CERTIFICATE OF INSURANCE (080)
3/13/86
THIS CERTIFICAt~ SSUED AS A MATTER .oF INFORMATI.oN .oNLY AND C.oNFERS
IN~~I~UP.oN'T~ CERTIFICATE H.oLDER. THIS CERTIFICATE D.oES N.oT AMEND,
jElf4E~C9{!7 Aq~R,T~E C.oVERAGE AFF.oRDED BY THE P.oLICIES BEL.oW.
ROGER BOUCHARD INSURANCE,
301 SO. MISSOURI AVE, BOX
CLEARWATER, FL 33518
INSURED
9~dlr on~~~w-;-COMPANIES AFFORDING COVERAGE
[1111'L ,.,.'" ~~---J
LETTER MASSACHUSETTSBAV INS. CO.
COMPANY B
LETTER
COMPANY C
LETTER
HEUER UTILITY CONTRACTORS IHe
12405 44TH STREET N
CLEARWATWER
33520
. .
COMPANY D
LETTER
THIS ,IS T.o CERTIFY THAT P.oLlCIES .oF INSURANCE LISTED, E1EL(:)W_HA VE E1EENJSf;.uED T.o II'lE INSURED NAMED ABOVE FOR THE P.oLICY PERI.oDINDICA TED.
N.oTWlTflSnNDINGANYlIEOUIREMeNT;TERMOFt CONDITi.oN .oF ANY C.oNTRACT .oR .oTHER DOCUMENT WITH RESPECT T.o WHICH THIS CERTIFICATE MAY
BE ISSUED .oR MAY PERTAIN, THE INSURANCE AFF.oRDED BY THE P.oLICIES DESCRIBED HEREIN IS SUBJECT T.o ALL THE TERMS, EXCLUSI.oNS, AND C.oNDI.
TI.oNS .oF SUCHP.oLlCIES.
TYPE OF INSURANCE
-GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED' OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
AUT.oM.oBILE LIABILITY
X ANY AUTO
X ALL OWNED AUTOS (PRIV, PASS)
X ALL OWNED AUTOS (~~~~Rpl~~N)
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
W.oRKERS' C.oMPENSATl.oN
AND
EMPL.oYERS' LIABILITY
.oTHER
POLICY NUMBER
POL1CY EffECTIVE
DATE (MMloolYY)
POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
DATE (MM/oolYY) EACH
OCCURRENCE
BODILY
1/01/87 INJURY $ $
PROPERTY
DAMAGE $ $
BI & PD $ $
COMBINED
500t
PERSONAL INJURY $ 500,
BODILY
1/01/87 INJURY $
(pER PERSON)
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED :$,000,
1/01/87
G2314~~ C ta \
1/01/86
24 \9J~Jo
~
BA516531
1/01/86
U067S288
1/01/86
830-3771
$100, (EACH ACCIDENT)
$ 01' (DISEASE-POLICY LIMIT)
$100, (DISEASE-EACH EMPLOYEE
1/01/86
1/01/87
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
GENERAL LIABILITY PROPERTY I~ SUBJECT TO Sl~OOO. DEDUCTIBLE PER CLAIM.
CI TV OF CLEARWATER ENG. IsEPT.
P.O. Box 4748
C learwa te,-, F l 33519