CERTIFICATE OF INSURANCE (025)
COMPANIES AFFORDING COVERAGES
INC.
ROGER BOUCHARD INSURANCE,
POBOX 6090
CLEARWATER, FLORIDA 33518
ACREE AIR CONDITIONING,
6209 ANDERSON ROAD
TAMPA FLORIDA 33614
NAME AND i\DDHESS OF INSlJRED
NORTHBROOK PROPERTY &
INC.
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I-,,)MF.'.~~Y B
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COMP~NY E
L[,HER
FLORIDA CONSTRUCTION, COMMERCE
INDUSTRY SELF INSURERS FUND
NORTHBROOK NATIONAL INSURANCE
U.
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FIRE INSURANCE COMPANY
FO~ THF,
This is to certify that policies of insurance listed below have been issued to the insured named above (lJ1d~EUfll~~ij! 1bl? iilllfi, Notwithstanding any requirement, term or condition
of any contract or other document with respect to which this certificate may be issued or may perAliJ{J'hA J.slrAn1~~ by the policies described herein is subject to all the
terms, exclusions and conditions of such policies,
BPP 015 4701
1'01 ley ,l__~i~!tsofLial:lil\tLirlJ_~~,u_~il..n~_~OOL_
','J"IRATION DATL I ! ,", I!I<"H ,,' I Acr;RF':,'l'
+---~E-R-1-O->>.,---+-- ________ .1-,:":-'I)I;I'c~Cf J--.----'---
I I I
- BODilY IN.lUF1Y -- 1--' ['$
'_, ___:~I,[ OF,~~';lJf~_~'~~___" 1__,____________:~r:F:',___
-GENERAL.-L-IABILlTY l '- - ,
A 00 COMPREHENSIVE FORM
00 pm:MISES ,OPERATIONS
D ,EXPLOSION AND COLL,'PSE
H AZA RD
D lINDmGROllND HAZARD
1.:1, PlmDUCTSiCOMPLETED
L,J.J OPERATIONS IIAZAHD
[iJ CONTHACTUAI INSURANCE
~. BI10AD FOHM PROPERT'!
LAJ DAMAGE
OOINDEf'ENDENT CONTRACTORS
[iJPEI1S0NAL INJUPY
AUTOMOBILE LIABILITY
B 00 COMPREHENSIVE FORM
DOWNED
00 HI f~ED
00 NON,OWNED
EXCESS LIABILITY
c 00 UMBHELLA FORM
D OTHm THAN UMBREl t.
FORM
D
WORKERS' COMPENSATION
and
EMPI:OYERSrLIABILITY
OTHER
DESCRIPTION OF OPERATIONS, LOCATIONS 'VEHICLES
06/18/84-
06/18/85
r-)f-~i: I r-' f PT '1' 1.I,A.rv1 ,t,,(; [
RECEIVED
OCT 5 1984
l30[ill_ y iN Il, q -i ,\'~ "
f-JH(i(--'I>r, :',(,NJ,(-,f-
,~I~lH:Nl-
,300,
$300,
CITY CLERK
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(30iJll_'y 'UI,H~'y
(F/\Cil f ~'~SUNJ
CA 015 4702
06/18/84-
06/18/85
f30DILY INJUHY
,~~~~CCIDENT), .1-
PROV'[ffl y [2.::~A(~~~~____L~~_______.______
BOIlIL Y INJURY ft,N" I 500
V-'fWPEPTY I)^Mt\,~;I= ~ f' ,
,.,.~,fJI~____+____
BODILY INlliHY fiND I; I
f,'F<OPFrn'y'D!.,M^(.::i[
529 0047 342
06/18/84-
06/18/85
COMf~INi:.[1
7-18-2031
Cancellation: Should any of tre above de~ed policies be cancelled before the explr,ItIClll date thereof, tll,e Issuing coni
pany wl!1 endeavor to mal~ days written notice to the below llilllH'cJ certificate holder, but failure te
mall such 110tlce shall Impose no obligation or liability of any kllld upon !rl(' ,,<wlpallY,
N~,M[ AND AD[)I,ESS OF eERTIFIC,\TE HOl flU?
CITY OF CLEARWATER
BUILDING DEPARTMENT
10 S MISSOURI AVE.
CLEARWATER FL 33516
ACORD 25 (10-82)
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