CERTIFICATE OF INSURANCE (134)
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THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
JOSEPH U.
Cj',}1. ;;W~':jNI---!
TAMF'(1 f FL
rl00RE!
AlTIE
INC.
COMPANIES AFFORDING COVERAGES
COMPANY
LETTER
A
B
C
o
E
MICHIGf~N MUTUtiL.
i~li'1Ef';; I SURE
33606
COMPANY
LETTER
( tsl ~5 ) :~~!.:; 1 -.. ~~ t.:r 9 9
NAME AND ADDRESS OF INSURED
KLOOTE CONSTRUCTION &
ENGINEEF:ING C:DFW
F' [I BOX 23422
T ~1~1F'(1 FL.
COMPANY
LETTER
FeCI
COMPANY
LETTER
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,,-~....')O~,,-t
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
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
limits 0
AGGREGATE
COMPREHENSIVE FORM
MGCPP02755:::;B
BODILY IN.::JRY
,
(>?/()1./88
PREMISES-OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETEO
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
OAMAGE
INDEPENDENT CONTRACTORS
PRDPERT Y DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
,
~50()
J. i.) t} 1.)
PERSONAL INJURY
PERSONAL INJURY
,
INCi...
COMPREHENSIVE FORM
MG43'l835822
():? ./() 1,/88
BODILY INJURY , :~.:5()
lEACH PERSONI !.:500
BODIL Y INJURY ,
lEACH OCCURRENCEI
PROPERTY DAMAG E 1.00
BOOILY INJURY AND ,
PROPERTY DAMAGE
COMBINED
x
X
HIRED
NON.QWNED
EXCESS LIABILITY
"f.)
.\..1
X UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
MGGL.O;~70549
07/01./88
BODll.V INJURY AND
PROPERTY DAMAGE
COMB INfO
WORKER'S COMPENSATION
c
Ind
EMPLOYER'S LIABILITY
OTHER
7645
1.00
ESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES
Cancellation:
Should any of the above descr~,d policies be cancelled before the expiration date thereof, the issuing com.
pany will endeavor to mail ,-,0 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 FICATE HOLDER
" ? /"1 OJ-'S;J
CITY OF CL.EARWATER
()JLP.
PuG" BOX 4748
CI...E~:i!~:~,!i~1 TEI=<.J FL
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