CERTIFICATE OF INSURANCE (135)
PRODUCER
JEFFERSON-ALLSOPP, INC.
P.O. Drawer L
Lake1and, Fl. 33802
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.
COMPANIES AFFORDING COVERAGE
CLARK BOILER & }UU~UFACTURING, ETAL
P.O. Box 3556
Lake1and, Fl. 33802
COMPANY A
LETTER HARTFORD INSURANCE COMPANY
COMPANY B
LETTER EMPLOYERS SELF INSURERS FUND
COMPANY C
LETTER
COMPANY D
LETTER
INSURED
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.lNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMIODIYYI
EXPIRATION
(MM'DD/Y\')
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY 21 UEN ZR 3502
QOCCURRENCE
OWNER'S & CONTRACTORS PROTECTIVE
8/12/87
8/12/88
GENERAL AGGREGATE
PRODUCTS-COMP/OPS AGGREGATE
PERSONAL & ADVERTISING INJURY
EACH OCCURRENCE
FIRE DAMAGE (ANY ONE FIRE)
MEDICAL EXPENSE (ANY ONE PERSON)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
21 DEN VP 6459
CSL $
8/12/87 8/12/88
BODILY
INJURY
(PER PERSON) $
BODILY
INJURY
tER $
CCIOENT)
PROPERTY
DAMAGE
EACH
OCCURRENCE
$ $
----
STATUTORY
8/12/87 8/12/88 $ lEACH ACCIDENT)
$
$
EXCESS LIABILITY
OTHER THAN UMBRELLA FORM
B
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
830 4536
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL ITEMS
CITY OF CLEARWATER
Occupational Licensing Division
~p 0 Box 4748
Clearwater, FL 33518
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX.
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
L1ABILlT OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHO ED REPRESENTATIVE