CERTIFICATE OF INSURANCE (214)
CERTIFICATE OF INSURANCE: I
PRODUCER
Bill Williams, Ross & Assoc.
3754 Central Avenue
st. Petersburg, FL
33711
PHONE 813-327-0621
I
OP ID KL 03/13/92
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
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COMPANY LETTER A Auto Owners Insurance
-~~;;;;;-~;-i3-----<:I-(;Ii~--------------:-I~~~~~;~~D-t-----------
-------------------------------------------------------~~-----~-------~----
COMPANY LETTER C I
-~~;;;;;-~;;;;-j)-------------------------------~-~Aft-l-el-~~--~--~-
------------------------------------------------f------------------------~-
COMPANY LETrER E ..,. ,...~ ...
,... f' .-"-., -L~_~. ., 1
> COVERAGES <=========================================================================.=============aD~~=~=2~~t:~~~~~=r.=
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED XBOv~ rvn TRB ~~ICY
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 TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURED
SUDcoast Excavating, Inc.
P.O. Box 838
Ozona FL
34660
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COI
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF I POLICY EXP
--_.~_.. . BATE-. .
LIMITS
--- ------------------------------- --------------------------- --------------- -------------- ----------------------------------
GENERAL LIABILITY
GENERAL AGGREGATE 2 , 000, 00
------------------- --------------
PROD-COMP/OP AGG. 1,000,00
[XI OWNERS'S & CONTRACTOR'S
PROTECTIVE
------------------- -------------- I
50,000
B [XI COMMERCIAL GEN LIABILITY
I CLAIMS MADE [X I OCC.
Binder 27076894 03/15/92 03/15/93 PERS. & ADV. INJURY 1,000,00
EACH OCCURRENCE
FIRE DAMAGE
(ANY ONE FIRE)
MED. EXPENSE
(ANY ONE PERSON)
5,000
--- ------------------------------- --------------------------- --------------- -------------- ------------------- --------------
AUTOMOBILE LIAB
COMB. SINGLE LIMIT 1, 000, 00
[ I ANY AUTO
[ I ALL OWNED AUTOS
A [XI SCHEDULED AUTOS
[XI HIRED AUTOS
[XI NON-OWNED AUTOS
[ I GARAGE LIABILITY
[ I
890212 20112461 03/15/92 03/15/93
BODILY INJURY
(PER PERSON)
BODILY INJURY
(PER ACCIDENT)
PROPERTY DAMAGE
--- ------------------------------- --------------------------- --------------- -------------- ------------------- --------------
EXCESS LIABILITY
A [XI UMBRELLA FORM
[ I OTHER THAN UMBRELLA FORM
EACH OCCURRENCE 1 , 000, 00
892112 71526499 03/15/92 03/15/93 ------------------- -----_________
~GREGME 1,000,00
--- ------------------------------- --------------------------- --------------- -------------- ------------------- --------------
WORKERS' COMP
AND
EMPLOYERS' LIAB
ISTATUTORY LIMITS
EACH ACCIDENT
DISEASE-POL. LIMIT
DISEASE-EACH EMP.
--- ------------------------------- --------------------------- --------------- -------------- ----------------------------------
OTHER
B CONTRACTORS EQUIP
B BUILDERS RISK
Binder 573248
IMC 514982
03/15/92 03/15/93
06/07/91 06/07/92
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS State of Florida Operations
Only
IT IS HEREBY AGREED AND UNDERSTOOD, ~BA% CITY OF CLEARWATER BE NAMED
> ~~I~~~~~~ERI~::~~~==~=~==~~:~::~==~~~N .~~~=~~=~~~~=~~~~:==================
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOQBLIGATION OR LIABILITY OF
= ANY KIND UPON THE COMPANY, ITS AGENTS (~~;:~=~tS'
:-;;;;;;;;;;-;;;;;;;;;;;;;;---------~~------- --
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL
34616
ACORD 25-S (7/90)