOYER'S LIABILITY All states except mc state
WC 637371 (TX & funds
MN) $ ,000 Employer's Liability
I COMPREHENSIVE GENERAL Eft, 11/1/79 $I. , 00<;000 Each Occullence $ ,000 Each Occurrence
LIABILITY INCLUDING CLA 210026 Exp. 11/1/80 sl , 000>00 Aggregate $ ,000 Aggregate
~ Contractual Liability
r9 Prod, and Comp, Operations a combined single limit 0' $ ,000 Each Occurrence
MANUFACTURER'S AND Eft, $ ,000 Each Occurrence I: ,000 Each Occurrence
CONTRACTOR'S LIABILITY Exp, ,000 Aggregate
a combined single limit 0' $ ,000 Each Occurrence
OWNERS' LANDLORDS' Eft, $ ,000 Each Occurrence Is ,000 Each Occurrence
AND TENANTS' LIABILITY Exp,
a combined single limit of S ,000 Each Occurrence
OWNERS' AND Eft, $ ,000 Each Occurrence I: ,000 Each Occurrence
CONTRACTORS' PROTECTIVE Exp, ,000 Aggregate
a combined sinale limit 0' S ,000 Each Occurrence
AUTOMOBILE LIABILITY
DOwned Automobi les Eft, $ ,000 Each person S ,000 Each Occurrence
o Hired Automobiles Exp, $ ,000 Each Occurrence
o Non.OWned Automobiles a combined Single limit 0' S ,000 Each Occurrence
COMPREHENSIVE AUTO, Eft, 11/1/79 sl,OO<;OOO Each person 1$ ,000 Each Occurrence
1 MOBILE LIABILITY CLA 210026 Exp, 11/1/80 SJ.,oo(;1lOO Each Occurrence
a combined single limit 0' S ,000 Each Occurrence
OTHER: Eft,
Exp,
.~ Company Number re'ers to the Company designated at the top of the form.
Description, Location 0' Operations, Automobiles Covered Of Remarks:
Highland Lakes and William Wallace
In the event of any material change in, or cancellation of, said policies, the company will
endeavor to give 30 days written notice to the party to whom this certificate is issued, but
failure to give such notice shall impose no obligation nor liability upon the company.
CERTIFICATE ISSUED TO:
NAME 'City of Clearwater
Ind 112 S. Osceola Ave.
ADDRE~ Clearwater, Fla. 33515
I
February 14
19
80
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ORIGINAL