CERTIFICATE OF INSURANCE (178)
This is to certify that
I' CERTIFICATE OF INSURANCE
H STATE RM FIRE AND CASUALTY COMPANY, B,oomilton, Illinois
o STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
has in force for
Mike Baker Ele~t~;r. Tnr.
Name of Policyholder
Address of Policyhoider
location of operations
the following coverages for the periods and limits indicated below.
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
(eff./exp,)
LIMITS OF LIABILITY
pending
MComprehensive
General Liabi I ity
o Dual Limits for:
Each Occurrence $
Aggregate $
3/15/89-03/15/9
o Manufacturers' and
Contractors' Liability
o
Owners', Landlords' and
Tenants' Liability
The above insurance includes
(applicable if indicated by ~ )
Each Occurrence $
Aggregate" $
o PRODUCTS-COMPLETED OPERATIONS
o OWNERS' OR CONTRACTORS' PROTECTIVE LIABILITY
o CONTRACTUAL LIABILITY
o BROAD FORM PROPERTY DAMAGE
o BROAD FORM COMPREHENSIVE GENERAL LIABILITY
4tJ
BODILY INJURY
PROPERTY DAMAGE
B Combined Single Limit for: BODILY INJURY AND
PROPERTY DAMAGE
Each Occurrence
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Jeff./exp.) __
3/15/89-09/15 8
Aggregate $
C()NTRACTUi\L__LY~BI~ITY LIMITS
(If different than above)
pending
auto
~
o
o
Each Occurrence $
Each Occurrence $
Aggregate $
o Combined Single Limit for:
Each Occurrence $
Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Each Accident $
Disease,Each Employee $
Disease,Policy Limit $
EXCESS LIABILITY
o Umbrella
o Other
Workers Compensation
o and Employers
Liability
$ '----.5QO 000
000 000
BODILY INJURY
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
"Aggregate not applicable if Owners', Landlords' and Tenants' Liability Insurance excludes structural alterations, new construction or demolition,
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,
EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED
I I
~ity of Clearwater
PO Box 4748
Clearwater FL 33518
S'
agent
Title
(558)F6'994.9 Rev, 1.86 Printed in U.S,A.