CERTIFICATE OF INSURANCE (177)
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.
c.rlisle, Fields & Co.
P. O. BOX 191(1
Clemtater Fl 3%18-1910
~. ID KC
COMPANIES AFFORDING COVERAGE
Mike Baker Electric, bit".
11781 Walsir.gh_ Rd.
L;rrgo Fl MMO
ATTN: 8eor-ge' E. Baker, Jr.
COMPANY A
LETTER !llERS INSURllfa CO.
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED.
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 CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTiVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
OATE (MMIOOIY't) OATE (MM/ODIYY) EACH
OCCURRENCE
BODILY
J/151~ JJl~/'" INJURY $
I I I I PROPERTY
I I DAMAGE $
I I
I I I I
I I I I BI & PD $ $
COMBINED
I I I I
I I I I
I I I I PERSONAL INJURY $
BODILY
INJURY $
J/151~ JJl~/'" iPER PERSON)
I I I I 6001L'(
!NJU"'(
I I I I iPER ACCluENT] $
I I I I PROPERTY
I DAMAGE $ .,
I I I
I I I I BI & PD
COMBINED $
~~t~~ED $
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTs/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
87-t61!~'
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS,)
ALL OWNED AUTOS (OTHER THAN)
PRIV. PASS,
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
850!1!-2OeJl!3'!
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
e6O-5984
~3/(11~
I
+-..LL---'--1
I I
_____,_1 ~ ~ I:
$
$
$
(EACH ACCIDENT)
(DISEASE,POLlCY LIMIT)
(DISEASE,EACH EMPLOYE )
OTHER
I I
I I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CITY fF CLEARWATER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1(1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, etn:,FAILURE TOcMAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF A~ KIND UPON T~E CO"wANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZEr), REPRESENT A TIV 0
( ;' ,
!
P.D. BOX ~748
ClEARtMTER Fl 33518-