CERTIFICATE OF INSURANCE (116)
ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
E CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
HE COVERAGE AFFORDED BY THE POLICIES BELOW.
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PANIES AFFORDING COVERAGE
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INSURED
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
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THIS IS TO CERTIFY THAT 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 CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE
POLICY NUMBER
POLICY EfFECTIVE
DATE (MMIDOIYY)
POLICY EXPIRATION
DATE (MM/DDIYY)
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
Uu/It
1IUIII
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AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS)
ALL OWNED AUTOS (OTHER THAN. )
PRIV. PASS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
a)lG01U7
1/U/11
1/U/D
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
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7
RECEIVE])
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
OTHER
JAN 28 )981
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/SPECIAL ITEMS
LIABILITY LIMITS IN THOUSANDS
OCCQ~~~NCE AGGREGATE
BODILY
INJURY
PROPERTY
DAMAGE
$
~~t~~ED $
$
PERSONAL INJURY
BODILY
INJURY $
(PER PERSON)
BODILY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PO
COMBINED $
BI & PO
COMBINED
STATUTORY
$
$
$
(EACH ACCIDENT)
(DISEASE,POLlCY LIMIT)
(DISEASE,EACH EMPLOYEE)
CITY OF CLEARWATER
Engineering Dept
POBox 4748
Clearwater, FL 33518
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,'!UT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE