CERTIFICATE OF INSURANCE (162)
COLLIER COBB ~ ASSOC. OF THE
CAROLINAS, INC. P.O. BOX 31817
CHARLOrrE, NC 2823:1.
INSURED
BURN UP ~ SIMS COMTEC, INC.
C/O BURNtJP ~ SIMS, INC.
P. O. BOX 15070
FT LAUDERDALE, FLORIDA 33318
1HIa CEIITIFICATE 18 ISIUED AS A MATTER OF INFORMAnON ONLY AND
CONFERI NO RIGHTS UPON THE CERTlFlCAlI HOLDER. THIS CERTIFICATE
DOEI NOT AMEND. EXlIND OR AL'nR THE COVERAGE AFFORDED BY THE
POLICIEI IELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER NATIONAL UNION FIRE INS. CO.
COMPANY B
LETTER INSURANCE CO OF NORTH AMERICA
COMPANY C
LETTER GENERAL REINSURANCE CORP.
COMPANY D
LETTER
THIS IS TO CERTIFY THAT POLlCIEI OF INSURANCE LInED ULOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA liD. NOTWI1MSTAIIDlNG ANY REQUIREMENT. lIRM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
THIS CERTlRCAlI MAY BE IHUED 011 MAY PERTAIN. 'IJIE,INIU11A1l1CE AFFORDED BY THE POUCIEI DESCRIUD HEREIN IS SULJECT TO ALL THE
lIRMa. EXCLUSIONS. AlID COIIDITIONI OF IUCH POUCIIs.
TYPE OF INSURANCE
POUCY NUMBER
GENERAL UABIUTY
X COMPREHENSNE FORM
X PREMISES/OPERATIONS
X UNDERGROUND
EXPlDSIDN & COUAPSE HAZARD
X PROOUCTS/COMPlETED OPERATIlWS
X CONTRACTUAL
X INDEPENDENT ClINT1lACTDRS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
GL5901252RA
AUTOMOBILE UABIUTY
X ANY AUTO
X ALL OWNED AUTOS (PRIV, PASS.)
X (OTllER THAN )
ALL OWNED AUTOS PRIV, PASS.
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE LIABlUTY
ISA 1803
WORKERS' COMPENSAnON
AND
EMPLOYERS' UABIUTY
*X6145
OTHER
I'lUY EFfEcnllt
DAn (MM/IIl/YVI
UABILlTY LIMITS IN THOUSANDI
EACH
CURRENCE
POlCY EXPllATIlN
DAn fMM/IIl/YYI
5/01/88
BODILY
INJURY
$
5/01/89
$
PROPERTY
DAMAGE $
$
~~Ue?NED $
$
2000
PERSONAL INJURY
$
5/01/88
BlIllI.Y
INJURY
(PER PERSIJlI $
BlIllI.Y
IN.UlY
I'DI "CIlEIIT) $
PROPERTY
DAMAGE
5/01/89
$
B1&PD
COMBINED $ 1000
foUe?NED $
$
8/01/88
STATUTORY
$ 1 OO(EACH ACClIIENT)
$ 500(OISEASE'PlllCY UMIT}
$ 1 OO(OISEASE'EACH EMPLOYEEI
8/01/89
DESCRIPllON OF OPERAllONS/LOCATlONS/VEHlCLES/SPECIAL ITEMS
RE: *THE CORP ~ ITS SUBSI[IIARIES ARE QUALIFIED SELF-INSURERS FOR THE
$250,000 EA OC FOR WC IN FL,GA,NC,SC,TN,MS a. AL. ABOVE POLICY COVERS
CITY OF CLEARWATER
LICENSE DEPARTMENT
CLEARWATER, FL 33516