CERTIFICATE OF INSURANCE (103)
I.
ADDc~~5 OF AGENCY
HUCKLEBERRY, SIBLEY & HARVEY
INSURANCE & BONDS, INC.
1901 LEE ROAD
WINTER PARK, FLA. 32789
TEL. NO. (305) 647-1616
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COMPANIES AFFORDING COVERAGES
Wimer-Stubbs Associates, Inc. &
wlS Specialty Floors Inc.
P.O. Drawer W
Deland, Fl. 32721-2622
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
South Carolina Ins. Co.
NAME AND ADDRESS Of INSURED
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement. term or condition I
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 thel
terms, exclusions and conditions of such policies.
TYPE OF INSURANCE
POliCY NUMBER
POliCY
EXPIRATION DATE
Limits of Liability in Thousands (
EACH
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY
$
$
Q COMPREHENSIVE FORM
Q PREMISES-OPERATIONS
EJ EXPLOSION AND COLLAPSE
HAZARD
o UNDERGROUND HAZARD
[] PRODUCTS/COMPLETED
OPERATIONS HAZARD
fJ CONTRACTUAL INSURANCE
[] BROAD FORM PROPERTY
DAMAGE
f] INDEPENDENT CONTRACTORS
XJ PERSONAL tNJURY
SMP4270258
9-1-87
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE $
COMBINED
500
PERSONAL INJURY
$
AUTOMOBILE LIABILITY BODILY INJURY
(EACH PERSON)
[Xl COMPREHENSIVE FORM BA4325389 9-1-87 BODILY INJURY
[]I Ov'lNED (EACH ACCiDENT)
[Xl HIRED PROPERTY DI,f,1AGE
[Xj r~ON.oWNED BGDIL Y INJURY A~D
PROPERTY DMMGE
COMBINED
EXCESS LIABILITY
BODIL Y INJURY AND
j[] UMBRELLA FORM SCU7416 9-1-87 PROPERTY DAMAGE
o OTHER THAN lN6RELLA COMBINED
FORM
WORKERS' COMPENSATION
and WC4270555 9-1-87
EMPLOYERS' LIABILITY
,-,-<.,.--',,"-. -~,'--""--'~'--.-'-',- . . .<-,,~---,,~ '"- -'>. -~"""'--
OTHER
Installation SP4270133 9-1-87
$
$
$1,000
$ 1 ,000
Project:
Jack Russell Stadium
Pinellas County
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I ;~,.j,r.l[ kN~} .l..C.DR:~-::, :JF Cf FTlr:CATE HO~C:ER
i City of Clearwater
i P.o. Box 4748
Clearwater, Fl. 33518-4748
I
I
I
~
10-6-86
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. ,~
1
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Cancellation: Should any of the 3bove described pOlicies be cancelled before the expiration date thereof. the Issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder. but failure to
mal! such notice shall impose no obligation or liability of any kind upon the company.
DATE ISSUED'
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r'~ ,- ~
J~~~REP~NTAT!V'E
Benjamin P. Sib1ey,CIC,CLU
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C'" ".-...~""'1.,"-'.,...,......'t'~~:1:.~,\',~-'o/'~"""""".."~r:',.-"':""". ..,.., , ~ "~~."'~,..':" ;lo/"':""~~"~-.....""~"!'""_ -_.. ''''~~-'''-'' .~-'-"":"'P.'~-....~~...~~',....p'~I:W<l""P!~~""":",~'