CERTIFICATE OF INSURANCE (128)
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COLLIER COBB & ASSOC. OF THE
CARrn_INAS. INC. P.O. BOX 31817
CHARLOTTE, NC 28231
COMPANIES AFFORDING COVERAGE
BURNUP& SIMS COMTEC, INC.
c/o BURNUP & SIMS INC.
P.O. BOX :t5070
FT. LAUDERDALE. FL 33318
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETlER
COMPANY D
LETlER
COMPANY E
LETTER
NATIONAL. UNION FIRE INS. CO.
INSURANCE CO OF NORTH AMERICA
GENERAL REINSURANCE CORP.
. .
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING 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.
POliCY EfFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
TYPE OF INSURANCE POLICY NUMBER OATE IMM/OD/VYI OATE (MM/OO/YYI EACH
OCCURRENCE
GENERAL LIABILITY BODILY
A X COMPREHENSIVE FORM GLA5900308RA 5/0:1./8"7 5/01/88 INJURY $ $
X PREMISES/OPERATIONS PROPERTY
X UNDERGROUNO DAMAGE $ $
EXPLOSION & COLLAPSE HAZARO
X PROOUCTS/COMPLETEO OPERATIONS
X CONTRACTUAL BI&PD $ $
COMBINED
X INOEPENOENT CONTRACTORS 2000
X BROAO FORM PROPERTY OAMAGE
X PERSONAL INJURY PERSONAL INJURY $
AUTOMOBILE LIABILITY BODILY
ISA:I.789 5/01/87 5/0 :1./80 INJURY $
ANY AUTO (pER PERSON)
X ALL OWNED AUTOS (PRIV. PASS.) BODILY
X ALL OWNED AUTOS (OTHER THAN) INJURY $
. PRIV. PASS. (rER ACCIDENTI
X HIRED AUTOS PROPERTY
X NON.OWNED AUTOS DAMAGE $
GARAGE LIABILITY BI& PD
COMBINED $
EXCESS LIABILITY.
UMBRELLA FORM BI & PD $
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION $ O(~EACH ACCIOENT)
AND
*X6145 EJ/O:l./87 EV01/8a $50 DlSEASE.POLlCY LIMIT)
EMPLOYERS' LIABILITY $ 0{OISEASE.EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONS/LOCATlONS/VEHICLES/SPECIAL IlEMS
m::: *THE Cm~F' & ITS SUBSIDIAFUEG ARE OUALIFIED SEL.F-"INSUF~Er~S FOr~ THE FIF~ST
$200.000 EA OC Frn~ WC IN FL.GA,NC,SC,TN,MS ~ AL. ABUVE POLICY COVERS EXCESS
CITY OF CLEARWATER
LICENSE DEPARTMENT
CLEAF~W^TER, FL. 33516