CERTIFICATE OF INSURANCE (062)
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CERTIFICATE OF INSURANCE
EFFECTIVE DATE
OF CERTIFICATE
11, 1985
ALLSTATE INSURANCE.fOMPANY HomeOffice,NorthbrOOlllJL
Illinois, hereby certifies that the following insurance is in force: -
POLICYHOLDER POLICY NUMBER POLICY PERIOD
ROBERT RODeSHIER DBA
PORTABLE WELDING SPLTS
13625 1.ESLIE DRIVE
HUDSON fL 33567
Q 49 376271 07/11
At
12:01 A.M.
Standard
1 L, 1985 Time
TO
11 . 1986
JUL
JUL
The person ororganization designated below is described in the policy as:
CITY OF CLEARWATER
PO 80X 411t9
CLEARWATER Fl 33518
LIENHOLDER
(Loss Payable Clause)
ADDITIONAL
X INTERESTED PARTY
WILLIAM C SHERWOOD
408 138-6285
Coverages designated below a re afforded foreach described vehicle:
76 FORD F250
LIABILITY 300,000
F25JKA56891
fA. ACC lDeNT
See reverse side for provision concerning Lienholderand Additional Interested Party.
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage
afforded by the policy referred to above.
BUlIao PRINTED IN USA
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lathe named Loss Payee and Additional Interested Party:
This policy, as respects the interest of the loss payee and additional interested party named on the
reverse side hereof, may be cancelled by the Company during the policy period by giving such person
ororganization lOdays written notice at its last address known totheCompany.
Proof of such mailing is deemed sufficient proof of such notice.