CERTIFICATE OF INSURANCE (166)
(j~: ~./ (J or; ,/ t~ (,'.:
PRODUCER
LON WORTH CROW INS AGCY
P. O. BOX 1~-1916
CORAL GABLES FL 33114-1916
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
BI1:0S. SEF~!J I CE~~) ,
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
MARYLAND CAGUALTY COMPANY
INSURED
JW:: .
17:~1 (::LEAF;:l.J!~TEt~""Lfil:;:GO t<[)
CLEARWATER, FL 33516
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 INSURANCE 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 EF'EC: ',1
DATE ,MM'DD,VY',
"OLiCY EXPIRATiON
DA TE IMMIOO:YY!
ALL LIMITS IN THOUSANDS
GENERAL LIABILITY
COMMERCIAL GUJERAL ~IABILiT\
-:J CI.M~S MADE D 'RE'oCE
OWNERS & CONTRACTORS PRO'E~T, E
GENERAL AGGREGATE
PRODUCTS.COMP/OPS AGGREGATE
PERSONAL & ADVERTISING INJURY
EACH OCCURRENCE
FIRE DAMAGE (ANY ONE FIRE)
MEOICAL EXPENSE (ANY ONE PERSG~,
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
r,ON.OWNED AUTOS
GARAGE ~IABILlTY
GSL $
BODll Y
iNJUPV
WEP PERSD~I $
BODll v
'NJUPV
rJC~DENT' $
EXCESS LIABILITY
EACH
OCCURRENCE
$
OTHER THAN UMBRELLA 'OR~
WORKERS' COMPENSATION'
AND
EMPLOYERS' LIABILITY
A !:i.'I]EKi{F:f; L.EGAL.
EC8691~132 06/01/88 U~/Ol/HY
$
$ (DISEASE. POLICY LIMIT)
$ (DISEASE EACH EMPLOYEE
BFl::. DFbC:k J VI J Ni
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
11: I GGEH'~) LEGAL L:( A!?! I.. 11''''(: $250, (jOO. EACH i)C CUf~I~ENCE;
ALI..-+:I~;~< (l~,l CONTf,ACTN<'S E(WIPMENT, (-is SCHEl:ll.lLEDr
CITY OF CLEARWATER
FINANCE DEPARlMENT
F' i) B r) )< ,(t '.7 it n
C U':: rd;:I/,.l;H E F;: I F I. :V, (d t:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX.
PIRATlON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL::.~O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
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