CERTIFICATE OF INSURANCE (114)
9/18/87
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.
ROGER BOUCHARD INSURANCE, INC.
301 SO. MISSOURI AVE, BOX 6090
CLEARWATER,. FL 33518
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY A
LETTER MASSACHUSETTS BAY INS. CO
COMPANY B
LETTER SOU"TH ATLANTIC COUNCIL
COMPANY C
LETTER
Ut i l i ty Contn!c1'ors Inc
12405 44th Street N
Clean..ate,-
COMPANY D
LETTER
SEi)i 2 I
~33520
COMPANY E
LETTER
. ,
THIS IS TO CERTIFY THAT 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 CONDI.
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
POLICY NUMBER OA TE (MM/OOIYY) DATE (MM/DDIYY) EACH
OCCURRENCE
BODILY
COMPREHENSIVE FORM 92314594 1/01/87 1/01/88 INJURY $ $
PREMISES/OPERATIONS PROPERTY
UNDERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL BI & PO $ $
COMBINED
INDEPENDENT CONTRACTORS 500t
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY $ 5001
AUTOMOBILE LIABILITY BODilY
INJURY $
ANY AUTO ADJ2750B14 1/01/87 1/01/8B (PER PERSON)
ALL OWNED AUTOS (PRIV PASS.) BODilY
ALL OWNED AUTOS (OTHER THAN) INJURY $
PRIV PASS, (PER ACCIDENT)
HIRED AUTOS PROPERTY
NON-OWNED AUTOS DAMAGE $
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BI & PO
...
...
$
STATUTORY
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
UNrsER I<I NDER
9/21./87
9/21/88
$1 00,. (EACH ACCIDENT)
$500 ~ (DISEASE-POLICY LIMIT)
$1 00 ~ (DISEASE, EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS
LIABILITY PROPERTY IIAHAGE SUBJECT TO $1,.000. DEDUCTIBLE PER CLAIM.
CITY OF CLEARWATER ENG. DEPT.
P. O. Bt\x 4748
Clearwater,. Fl 33518