CERTIFICATE OF INSURANCE (02)
I
RECEIVED .
o NATlor~L INDEMNITY COMPANY
o NATION;G.L FIRE & MARINE INSURANCE COMPANY
o COLUMBIA INSURANCE COMPANY
MAY 9 1985 ~ATIONAL INDEMNITY COMPANY OF FLORIDA
3024 Harney Street Omaha, Nebraska 68131-3580
CERTIFICATE OF INSURANCE
This certificate of insurance is NOT an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwith.
standing any requirement, term or condition of any contract oeJ:li1Yoc~espect 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.
Date
11/19/84
NAME OF INSURED
P.O. ADDRESS
Airport Express, Inc.
P.O. Box 2113, Largo, FL 34294
POLICY NUMBER KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES
GENERAL LIABILITY
0 Comprehensive Bodily Injury:
0 Premises-Operation Each Occurrence . . . . - . . .$
0 Explosion and Collapse Aggregate - . . . . . . . . . . .$
Hazard Property Damage
0 Underground Hazard Each Occurrence . . . . . . . .$
0 Products/Completed Aggregate ............$
Operations Hazard Bodily Injury and Property Damage
0 Contractual Insurance Combined Single Limit
0 Broad Form Property Each Occurrence . . . . .$
Damage Aggregate a . . . . ...... .S-
0 Owners or Contractors
Protective
=:I Personal Injury
Automobile Liability: ~
Bodily Injury . . . . . - . .Each Person . . . . . . . -. .. .$
Each Occurrence . . . . . . . .. .$
7BP 10 34 85 Property Damage . . . . . .Each Occurrence . . . . . . . . . .$
Bodily Injury and Property Damage Combined Single Limit .$300.000.00 11/19/84 11/19/85
Excess Liability: o Automobile o General Liability
Name of Primary Insurer:
Primary Limits: $
Excess Limits: $
Workmen's Compensation $ Statutory Limits
Employer's Liability $
Other
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES
1983 Chevy S/W#2GIAW35H601259813
1981 Chevy S/W1t1G1AL35J7BJ166066
In the event of any material change in or cancellation of said policies, the COMPANY intends to notify the party to whom this Certificate is addressed of such
change or cancellation, but undertakes no responsibility by reason of any failure to do so.
This Certificate issued to
Shell~'~~O~:J,e"~,
Title Roger T. Gobler/cb 2/7 /85
NOTE TO AGENT - Mail Copy to Home Office Immediately.
By
Tnr:
City of Clearwater
P.O. Box 4748
Clearwater. FL 33518
M-l DOg (2/82)
AMENDED
CERTIFICATE OF IN~UJANCE
AMENDED
o NATIONAL INDEMNITY COMPANY
o NATIONAL FIRE & MARINE INSURANCE COMPANY
o COlUM~AINSURANCECOMPANY
XX NATIO l INDEMNITY COMPANY OF FlORIOA
o NATION l INDEMNITY COMPANY OF MINNESOTA
3024 Harney Street Omaha, Nebraska 68131-3580
This certificate of insurance is NOT an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwith.
standing 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 conditions of such policies.
Date 3/5/85
NAME OF INSURED
P.O. AODRESS
Airport Express, Inc.
P.O. Box 2113, Largo, FL 34294
POLICY NUMBER KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES
GENERAL LIABILITY
0 Comprehensive Bodily Injury:
0 Premises-Operation Each Occurrence . . - . . . - .$
0 Explosion and Collapse Aggregate . .. ... . . . .. .$
Hazard Property Damage
0 Underground Hazard Each Occurrence . _ . . . . . .$
0 Products/Completed Aggregate . . . " - . .. . _.$
Operations Hazard Bodily Injury and Property Damage
0 Contractual Insurance Combined Single Limit
0 Broad Form Property Each Occurrence . . . . . . . .$
Damage Aggregate . .. -., . .. .. .$
0 Owners or Contractors
Protective
0 Personal Injury
Automobile Liability:
Bodily Injury . . . . . . . .Each Person. . . . . . _ . . . . . .$
7BP 10 34 85 Each Occurrence . . . . . . . . . .$
Property Damage _ . . . . .Each Occurrence . . . . . . . . . .$
Bodily Injury and Property Damage Combined Single Limit .$ 300 .000 .00 11/19/84 11/19/8
Excess Liability: o Automobile o General liability
Name of Primary Insurer:
Primary Limits: $
Excess Limits: $
Workmen's Compensation RECEl VED $ Statutory Limits
Employer's Liability $
Other
APR 2 1~?r;
5
DESCRIPTION OF OPERATIONS/lOCATlONS/VEHICLES
1983 Chevy S/W #2GIAW35H601259813
1977 Buick Estate Wagon #4R35R7X173133
CITY C:LLRK
In the event of any material change in or cancellation of said policies. the COMPANY intends to notify the party to whom this Certificate is addressed of such
change or cancellation, but undertakes no responsibility by reason of any failure to do so.
This Certificate issued to:
i//YJyJl~
By Shelly, Middleb(O~ O'L~ary, Inc.
rrt~ Roger T. Gobler/cb
NOTE TO AGENT - Mail Copy to Home Office Immediately.
City of Clearwater
P.O. Box 4748
Clearwater, FL 33518
M-100g 121821
AMENDED
CERTIFICATE OF INsulANCE
MtENDED
o NATIONAL INOEMNITY COMPANY
o NATIOIL FIRE & MARINE INSURANCE COMPANY
o COLUM IA INSURANCE COMPANY
XXNATIO L INOEMNITY COMPANY OF FLORIOA
o NATIO L INOEMNITY COMPANY OF MINNESOTA
3024 Harney Street Omaha, Nebraska 68131-3580
- ,
This certificate of insurance is NOT an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwith-
standing 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 conditions of such policies.
Date 3/1/85
NAME OF INSURED
P.O. ADORESS
Airport Express, Inc.
P.u. Box ll13, Largo, fL 34194
POLICY NUMBER KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES
GENERAL LIABILITY
0 Comprehensiw Bodily Injury:
0 Premises-Operation Each Occurrence . . . .. . . .$
0 Explosion and Collapse Aggregate . . . . . . . . . . . .$
Hazard Property Damage
0 Underground Hazard Each Occurrence . . . . . . . .$
0 Products/Completed Aggregate .. . .. .. . . . . .$
Operations Hazard Bodily Injury and Property Damage
0 Contractual Insurance Combined Single Limit
0 Broad Form Property Each Occurrence . . . . . . . .$
Damage Aggregate . .. . . . . . . ...$
0 Owners or ContractoB
Protectiw
0 Personal Injury
Automobile Liability:
Bodily Injury . . . . . . . .Each Person. . . . . . . . . . . . .$
7BP 10 34 85 Each Occurrence . . . . . . . . . .$
Property Oamage . . . . . .Each ,Occurrence . . . . . . . . . .$
Bodily Injury and Property Damage Combined Single Limit .$ 300,000. 11/19/84 11/19/85
Excess Liability: o Automobile o General Liability
Name of Primary Insurer:
Primary Limits: $
Excess Limits: $
Workmen's Compensation $ Statutory. Limits
Employer's Liability 'P ~ ("'f 't:"T"1="n
Other
-
"OD C) 100t;
OESCRIPTION OF OPERATIONS/LOCATlONS/VEHICLES
1983 Chevy S/W #2G1AW35H601259813
CITY CLERK
In the event of any material change in or cancellation of said policies. the COMPANY intends to notify the party to whom this Certificate is addressed of such
change or cancellation, but undertakes no responsibility by reason of any failure to do so.
This Certificate issued to:
City of Clearwater
P.O. Box 4748
Clearwater, FL 33518
M-100g (2/82)
/ By Shelly, Middlt!!i; &
Title Roger 1. liobler/cb
NOTE TO AGENT - Mail Copy to Home Office Immediately.
,
I ' .
, _' l _ .
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD6R.
THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDEDiY THE POLICIES LISTED BELOW.
NAME AND ADDRESS OF AGENCY I
' COMPANIES AFFO ING COVERAGES
-
Dikman Insurance AGency, Inc.
9071 Park Blvd.
SEminole, Fl. 33543
COMPANY
LETTER
A
B
C
o
E
COMPANY
LETTER
National
Indemnit Ins. Co.
NAME ANO AODRESS OF INSURED
COMPANY
LETTER
Airport Express,Inc.
P.O. Box 2113
Largo, Fl. 34294
COMPANY
LETTER
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement. term or condition
of any contract or other document with respect to which this certificate may be issued or may pertam. the msurance afforded by the policies deSCribed herem IS subject to all the
terms. exclusions and conditions of such policies,
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POt.ICY
EXPIRATION OATE
EACH
OCCURRENCE
AGGREGATE
GENERAL LIABILITY
BODILV INJURY
,
,
COMPREHENSIVE FORM
PREMlses- OPERATIONS
EXPLOSION AND COLLI..P$E
HAZARD
UNDERGROUND HAZARD
PROOUCTS;COMPLETED
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
PROPERTY DAMAGE
,
,
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
s
s
PERSONAL INJURY
PERSONAL INJURY
s
NON.()WNED
Binder/To Be Assigned
11- 19-85
BODIL Y INJURY S
lEACH PERSON)
BODIL Y INJURY ,
lEACH OCCURRENCE'
PROPERTY DAMAGE S
BODll Y INJURY AND , 300,
PROPERTY DAMAGE
COMBINED
AUTOMOBILE LIABILITY
COMPREHENSIVE FORM
OWNED
A
HIRED
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
,
WORKER'S COMPENSATION
and
EMPLOYER'S LIABILITY
OTHER
lEACH ACCIDE..'"
ESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES
Limo Service
1981 Chev. Impala SW
1983 Chev Caprice Classic SW
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail 1 n 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 CERYl FICATE HOLDER
City of Clearwater
Occupational License Dept.
Clearwater, Fl.
DATE ISSUED Nnvpmhpyo 1 q, 1 qR4
(~~
AUTHOy REPRES_TATlVE