CERTIFICATE OF INSURANCE (011)
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CITY OFILEARWATER
INIER-OFFICE COMMUNICA liON
I
DATE
'!t/'J.
.
, 19-8....4..
TO riry rlp.rk's Office
FROM Engineering Dept.
SUBJECT Attachment (Intp.rh~y Marine)
This original Certificate of Insurance
came to us.
I have made a copy of this for our files.
Thanks.
Claire Garman
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[] PLEASE REPLY ON REVERSE SIDE
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JOSEPH U.
601 SWANN
TAMPA, FL
MOORE,
AVE
33606
INTER-BAY MARINE
CONSTRUCTION CO
7950 118TH AV N
LARGO FL
INC.
COMPANY A
lETTER
COMPANY B
lEDER
COMPANY C
lETTER
COMPANY 0
lEDER
33543 COMPANY E
lETTER
CO OF N AMERlCA
2 ..
CITY CLER
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 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.
A
TYPE OF INSURANCE
GENERAL LIABILITY
rn COMPREHEN~VEFORM
~ PREMISES-OPERATIONS
~ EXPLOSION AND
COllAPSE HAZARD
~ UNDERGROUND HAZARD
~ PRODUCTS/COM PlET E D
OPERATIONS HAZARD
~ CONTRACTUAL INSURANCE
~ BROAD FORM PROPERTY
DAMAGE
~ INDEP, CONTRACTORS
[]1 PERSONAL INJURY
AUTOMOBILE LIABILITY
[]1 COMPREHENSIVE FORM
~ OWNED
[]l HIRED
~ NON.OWNED
EXCESS LIABILITY
[]1 UMBREllA FORM
0 OTHER THAN UMBREllA
FORM
POLICY NUMBER
POLICY
EXPIRATION DATE
LIMITS OF LIABILITY IN THOUSANDS (0001
EACH
OCCURRENCE
B
C
WORKERS' COMPENSATION
and
EMPLOYERS'lIABILiTY
OTHER
,~GGfIEGAF
BODilY INJURY $
MFCD06900550
0:VOl./35
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
PERSONAL INJURY
$
BAP036194158
03/01/
BODilY INJURY
(EACH PERSON)
5
BODilY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE $
BODilY INJURY AND
PROPERTY DAMAGE
COMBINED
UM13405FL
BODilY INJURY AND
03/01/ 5 PROPERTY DAMAGE
COMBINED
*MARINE PROTECTION & INDEMNITY EXCLUDING CREW:LIMIT $500,000
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the iSSUing compar',ywill
endeavor to mail 30 days written notice to the below named certificate holder, but failure to mail such notice sM11 im-
pose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER
CITY OF CLEARWATER
10 S MISSOURI AVE
CLEARWATER, FL
33516