CERTIFICATE OF INSURANCE (065)
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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,
COMPANIES AFFORDING COVERAGE
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COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
DII~
INSURED
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED.
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.
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
TYPE OF INSURANCE POLICY NUMBER DATE IMM/OOIYY) DATE (MM/OOIYY) EACH
OCCURRENCE AGGREGATE
GENERAL LIABILITY BODILY
.. COMPREHENSIVE FORM INJURY $ $
. PREMISES/OPERATIONS .. ...,., a-u-e ......... PROPERTY
UNDERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERA nONS
CONTRACTUAL BI & PD $ .. $,.
COMBINED
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY $-
AUTOMOBILE LIABILITY BODilY
INJURY $
ANY AUTO (PER PERSON)
ALL OWNED AUTOS (PRIV PASS,) .. .,.. I-II-IS ........ BODilY
INJURY
ALL OWNED AUTOS (OTHER THAN) (PER ACCIDENT) $
PRIV PASS
HIRED AUTOS PROPERTY
NON-OWNED AUTOS DAMAGE $
GARAGE LIABILITY ! BI & PD
I COMBINED
EXCESS LIABILITY +---
UMBRELLA FORM .. Jrf a-u-as .....u-. BI & PD
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION $
.. ""'$V." a-u-e I-IS-8I (EACH ACCIDENT)
AND
EMPLOYERS' LIABILITY $ (DISEASE-POLICY LIMIT)
$ ,. ([)IS~ASE~ACH EMPLOYEE)
OTHER I
I
I
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DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
City of Clearwater
P. O. Box 4748
Clearwater, Fl. 33518