CERTIFICATE OF INSURANCE (121)
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COMPANY
LETTER
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THIS CERTIFICATE IS ISSUEI~::~~~!~~I~~::A~O~ !N~Y~~ ~o~F~~I~IGHTS UPON THE CERTIFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BelOW. .
NAME AND ADORESS OF AGENCY
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COMPANIES AFFORDING COVERAGES
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COMPANY
LETTER
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NAME AND ADDRESS OF INSURED
LIBEF:TY rlUTUf.'iL.
INTER-BAY MARINE
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COMPANY
LETTER
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COMPANY
LETTER
LAF;:GO FL
33543
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement. term or con-
dition 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.
COMPANY
LETTER
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TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION OATE
GENERAL LIABILITY
BODILY INJURY
$
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COMPREHENSIVE FORM
MFCDO,f:.,900~S50
03/"C):t/Bt3
PREMISES-OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARO
PROOUCTS/COMPLETED
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PROPERTY DAMAGE
$
$
BOD 1 L Y INJURY AND
PROPERTY DAMAGE
COMBINED
$
$
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PERSONAL INJURY
PERSONAL INJURY
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and
EMPLOYER'S LIABILITY
OTHER
1351402984015
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BODIL Y INJURY
lEACH PERSON)
BODILY INJURY
lEACH OCCURRENCE)
$
$
AUTOMOBILE LIABILITY
COMPREHENSIVE FORM
OWNED
HIRED
PROPERTY DAMAGE
$
NON.oWNED
BOD I L Y INJURY AND
PROPERTY DAMAGE
COMBINED
$
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
,
WORKER'S COMPENSATION
H
tiriRINE F'
I
HU700013
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1..000
ESCRIPTION OF OPERATIONS/LOCATlONSIVEHICLES
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~() days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTI FICA TE HOLDER
CITY OF CLEARWATER
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