CERTIFICATE OF INSURANCE (154)
THIS CERTlFICAn IS ISSUED AS A MATTER OF INFORMAnON ONLY AND
CONFERS NO RIGHTS UPON THE CERTlRCAn HOLDER. THIS CERTlFICAn
DOES NOT AMEND. EXnND OR ALnR THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COLLIER COBB ~ ASSOC. OF THE
CAROLINAS~ INC. P.O. BOX 31817
CHARLOl'TE~ NC 28231
COMPANIES AFFORDING COVERAGE
BURNUP ~ SIMS COMTEC~ INC.
C/O BURNUP ~ SIMS INC.
P. O. BOX 15070
FT. LAUDERDALEt FLORIDA 33319
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 10 CERTIFY THAT POLICIES OF INSURANCE LIlTED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICAnD. NOTWITHSTANDING ANY REQUIREMEfIIT. 'nRM OR CONDlnoN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH
THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.JECT 10 ALL THE
TERMS. EXCLUSIONS. AND CONDmONS OF SUCH POLICIES.
PllCY EFFEC'nVE POl.tv EXPIRATION LIABILITY LIMITS IN THOUSANDS
TYPE OF INSURANCE POLICY NUMBER DATE IMM/DO/YYI DATE (MM/IlO/YYI EACH
OCCURRENCE
GENERAL LIABILITY BODILY
A X COMPREHENSIVE FORM GL5901252RA 5/01/88 5/01/89 INJURY $ $
X PREMISES/OPERATIONS PROPERTY
X UNDERGROUND DAMAGE $ $
EXPLOSION & COLlAPSE HAZARD
X PRODUCTS/COMPLETED fJ'ERAllWS
X CONTllACTUAL ~~t"~NED $ $
X INDEPENDENT CONTRACTORS 2000
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY PERSONAL INJURY $
AUTOMOBILE LIABILITY BlIJlLY
INJURY
X ANY AUTO ISA 1803 5/01/88 5/01/89 (PER PERSON) $
X AlL OWNED AUTOS (PRIV. PASS.) BlIJlLY
X AlL OWNED AUTOS (OTHER THAN) INJURY $
PRIV, PASS, (PER ACClOENTJ
X HIRED AUTOS PROPERTY
X NON-OWNED AUTOS DAMAGE $
GARAGE LIABlUTY BI&PD
COMBINED $ 1000
'EXCESS LIABILITY
UMBRELLA FORM ~~t~NED $ $
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION $ 10()(EACH ACCIDENTI
AND
EMPLOYERS' LIABILITY *X6145 8/01/87 8/01/88 $ 50()(DISEASE,POLlCY L1MITI
$ 10()(DISEASE'EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATlONS/LOCATlONS/VEHICLES/SPECIAL ITEMS
CORP ~ ITS SUBSIDIARIES ARE QUALIFIED SELF-INSURERS FOR THE
EA OC FOR WC IN FLtGA,NC,SC,TN,MS ~ AL. ABOVE POLICY COVERS
CITY OF CLEARWATER
LICENSE DEPARTMENT
CLEARWATER~ FL 33516
~_.:.......--.'''.;..i........... __