CERTIFICATE OF INSURANCE (3)
AIM Insurance AgencYI Inc.
P.O. Box 4985
CI earwater I Flori da 33518
COMPANIES AFFORDING COVERAGES
COMPANY A
~<:TTrI' Fireman's Fund Insurance Company
Borney GoogI es Goodtime Emporium
Decade Corporation d/b/a
519 Cleveland Street'
CI earwoter, Flarida 33516
C':'MP:'N.. B '~
LErT EP
CC""PA NY C .
l! TT[~ ~~
CG~~P~NY D .I
LHTfIl
C()f,IPANY E
LETTER
l'tAME ,l,NO .DNI!!>S Of INSURED
This is to certIfy th.lt policies o~ Insur.ince liste,-~ ~e'''w have befon issue" to the Insured named .)bove and are 1:1 tr;rCE: 3! this t'me
~PE OF INSURANCE
POlIe' NU"'BEIl
I PUder
OPIIl'>',;C" OAT[
----r-
! 9/15/79
Limits of liability in Tt:I)U5and~ (00(:)
t !..:..c~'
! ,X':I..;?~~..:r
A
" GENERAL LIABILITY
~ C,-"lt,'~'o:rr1(NSIVE ro~
o ~EM\~rS-oPERArIO!'fS
o E,'PI.:SlOh ~ND CCLLAPSE
O HA~'AD"
ll"DERGROlISD HAZARD
U ""00UCiS.COMPlfTEO
OPERATh)fIIS HAZARD
o CCNTP.>CTU~ I!'<SURANCE
o SP.QAD r:)1m PROPEFrrV
DAMAGE ..
o INDEP!N~ENT'C~!'<T~TORS
, 0 PERS(I"~' lN~""c ~, . '
!lOOIL v iNJUPY
1
I'
I
I S
.1
Is.
500
100
I
!' 500
I
i I 100
I
MXP3047015
PROPElll', U"'M~G[
80DIL Y .NJUF.'!' .>.Nn
PROFHITY DAM~CE
cOMelNro
'-
i'ER>C"...... I/OU;:>f,
~UTOMOBlLE L1A_BILJTY
o COW'''EHE''SIV~ F~R~
o o'.veEC '
o HIAW -
o NON~..:>_ .-~,k~i .j,
BOOILf .N JURY
,uc... PE..~C~.,
90DIL Y llIo;UP'r
IE'>'Cft OCCU'1RE:-.o:El
. ~ " ..':
..: .,..! .:........~~;...t .;~...:
F~Pl..r~ DAM....(
BOOII. Y INJURY ......u
PROPERTY DAM"'Gt
COW&l"'ED
.1 EXCESS UABI~, _ ._'
.. I 0 \!Met!fUA FORM " .'-
.10 (lTHElI THA~~B~~>,'
. FOAM ..' ,
" IWORKERS' COMPENSATION
I
" and
1 . EMPLOYERS'lIABILITY.
OTHER
BODILY 'N.nJIl'f ~"O
"
;...
PROPER rv DA'~"GE
COMBINED
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......
C'f SClliF'TiON ,,; 01'<:""; IC N~LOC"; 10..::;, 'VEHICLES
Cancellation: ~:-;~u:d any of the above des1-r1bed pOlicies be .:an::e~;eo ::'Oi~rp t:-.e Exp;ration date tnereot. the iSSl.:Ir.6 cc.rr:.
pany will endei:1vor to mail --Y-. days written notIce to tne belo.... named certificate hoide!. t.ut f"i:,"re t::
mail.suchnotlce shall imocse no obligation or liability of any kind upon tne com;Jany.
"'-.._-
I NAM( AND LCt'flfSS ~CEIlTIfIC"T[ ...."'U:EP.
I
i
I
I
City of CI earwoter
Clearwater, Flori~ 33518