INSURANCE CERTIFICATE (18)
,,~,.f~-
f
r51
(J5/1.12i~l-l
lIilS CUlTI11CATl
!HIS. tfRTUICI\H
.'
(~rtificate of Insuranc#.(,
IS IS~I)ID AS II MA1TlR 01 INfORMATIUN ONLY 1\1'10 CONHRS N~J'CHT!. UPON fH[ C(RTIf,I'ATf.
DOl ~ NOr M",(ND t xHNU OR A~ TER au covERACE AHOltoEO Ih HIE rO~ICI~~ llSHO l!(lO~
tiOlfllH
COaAPANIES ~fFOftOlf\lG COVERAGES
NAME ANO ADDRESS Of AGE~CV
EV!NSTON INSURANCE CO.
PINELLAS COUNTY FA~ BUREAU
13589 66TH ST N
LARGO FL 34641
NAME AND AODRESS of INSUI'lED
WAVERUNNERS OF WEST
3222 W. GROVE ST.
TAMl?A FL 33614
FLORIDA, INC.
---....--.----"~
TV~ Of INSURANCE
POLICY NUMBER
POLlf; y
(XPIRATlON DAl(
AG(,~[Gn(
BODll'/ ,"'JURY
GENERAL LIABILITY
o COMl'REHEN5IVE fORM
o PREMISES_OPERATIONS
O EXPL0510N AND COLLAPSE
HAZ.a.Rtl
o UNDERGflOUND HA~ARD
O PRODUCTSICOMPL(T(D
OPERATlO"'S HAZARD
o CONTRIICTI,JAL lNSuAANCE
O 6RO,I,O fORM PROPERTY
DAMAGE
o '~OEPE"'OENT CONTR...CTORS
D PERSONAL INJUR'(
PROPERTY OAMA(i( S
BOOll Y INJURY AND
pllOPERTY tlAM...Cl
COMalNED
PERSONAL INJURY
,
BODll Y INJURY
lEACH PERSON I
90DIl '(INJURY
(EACH ACCIDENT)
PROPEPTV OA"'Av(
I!ODI~ Y INJURY AND
pAOPEIHY O"''''I'.(;E
COMBINED /
~
AUTOMOBilE LIABILITY
o ,COMPFlEHEHSIVE FORM
DOWNED
o HIRt:D
o NON.QWNto
I
S
EXCESS LIABILITY
o UM!lFlEL~A ~ORM
o OTHER THANUM9RELLA
rORM
600lL Y INJURV AHD
PROPERn' DIlMAGE
COMBINED
S
WORKERS' COMPENSATION
'l'Id
EMPLOYERS' LIABILITY
OTHER
LIABILITY ONLY TBA
\HC~ACC1(l'l
4/29/95
LIMITS: 250/500/100
O(S(:RlPTIOH OF Of'(RATIONSIl-OCATIOIcSNEHICUS
EFFECTIVE 4/29/94
CERTIFICATE HOLDER IS LISTED AS ADDTIONAL INSURED.
Cancellation: Should any of the ;jlbov@ desC{ty@d policies be cancelled before the expiration date thereof. the issuirlg com-
pany will endeavor to mail _ d;jlYs written notice to the below ['lamed certificate holder, but failure to
mail such notice shall impose no obligation or liability of ;fJny kind upon tne company,
NAME AND IlDOAES5 OF CERTIFIC.a.TE HOLDER:
CITY OF CLEARWATER
25 CAUSEWAY BLVD.
CLEARWATER FL 34630
4/29/94 wk
D...n 155UED'
!t.;.kA-li P ILl/i)
...UTHORllED MPRESENT...Tl\IE