CERTIFICATE OF INSURANCE (096)
TH" e""'''AH " ",,,J ~~~~!~~'~~~A~O~ !,~ ~~ ~O~'~:~GHT' U.O, TH' """'CAT< HO'''.
THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLlCI ES LISTED BELOW,
JOSEPH u.
601 SWANN
TAMPA, FL
MOORE,
AVE
INC.
COMPANIES AFFORDING COVERAGES
33606
COMPANY A
LETTER
COMPAf\;Y B
LETTER
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
KLOOTE CONSTRUCTION ~
ENGINEERING CORP
POBOX 23422
TAMPA FL
33623
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. rerm 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 TYPE OF INSURANCE POLICY NUMBER
LETTER
COMPREHENSIVE FORM HG864H35823
PREMISES-OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PERSONAL INJURY
COMPREHENSIVE FORM MG43483582:~
NON-<lWNED
MG294835825
WORKER'S COMPENSATION
'.C .na 7645
EMPLOYER'S LIABILITY
OTHER
POLICY EACH
EXPIRATION DATE OCCURRENCE AGGREGAT
BODILY INJURY
07/01/87 500, 500,
PROPERTy DAMAGE $ $
2::;0, 250,
BODIL Y INJURY AND
PROPERTY DAMAGE $ ,
COMBINED
PERSONAL INJURY
$
07/01/87
BODILY INJURY
(EACH PERSONI
BODILY INJURY
(EACH OCCURRENCEI
250
$ ~OO
PROPERTY DAMAGE $
BOD I L Y INJURY AND
PRDPERTY DAMAGE
COMBINED
07/01/87
BODI L Y INJURY AND
PROPERTY DAMAGE
COMBINED
01/0-1787-
lEACH ACCID NTI
ESCRIPTION OF OPERATlONS/LOCATlONSIVEHICLES
GULF TO BAY BLVD @ PARK PLACE (84-29) JOB +163
Cancellation: Should any of the above described policies be cancelled before the expiration da
pany will endeavor to mail :J() days written notice to the below named cer
mail such notice shall impose no obligation or liability of any kind upon the company.
""/
;:/~l.,_......
NAME AND ADDRESS OF CERTIFICATE HOLDER
DATE ISSUED,
CITY OF CLEARWATER
POBOX 4748
CLEARWATER FL