CERTIFICATE OF INSURANCE (2)
INSURANCE FROM
C'NA
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CERTIFICATE OF INSURANCE
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The Policy identified below by a policy number is in force on the date of Certificate Issuance. Insurance is afforded only with respect to those coverages for which a
specific limit of liability has been entered and is subject to all the terms of the Policy having reference thereto including for Umbrella Excess Third Party liability
Insurance a provision requiring the maintenance of underlying insurance or self insurance. This Certificate of Insurance neither affirmatively nor negatively amends,
extends or alters the coverage afforded under any policy identified herein,
In the event of cancellation of the Policy the Company issuing said Policy will make all reasonable effort to send notice of cancellation to the Certificate Holder at the
address shown herein, but the Company assumes no responsibility for any mistake or for failure to give such notice,
NAME AND ADDRESS OF INSURED
Wi lliam H. Heinemann, Inc.
3621 - 49th Street, N.
St. Petersburq. FL 33710
NAME AND ADDRESS OF CERTIFICATE HOLDER
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DATE OF CERTIFICATE ISSUANCE:
CITY OF CLEARWATER
P. O. Box 4748
Clearwater, F L 33518
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25 1977
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Attn: R. G. Whitehead, CMC
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City of Clearwater, Florida is an additional insured as respects the property
at 815-25 Court Street Clearwater, Florida.
THIS CERTIFICATE IS IlsuED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE HOLDER
LIMITS OF LIABILITY
EACH OCCURRENCE
R. S. HM~MERSCHLAG & CO.
TYPE OF INSURANCE IS DESIGNATED BELOW
COVERAGES
EACH PERSON
I. 0 Comprehensive Automobile Liability
o Basic Automobile Liability
Bodily Injury Liability $
Property Damage Liability
Bodily Injury and Property
Damage Liability Combined
Uninsured Motorists
Bodily Injury Liability
Property Damage Liability
$
$
$
o Uninsured Motorists
II. llCI Comprehensive General Liability
o Owners'. Landlords' and Tenants' Liability
o
o Manufacturers' and Contractors' Liability
o Owner's and Contractor's Protective Liability
o Beauticians' Malpractice Liability
Bodily Injury and Property
Damage Liability Combined
Bodily Injury Liability
Property Damage Liability
III. 0
IV. 0 Workmen's Compensation
Employers' Liability
V. 0 Umbrella Excess Third Party Liability
A, Statutory Statutory Locations:
B. Bodily Injury $ t
The Excess Insuror's Limit of Liability is (Complete one)
(a) $ in excess of a Retained Limit
(b) Up to $ in excess of a Retained Limit
and in excess of various underlying Insuror's Limits of Liability
t each Accident
Complete below, by designating company by number in the box and entering policy number and expiration date in the sections corresponding to the type of insurance
indicated above.
I. II. BP 378 61 59 III. Policy Number
0 III 6-15-78 0 Expiration Dote
IV. V. Policy Number
0 0 Expiration Dote
IT] Continental Casualty Company
W Transportation Insurance Company
m National Fire Insurance Company of Hartford
m Transcontinental Insurance Company
[I] American Casualty Company of Reading, Po,
m Valley Forge Insurance Company
G-32343-J
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R. S. HAMMERS
PANY: INSURANCE
1840 NORTH FARWELL AVENUE. MILWAUKEE, WISCONSIN 53202 . TEL: 276-6295 (414)
LIFE. FIRE. CASUALTY. GROUP. ..\rARIXE . EXCESS AND SUHPLUS LINES. LLOYDS
August 25, 1977
Mr. R. G. Whitehead
City Clerk
City of Clearwater
P. O. Box 4748
Clearwater, F L 33518
Subject: Wi lliam H. Heinemann, Inc.
Mr. Whitehead:
This wi II acknowledge you r lette r of August 19, 1977 re lati ve to the
Heinemann property at 821 Court Street, Clearwater.
My apologies, I was under the impression that the insurance company
had forwarded you a Certificate of Insurance some time ago. Obviously,
this is not correct. I now enclose an appropriate certificate reflecting
the fact that the City of Clearwater has been named as an additional
insured as respects the property referred to.
I trust you wi II find the enclosed satisfacto ry.
Ve ry",tn:i'i;?ou rs
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ARK:ds
Enclosure
cc: Mr. Ted Cox
MEMBEH: MILWAUKEE . WISCONSIN . NATIONAL ASSOCIATIONS OF INSURANCE AGENTS
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AuJUs't 19, 11"
Hr. Arnold R. KelleDber,e.
Vice Pre.ietea't
R. S. Hammerschla. I Co.,any
1"0 North Farwell Avenue
Milwaukee, Wi.oo.ain 11202
Dear Hr. X.li.Db.Pler:
Reference ia .... 'to your i.~~er of Ap~il 1, 1'7', 1:0
Hl". 'led Cox, Se1 Aire ae.l,y, ando\U' le'tter'to you
dated May I, 117',botb ot whieh oo"o..n insuranoe
coy.rale tor Willi.. B. Heinemann, Inc. W. have re-
oei.ed no responae ~o oU' l.~er of Kay a, and we note
in your letter of April 1 that insurance oovera._
.xpired on J~ 15, 1977.
w. .uat a.ain ask tor ..14_noe of inaurance oov...ge,
with the City of Clearwater lis~d aa aft additional
in.ured .. relat.. to the four p1an'ter-pylons affixed
to the roof ot 'the bu11ctinc at 821 COUPt Street. Clear-
water, aDd which extenet into tbe rlpt of way on Prospeot
A"enue.
Unless we Noel.e such e.ldenoe of ooveraae within a
rea.onable ,ulodol t:l.Jae. we shall b. forced to turn the
matter o.e. 'to our Le.al Depart.ent for po..ible cano.lla-
tion of the AlNe...t uneter Seotion 111 of the Ci'ty Code.
Very truly your..
R. Q. "i~.head. CHC
City Clerk
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cc : City Lelal Depar'tIHnt
Mr. Ted Cox. Bel Air. ie.loty
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Hay 3, 1977
tiT'. l\rnold R. Kellenberger
Vice President
R. ~;. HamJ.lerschlag & Company
1840 North Farwell Avenue
i'Iih;aukee, '.lisconsin 53202
Dear : Ir. Kellenberger:
l~eference is made to your letter dated P,pril l, 1 g 77,
to ;;r. Ted Cox, 3el l\ire i~etil ty, Inc., Bel Aire l.,luff,
Floric.a, S ubj ect: '\\illiarn H. Leinemann, Inc.
We appreciate the information provided in your letter;
however, the agreement the City has with Mr. Heinemann
requires that a regular Certificate of Insurance be
provided the City each year indicatin;:: the types anc1
li~its of liability. In order to meet these require-
ments, we will appreciate your forwarding us a Certificate
at your earliest convenience.
Very truly yours,
~. G. ~hitehead, CMC
City Clerk
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PANY: INSURANCE
R. S. HAMMERS
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1840 NORTH FARWELL AVENUE. MILWACKEE, WISCONSIN 53202 . TEL: 276-6291({414) ,.,.
LIFE. FIRE. CASUALTY. GROUP. JI\RL',E . EXCESS AND SUHPLUS LINES. LLOYDS
April 1 , 1977
Mr. Ted Cox
c/o Bel Aire Realty, Inc.
2811 West Bay Drive
Be I Ai re Bluff, F L 33540
Subject: William H. Heinemann, Inc.
815-25 Cou rt Street
Clearwater, Florida
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APR 13 J.g;'7
Mr. Cox:
cny CLL~U('
This will confirm our telephone conversation regarding the liability
insurance on the above property.
We insu re this location unde r Po Hcy No. BP 296-30-08 in the Continental
Casualty Company. The policy referred to has a policy period June 15,
1976 to June 15, 1977. We are providing bodily inju ry liabi lity limits of
$500,000 and property damage limits of $100,000.
In addition, we have all of Mr. Heinemann's entities covered under an
Umbre lla Liability Policy.
I trust this wi II be sufficient fo r you r needs.
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Very truly your),
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A:~~\~ rt" K'e~~~e~~r" c/.
Vice President 1/
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ARK :ds(
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MEMBER: MILWAUKEE . WISCONSIN . NATIONAL ASSOCIATIONS OF INSURANCE AGENTS
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",1" ll, 1:)7\3
iil'. A.rnold ? Kellenberp;er
'!i.CF: Pr~si(lent
r, S. TTaT:)T1p.rscrlla\~ f. Cr):rtpany
, 011 ') ~,rOl~t>, T\.:;rHcl1 .^-V0.nl1e
'i lwaukce, :risconsin 53202
~;ear ilr. Kellenberser:
....,,(~ liability insu'"'ance
":?~;::.;~es ,Lme 15, 1'.17S.
foC' -:i21iaTn
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nei F~l'ann, Jpc.,
']1~,-,;~ the r'ene\r7al is iSSUe(~, ~2 :"ase send Ll1.s officf?
a c?:"tificate of insurance ] istin.f~ the Ci,tv of Clear;.'atel'
aSl(~(~;_tional insl)red.
V01J~ cooperation is a,pprcci,:.t~.~.
Vsr~T t1~~.11': YOllrs,
(~~:rs.) Lucille Hil1iaI'1s
f\ssistant City Clerk
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