CERTIFICATE OF INSURANCE (056)
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
SUNCOAST PAVING, INC.
Rt. #1, Box 222, Anclote Rd.
Tarpon Springs, FL 33589
COMPANY A Iowa National Mutual Co.
LETTER Insurance
COMPANY B Hartford Insurance Co.
LETTER
COMPANY C Florida Construction, Commerce & Industry
LETTER Self Insurers Fund
COMPANY D
LETTER
COMPANY E
LETTER
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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 OTttER DOC_UMEHI \'{lniJ'lESI'I:l~TTO WtlICrUl-itS _c~crrlFiCATE_MAY
- --BE 155tiEa--eR-MAV-)>ERT AiN, -THE-tNSURANCEAFFORDEU13Y THcPOJ:lCIESDESCR1BEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMlDDNY) DATE (MM/DDNY) AGGREGATE
GENERAL LIABILITY BODILY $ $
X COMPREHENSIVE FORM To Be A . d 4/2/85 4/2/86 INJURY
X PREMISES/OPERATIONS liFe E I V ED PROPERTY $ $
UNOERGROUNO DAMAGE
EXPLOSION & COLLAPSE HAZARO
X PROOUCTS/COMPLETED OPERATIONS
X BI & PO $ 500 $ 500
CONTRACTUAL COMBINED
X INOEPENOENT CONTRACTORS APR 23 lOpe:
X BROAO FORM PROPERTY OAMAGE
X PERSONAL INJURY PERSONAL INJURY $ 500
X Broad Form CGL
AUTOMOBILE LIABILITY BODILY
INJURY $
ANY AUTO (PER PERSON)
X ALL OWNED AUTOS (PRIV. PASS,) To Be Assigned 4/2/85 4/2/86 BODILY
INJURY $
X ALL OWNED AUTOS (OTHER THAN) (PER AOOOENT)
PRIV. PASS.
X HIRED AUTOS PROPERTY
X NON,OWNED AUTOS DAMAGE $
GARAGE LIABILITY BI & PO $ 500
COMBINED
EXCESS LIABILITY
X UMBRELLA FORM To Be -Assign-ed 4/5/85 4/5/86 - BI&PD
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND 7-18-1934 (EACH ACCiDENT)
1/1/85 12/31/85 (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY
(DISEASE-EACH EMPLOY
OTHER I
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DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS
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