INSURANCE CERTIFICATE (2)
COMPANIES AFFORDING COVERAGES
COMPANY A
LETTER Qualified Self Insurer
COMPANY B
LETTER Ambassador Insurance Company
COMPANY C RECE1V~D
LETTER
COMPANY 0
LE TTER V '1 1983
COMPANY E
LETTER
ARTHUR J. GALLAGHER & CO.
8355 N.W. 53RD ST. SUITE 215
MIAMI, FLORIDA 33166
TEL. NO. (305) 592-6080
NAME AND ADDRESS OF INSURED
School Board of Pinellas County
1960 E. Druid Road
Clearwater, FL 33518
This is to certify that policies of insurance listed below have been issued to the insured named above and are In force at this ti N tw hst i e rent. 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.
TYPF OF INSURANCF
GENERAL LIABILITY
A
[Jd COMPREHENSIVE FORM
GO PREMISES,-Of'ERATIONS
D EXPLOSION AND COllAPSE
HAZARD
D UNDERGROUND HAZARD
r:-J PRODUCTS/COMPLETED
L)Q OPERATIONS HAZARD
[}(J CONTRACTUAL INSURANCE
D BROAD FORM PROPERTY
DAMAGE
D INDEPENDENT CONTRA.cTORS
a PERSONAL INJURY
AUTOMOBILE LIABILITY
I D COMPREHENSIVE FOfiM
D OWNFD
o HillED
D NON,OWNED
EXCESS LIABILITY
B
D UMBRELLA FORM
Ga OTHER THAN UMBRELLA
FORM I FOLLOW FORM'
WORKERS' COMPENSATION
and
EMPLOYERS'L1ABILlTY
OTHER
POLICY NUMBER
PCLi(,Y
FXPIRAT'UN DAn
Limits of Liability in Thousands (000)
EACH
OCCURRENCE
S(JL:'ILY INJURY
Self Insurer as per State
of Florida Statue 768.28
7/1/84
PHOPERTY DAMAGE $
SEE BE OW
J~(Cltrr~ID)
BODILY IN.JUfiY AND
PROPERTY DAMAGE
COMBINED
I'I'H::ONAL INJURY
School Boare' ",
RlSi' il/,el,
---r
I
I 00CI, Y InJURY
(EACh ACCIDENT)
~;P;~;~DAMAGE
$
INJURY
PERSON)
,:lty
,I"
[,t:>_.t'-:tF\i,~ ,_
1)(lDII,Y INJUfW AND
,'liOPFRTY DAMAGE
COMBINED
BODILY INJURY AND
ELP 001602
PROPERTY DAMAGE
COMBINED
7/1/84
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
* LIMITS: $100,000 each person - Including SIR
$200,000 each occurrence - Including SIR
City of Clearwater, Fl. as additional insured solely
I
Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER'
DATE ISSUED:
September 16, 1983 sd
, City of Clearwater, Florida
112 Osceola Avenue
Clearwater, FL 33518
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