CERTIFICATE OF INSURANCE (191)
COLLIER COBB ~ ASSOC. OF THE
CAROLINAS~ INC. P.O. BOX 31817
CHARLOTTE~ NC 28231
704-376-9161
BURNUP ~ SIMS COMTEC~ INC.
C/O BURNUP & SIMS INC.
P. O. BOX 15070
FT. LAUDERDALE~ FLORIDA
33318
THl8IS-TO-CERTlFYntAT POUCII8 OF INaUMNCl-l.ISTEItllaOWcHAVlaHN ISSUED TO THE.fNSURED-NAMED'A80VE FOR ,THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY IIEQUlRI_NT, TlIIM 011 CONDlnDN OF ANY CONTRACT OR,.cRJtJI\ P~...1W~NT wmt IIESPECT TO WHICH
THIS CElmFlCATE MAY BE 18SUED 011 MAY PERTAIN, THlINSUllANCE AFFORDED BY THE POUCIELI:fUCJII~~ SUBJECT TO ALL THE
TERMS, EXCWSlDNS, AND CONDITIONS OF 8UCH POUCIES. ......
LIABILITY LIMITS IN THOUSANDS
EACH
OCCURRENCE
TYPE OF INSURANCE
GENERAL UABIUTY
COMPReHENSIVE FlIRM
PREMISES/DPERATKlNS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PROOUCTS/COMPlETED OPERATIONS
CDNlllACTUAL
INDEPENDENT CDNTRACTlIRS
BROAD FlIRM PRDPERTY DAMAGE
PERSlWAL INJURY
AUTOMOBILE UABIUTY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS,)
ALL OWNED AUTOS (OTHER THAN )
PRlV, PASS,
HIRED AUTOS
NDN-OWNED AUTOS
GARAGE LIABILITY
EXCESS UABIUTY
UMBRELLA FlIRM
OTHER THAN UMBRELLA FlIRM
WORKERS' COMPENSAnDN
AND
EMPLOYERS' UABIUTY
OTHER
*SEE A[I[IENDUM
THIS CEIlTlFlCATE 18 ISSUED AS A MATTER OF INFORMAnoN ONLY AND
CONFER8 NO RIGHTS UPON, THE CElmFICATE HOLDER. THIS CER11F1CATE
1)OE8 NOT AMEND, EXTEND OR ALTER THE COY!RAGE AFFORDED BY THE
POUCII8 BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
E
NATIONAL UNION FIRE INS. CO.
GENERAL REINSURANCE CORP.
REC.r.IVED
MAY 4
POLICY NUMBER
PlU:Y EFfECTM
1IA1lIMM/1II/YY)
PlX.CY EXPlRATIlN
1IA1l(MM/1II/YY)
GL5902540RA
BODILY
INJURY
$
5/01/89
5/01/90
$
PROPERTY
DAMAGE $
$
CAl1859.51RA
~6t"~NED $ $
2000
PERSONAL INJURY $
BOOILY
5/01/90 INJURY
(PER PERSlWl $
BlIIILY
INJURY $
IPEIl ACCIIlEIITI
PROPERTY
DAMAGE $
BI&PD
COMBINED $ 1000
~6t"~NED $ $
5/01/89
STATUTORY
*X6145
8/01/88
$
$
$
(EACH ACCIDENT)
(lllSEASE-PDUCY LIMIT)
(DtSEASE,EACH EMPLOYEE)
8/01/89
DESCRIPll0N OF OPERAll0NS/LOCAll0NS/VEHICLES/SPEClAL ITEMS
RE: *THE CORP ~ ITS SUBSIDIARIES ARE QUALIFIED SELF-INSURERS FOR THE FIRST
$250,000 EA OC FOR WC IN FL~GA,NC,SC,TN,MS ~ EXCESS
CITY OF CLE:ARWATER
LICENSE DEPARTMENT
CLEARWATER~ FL 33516
I
I
COLLIER COBB & ASSOCIATES
OF THE CAROLINAS, IN C.
400 FIRST CITIZEi\:S BANK PLAZA, CHARLOITE, 0:0RTH CAROLI~A 2.:\202
P,O BOX 11S1~
ZIP 282H
(I \."-+) l{ (~"q it'll
'--AlY f}E'N-n U-I{ - ,
*THIS POLICY PROVIDES $10 MILLION LIMIT EXCESS THE SELF-INSURED
RETENTION OF $250,000. EACH OCCURRENCE FOR WORKERS' COMPENSATION
AND EMPLOYERS' LIABILITY.
INSURANCE . BONDS . RISK MANAGEMENT . EMPLOYEE BENEFITS