CERTIFICATE OF INSURANCE (123)
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.
Ken Herndon and Associates, Inc.
600 Bypass Drive Suite 116
Clearwater, Florida 33546
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
n
Raynor Company
9111 130th Avenue North
Largo, Florida 33543
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED.
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.
POLICY EFfECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
TYPE OF INSURANCE POLICY NUMBER OATE (MMIOOIYY) OA TE (MMlOOIYY) EACH
OCCURRENCE
GENERAL LIABILITY BODILY
COMPREHENSIVE FORM INJURY $ $
SANG 86 4 H4928 4 4-1-87 4-1-88
PREMISES/OPERATIONS PROPERTY
UNOERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
X PRODUCTs/COMPLETED OPERATIONS
X CONTRACTUAL BI & PD $ $
COMBINED
X INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY PERSONAL INJURY
AUTOMOBILE LIABILITY BOOIL Y
INJURY $
ANY AUTO SAMG 43 4 H4928 2 4-1-87 4-1-88 (PER PERSON)
ALL OWNED AUTOS (PRIV. PASS) BOOIL Y
ALL OWNED AUTOS (OTHER THAN) INJURY $
PRIV. PASS. (PER ACCIDENT)
HIRED AUTOS PROPERTY
NON-OWNED AUTOS DAMAGE $
GARAGE LIABILITY BI & PD
COMBINED $
EXCESS LIABILITY
UMBRELLA FORM BI & PD $ 5,000 $ 5,000
SAMG 29 4 84928 3 4-1-87 4-1-88 COMBINED
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION $ (EACH ACCIDENT)
AND $
SAMG 37 4 H4928 1 4-1-87 4-1-88 (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY $
(DISEASE-EACH EMPLOYE )
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
City of Clearwater Legal Dept.
1200 Osceola Avenue
Clearwater, Fl. 33515