CERTIFICATE OF PROPERTY INSURANCE
DATE (MM/DDNY)
1/30/03
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
COM~ANY CITIZENS PROEPRTY INS CO
..
PRODUCER
NOVAK AGENCY - INSURORS
11590 SEMINOLE BLVD.
LARGO, FL 33778
(727) 393-0640
INSURED
COMPANY
B
ROY LEE MILLER II
6685 142ND AVE N
LARGO, FL 33771
COMPANY
C
COMPANY
D
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THIS is TO CERTIFY THAT THE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS
LTR DATE (MMlDDNY) DATE (MMlDDNY)
X PROPERTY BUILDING $
A CAUSES OF LOSS FRJH0287807-01-0000 1/30/03 1/30/04 PERSONAL PROPERTY $
BASIC BUSINESS INCOME $
BROAD EXTRA EXPENSE $
SPECIAL BLANKET BUILDING $
EARTHQUAKE BLANKET PERS PROP $
FLOOD BLANKET BLDG & PP $
X HO-3 $
$
INLAND MARINE $
TYPE OF POLICY $
$
CAUSES OF LOSS $
NAMED PERILS $
OTHER $
CRIME $
TYPE OF POLICY $
$
BOILER & MACHINERY $
$
OTHER
A PERSONAL LIABILITY FRJH0287807-01-0000 1/30/03 1/30/04 $300,000
LOCATION OF PREMISESIDESCRIPTION OF PROPERTY
ON THE SINGLE FAMILY DWELLING LOCATED 1378 TURNER ST., CLEARWATER, FL 33756.
SPECIAL CONDITIONS/OTHER COVERAGES
CERTFICIATE HOLDER IS ADDED AS ADDITIONAL INSURED.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL END
_30___
CITY OF CLEARWATER
ENGINEERING DEPT
P.O. BOX 4748
CLEARWATER, FL 33758-4748
OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE
FJ NOVAK I'
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