CERTIFICATE OF INSURANCE
Altamura Marsh & Assoc
P.O. Box 6980
fZj s I~ g
DA T1! tllMlDO/YYl
12/23/97
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
Clearwater, FL 33758-6980
INSURED
COMPANY
A AMERICAN STATES INS CO
GOLDEN COUGAR BAND
BOOSTERS INC
POBOX 14923
CLEARWATER, FL 33766
COMPANY
B
COMPANY
C
,
I
co !
LTR I
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, 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 CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I I I '
! POlICY NUIoI8ER I POLICY EFFECTIVE POLICY EXPIRATION '
I ~ DATE IIlMlDDM1 1 DATE (MM/DDIYY)
I
I
I
!
TYPE OF INSURANCE
UMITS
01-CL-407938-3
08/15/97 08/15/98
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
I GENERAL lIABIUTY
!'Xl COMMERCIAL GENERAL LIABILI'TY '
A ~~~:S:~C~S:~~R
r---1
i GENERAL AGGREGATE
PRODUCTS-COMP~PAGG
'----'
I AlITOMOBILE UABIIJTY
, I Aiof'( AUTO
I , AlL OWNED AUTOS
LJ SCHEDULED AUTOS
W HIRED AUTOS
W NON-OWNED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
! (Per person)
$
ANY AUTO
i BODILY INJURY
I (Per accident)
!
I PROPERTY DAMAGE
i AUTO ONLY - EA ACCIDENT
I OTHER THAN AUTO ONLY:
........................... M
.....m. .........................w._..__._._...._.....
...._m_._.__.._....._....._..._...._..........
_...._..w_w_w......_.........................
.._mn_. m...mm.__....___..__._._............
..mm.............._m_..._..._..._.........H.......
.....m...........m...._...._....._......_.....~.
................._....._................~
....... -. ....._..._-....~............
~
: GARAGE UABIUTY
EACH ACCIDENT I $
I AGGREGATE I $
I EACH OCCURRENCE I $
i AGGREGATE I $
, EXCESS LIA8lUTY
, ' UMBRELLA FORM
'----'
THE PROPRIETOR!
PARTNERSlEXECUTIVE
OFFICERS ARE:
OTHER
c--,
IINCL
EXCL:
1$
1$
i$
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPI.OYERS'lIABIUTY
DESCRIPTION OF OPERATIONSlLOCATlONSIVEHICLESICIAL ITEMS
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED.
RE: PHILLIES PARKING
CITY OF CLEARWATER
RISK MANAGEMENT DEPT.
P.O. BOX 4748
CLEARWATER, FL 34618
SHOULD ANt OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOllCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATlOH OR LIA8lUTY
COMPANY, ITS AGENTS OR REPRESENTATIVES.