CERTIFICATE OF INSURANCE (183)
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.3/30/89
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
PRODUCER
Ken Herndon and Associates, Inc.
600 Bypass Drive Suite 116
Clearwater, Florida 34624
COMPANIES AFFORDING COVERAGE
CODE
82 6067
~~NY A
Michigan Mutlla,lIt:I,Sll:t'a,t:I,~e, Ce).
SUB-CODE
INSURED
~~NY B
Raynor Company
9111 130 Avenue North
Largo, Florida 34624
t~~NY C
t~~NY D
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
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
. DATE (MM/DDNY) DATE (MMIDDNY)
ALL LIMITS IN THOUSANDS
SRHGCPP 0276126
4/1/89
A GENERAL LIABILITY
4/1/89
4/1/90
GENERAL AGGREGATE
1,000
500
100
100
50
5
XANY AUTO
XALL OWNED AUTOS
XSCHEDULED AUTOS
XHIRED AUTOS
XNON-OWNED AUTOS
GARAGE LIABILITY
SRHG 43 4 H49282
250
OTHER THAN UMBRELLA FORM
$
500
100
A EXCESS-LIABILITY
X
SRHGCU 027110600
~TE
$ 5,000
WORKER'S COMPENSATION
AND
WC 0784216
4/1/89
4/1/90
$
$
$
100
500
100
(EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOY E)
EMPLOYERS' LIABILITY
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/RESTRICTIONS/SPEClAL ITEIIS
ceAl'lFlCATE HOLDER
City of Clearwater Legal Dept.
PO Box 4748
Clearwater, Fl. 34617
CANCELLATION
ATTN: Charley Dobbins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAll.3.0.....- 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,
ACORD 25-S (3/88)
---.-.Ph<7......../. ~
I).~ ~p @ACORD CORPORATION 19