CERTIFICATE OF INSURANCE (083)
Ken Herndon and Associates, Inc.
600 Bypass Drive Suite 116
Clearwater, Fl. 33546
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
COMPANY A
LETTER
COMPANY B
INSURED LETTER
COMPANY C
Raynor Company LETTER
9111 130th Avenue North COMPANY
Largo, Fl. 33543 LETTER D
COMPANY E
LETTER
. .
Michigan Mutual Insurance
RECEIVED
v1AR26 1986
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P 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 EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
DATE (MM/DDIYY) DATE (MM/DDIYY) EACH AGGREGATE
OCCURRENCE
BODILY
4-1-86 4-1-87 INJURY $ 500 $ 500
PROPERTY
DAMAGE $ 100 $ 200
BI & PD $ $
COMBINED
GENERAL LIABILITY
COMPREHENSIVE FORM SRMG86 4 H4928 4
PREMISES/OPERATIONS
UNDERGROUND
EXP.LOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
PERSONAL INJURY $ 500
AUTOMOBILE LIABILITY
X ANY AUTO SRMG43 4 H4928 2
X ALL OWNED AUTOS (PRIV PASS,)
X ALL OWNED AUTOS (~~~JHp1~~N)
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE LIABILITY
4-1-86
4-1-87
BODILY
INJURY
(PER PERSON) $ 250
BODILY
INJURY
[PER ACCIDENT) $ 500
PROPERTY
DAMAGE $ 100
BI & PD
COMBINED $
EXCESS LIABILITY
X -lJMElRELG\FORM
OTHER THAN UMBRELLA FORM
SRMG29 LrS-49285--
4~r;;;86- ... - ~.. -4;.;1;.;;87-
.81& PD
COMBINED
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
SRMG37 4 H4928 1
4-1-86
4-1-87
OTHER
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/SPECIAL ITEMS
**30 Days Written Notice of Cancellation Pertains to Workers Compensation
City
1200 Osceola Avenue
Clearwater, Florida 33515