CERTIFICATE OF INSURANCE (197)
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CERTIFlCA'
Of INSURANCE
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ISSUE DATE (MM/DDIYY)
6/1/89
MICHAEL L. GREGORIUS (314) 241-7811
WELSCH, FLATNESS & LUTZ, INC.
P.O. BOX 57910
ST. LOUIS, MO. 63157
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
COMPANIES AFFORDING COVERAGE
CODE
f~~~NY A
SEE ATTACHED
SUB-CODE
INSURED MCCARTHY EASTERN CONSTRUCTION
MCCARTHY BROTHERS COMPANY
1341 NORTH ROCK HILL ROAD
P.O. BOX 20036, BRENTWOOD STATION
ST. LOUIS, MISSOURI 63144
COMPANY
f~~~NY B
f~T~~~NY C
f~T~~~NY D
f~T~~~NY E
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDDIYY) DATE (MM/DD/YY)
ALL LIMITS IN THOUSANDS
OCCUR.
GENERAL AGGREGATE $
PRODUCTS-COMP/OPS AGGREGATE $
PERSONAL & ADVERTISING INJURY $
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
Pi.
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
SEE ATTACHED
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
o HIRED AUTOS
NON-OWNED AUTOS
. GARAGE LIABILITY
OTHER THAN UMBRELLA FORM
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS
S-12
CERTIFICATE HOLDER
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FLORIDA 34618-4748
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL -:3B- DAYS WRITTE!\; NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ACORD25.~(3/88)
AUTHORIZED REPRESENTATIVE . /fl.. 00 0
DENNIS D. FLATNESS 'fJd!/;truv & cJ&;rJLM.O
@ACORDCORPORATION 1988
SCHEDULE OF WORKERS COMPENSATION POLICIES
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STATE POLICY # AND COMPANY EXPIRATION DATE EMWLOYERS LIABILITY LIMIT
- I
FLORIDA. VIRGINIA & WCl-351-462565019 6/1/90 EACH ACCIPENT $1,000.000
SOUTH CAROLINA LIBERTY MUTUAL DISEASE POLICY LIMIT $1.000,000
INSURANCE COMPANY DISEASE EACH EMPLOYEE $1,000,000
MISSOURI. GEORGIA & WCl-341-089875019 6/1/90 EACH ACGIDENT $1,000.000
KENTUCKY LIBERTY MUTUAL DISEASE fOLICY LIMIT $1,000,000
INSURANCE COMPANY DISEASE EACH EMPLOYEE $1,000,000
MICHIGAN, NEW JERSEY, WCl-341-089608019 6/1/90 EACH ACC.IDENT $1,000,000
NEW HAMPSHIRE. VERMONT, LIBERTY MUTUAL DISEASE ~OLICY LIMIT $1,000,000
CONNECTICUT. DISTRICT OF INSURANCE COMPANY DISEASE EACH EMPLOYEE $1,000.000 i
COLUMBIA .~
TEXAS 6EEUB424J4958 EACH AcckDENT
TRAVELERS INS. CO. 6/1/90 $ 500.000
DISEASE POLICY LIMIT $ 500.000
DISEASE~ACH EMPLOYEE $ 500,000
MASSACHUSETTS 6UB629J535289
TRAVELERS INS. CO. 4/1/90 EACH ACC~DENT $ 500,000
DISEASE POLICY LIMIT $ 500,000
DISEASE EACH EMPLOYEE $ 500.000
WISCONSIN 6UB370J925889
TRAVELERS INS. CO. 6/1/90 EACH ACCIDENT $1,000,000
DISEASE POLICY LIMIT $1,000,000
DISEASE~ACH EMPLOYEE $1,000,000
MINNESOTA 0310-00-099996 6/1/90 EACH ACCIDENT $1.000,000 ,-
WAUSAU DISEASE POLICY LIMIT $1,000,000
DISEASE EACH EMPLOYEE $1.000,000
MARYLAND 8-1352-6 CONTINUOUS UNTIL EACH ACqDENT $1,000,000
STATE FUND CANCELLED DISEASE POLICY LIMIT $1,000,000
DISEASE EACH EMPLOYEE $1,000.000
NORTH CAROLINA 094JC0915049880 6/1/90 EACH ACCIDENT $1,000.000
AETNA C & S DISEASE POLICY LIMIT $1,000,000
DISEASE EACH EMPLOYEE $1,000,000
I
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