CERTIFICATE OF INSURANCE/CROSS ENVIRONMENTAL SERVICES FOR OLD MAAS BROTHERS STORE
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RECEIVED
APR 2 6 1994
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CITY CLERK DEPT.
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CROSS ENVIRONMENTAL SERVlCES,INC.
eNVIRONMENTAL CONTRACTORS
April 21, 1994
City of Clearwater
P.O. Box 4748
Clearwater, Florida 34618
RE: OLD MAAS BROTHERS STORE
To Whom It May Concern:
Enclosed please find a copy of the Original Certificate of
Insurance Ior the above re~erenced project.
If you need any further assistance, please do not hesitate
to call.
Sincerely,
e~SfoLw)"---
Erin S. Brown
Enclosure
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APR 25 1994 ~,
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MGT.
P.O, Box 229. Crystal SprlngsJL 33524 . (813)783-1688.
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A1~..I~I..
PRODUCER
INQUIRES: 813-796-6666
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER, THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW,
AMERICAN IlJSINESS lliSURI\NCE
SOJl'HE1\ST, INC.
P.O.,BJX 31666
~A, FLORIDA 33631-3666
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COMPANIES AFFORDIN.G COVERAGE
COMPANY A
LETTEA Planet Insurance Carpany
INSURED
COMPANY B
LETTER
Aut~rs Insurance Carpany
Cross Enviromnental Services, Inc.
P.O. Box 229
Crystal Springs, Florida 33524
Project NaJred: OLD MAlIS BROI'HEllS Sl'QRE
Contiact Cost: $209,200.00
COMPANY C
LETTER
Florida Ehployers Safety Assoc. S.I.F.
~~~~~NY D
COMPANY E
lETTER.
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH AESPECT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDDIYYJ : DATE (MMJDD/YY)
LIMITS
: GENERAL LIABILITY
A X COMMERCI~L GENERAL LIABILITY:
_.~ T"-''''~CLAIMs MADe: x-'.'OCCUR.
...,...,____ L.","""...
, ; OWNER'S & CONTRACTOR'S PROTo
i ! .
,xAsbestos Liability
_, ...J _..........___."._".__""""_".._"._._,._..__,."~ m......____, :
GENERAL AGGREGATE ! $
N:;I 010137202
12/3/93
12/3/94
PRODU-cT-S~COMPf6p"AGG~ : $ '1 ~'obo~' 000: ..
! PERSONAL & ADY. INJURY .,,~.~_"1; OOO~ 000..
('EAC'H O?~~"~_~.ENCE--_n. .J.~..._l._~..~OO, OOO~-
i FIRE DAMAGE (Anyone lire) i $ 50, 000..
"'__'"'''''''' ..... ..""..... " _1
j MEO. EXPENSE (Anyone person): S 5 , 000..
! AUTOMOBILE LIABILITY
i' '''X ,ANY AUTO
B '':'':--''-jALL O~NED AUTOS
C,
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
515-00346
COMBINED SINGLE . 1,000,000.
LIMIT
BODILY INJURY .
(Per person)
11/1/93 11/ 1/94 , BOOIL Y INJURY
: (Per eccldent) .
, PROPERTY DAMAGE .
, EACH OCCURRENCE .
AGGREGATE ;$
i STATUTORY LIMITS
4/1/94 4/1/95 : EACH ACCIDENT .1,000,000.
" ~. OJSEAS'E~POLlCY--LIMiT"'''' .1,000,000.
,.. ..,. .. w..,.. m. , m" .1;000,000.
: DISEASE-EACH EMPLOYEE
iSCHEDULED AUTOS
"'X ..,AEDAUTOS
, . X : NON-OWNED AUTOS
GARAGE LIABILITY
20392765
EXCESS L1A8ILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
i OTHER
PROJECl' NO. 75
. 4/19/94
5/20/94
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
*THE .llG>REGA.TE LIMIT OF LIABll.ITY IS APPLICABLE'lU ALL OF '!HE NAMED llEURED'S SClIEDJLED
PRO:J}C]'S OORING THE POLICY PERIOD SHaiN ARNE. CITY OF CLlWlWATER AND Bll.'IMJRE OJNSTRUCl'IOO
a::MPANY, INC, ARE HEREBY ADDED lIS ADDITIONAL INSURED EXCEPT FOR WORKERS a:MPENSATIOO.
,,;.;:,;:.-,::..,
CANCELLA nON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
'; EXPI~lfN DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
j MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
.- j LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Bll.'lMJRE UlNSTRurIOO en., INC. .;1 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
1055 PCNCE DE LEDN BLVD. '....: AUT~D AE~AT~Yy-' ~
BELLE!\IR BE1\OI, FL 34616 .j c:::::::: / / ./?Cr?M-!'
*10 J:ll\.YS OOl'ICE OF CANCELIATIOO l\PPLIFS FORR:fl-PAYMENl'. . .PRJMIUII. ....
ACORD 25~sJi t9ofr:s~:ts:(~7m~!;!:~:S"~:\;i',::.:' ~;";.':'::;:,:;~!:.'~}-'~:' :-,;:~<, ~,', .~.' ~:,~,~'i "'7,:, :?'~. ..-~-,.': ',,7'r;.~~' ~.~,~:: :::".::' '::~:~~'-'''' ,~~ "l:'2/~~~'3~;;~..~,~':.:~r~':1tf:r~;,1~,:,,;:~~{f'; @ACORD'~ CORPORA 110N 1'990
CITY OF CLlWlWATER
P.O. OOX 4748
~, FLORIJ:ll\.