CERTIFICATE OF INSURANCE (041)
~ ~l..--!'
GJI~tOv1PPNY
I
I
I,
"
!i
II
218 UVE OAKS BOULEVARD · PO BOX 817 CASSELBERRY, FLORIDA 32707 · 305/834-0022
To: Certificate Holder
The enclosed is evidence of insurance on the Umbrella policy which was extended
from 10/28/84 to 12/28/84.
Also enclosed is the renewal certificate of insurance on the same effective
12/28/84 and with an ex pi ration date of 2/11/86.
THANK YOU VERY MUCH
R E eEl V En
JAN21 198~
CITY CLERK.
SUR E T Y
BONDSandlNSURANCE
Lfj
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MMlDDIYY)
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
6~~~~~TY $ $
~~t~~ED $ $
PERSONAL INJURY $
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS,)
ALL OWNED AUTOS (OTHER THAN)
PRIV, PASS,
HIRED AUTOS
NON-OWNED AUTOS
GARAGE L1ABI L1TY
BOOILY
INJURY $
(PER PERSON)
BOOIL Y
IN.lJRY $
(PER ACCIIlENT)
6~~~~~TY $
~~t~~ED $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
UM 12300 FL
10/28/84 12/28/84 ~t:~ED
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
(EACH ACCIDEND
(DISEASE. POLICY L1MI
(DISEASE-EACH EMPLO EE)
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS Proj ect: Prequa11flng for Bld
Guignard Company
P.O. Box 817
Casselberry, FI. 32707
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 BEl-OW.
COMPANIES AFFORDING COVERAGE
W.E.D. Contractors Inc.
P.O. Drawer 351
Winter Haven, Fl. 33882
COMPANY A
lETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
E
Safety Mutual Insurance Co.
~,....
I
INSURED
ED
vAN 21 198~
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
OA TE (MMIDONY) OA TE (MM/DDNY)
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS PROPERTY $
UNDERGROUND DAMAGE
EXPLOSION & COLLAPSE HAZARD
PROOUCTSICOMPLETED OPERATIONS
BI & PD $
CONTRACTUAL COMBINED
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
. PERSONAL INJURY PERSONAL INJURY
AUTOMOBILE LIABILITY BODILY $
INJURY
ANY AUTO (PER PERSON)
ALL OWNED AUTOS (PRIV, PASS.) BOOILY
IN.AJRY $
ALL OWNED AUTOS (OTHER THAN) (PER ACCIDENT)
PRIV. PASS,
HIRED AUTOS PROPERTY $
NON-OWNED AUTOS DAMAGE
GARAGE LIABILITY BI & PD $
COMBINE~
EXCESS LIABILITY
UMBRELLA FORM UM 12300 FL R 2/28/84 -2/11/86 BI & PD
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION (EACH ACCIDENT)
AND
EMPLOYERS' LIABILITY (DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERA T10NSlLOCA T10NSNEHICLESlSPECIAL ITEMS
Project: Pre-qualifing for Bid
City
P.O. Box 4748
Clearwater, Fl. 33518
cc:
wild & Assocs Inc.
Prospect Avenue, Clearwa