CERTIFICATE OF INSURANCE (031)
HARTIN HAYES . CO INC A ,:~,....,.
COMPANY
POBOX 2~45 LETTER
NASHVILLE TN 37219 COMPANY B
LE TTER
NAME AND ADDRESS Of INSURED C
COMPANY
LETTER
W.L COBB CONSTRUCTION CO COMPANY D
PO BOX 2200 LETTER
LARGO FLA 34294 COMPANY E
LETTER
'ICertificate of Insurancel
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL Y AND CONFERS NO RIGH""-;~PON THE CERTIFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW
AND ADDRESS OF AGENCY
TYPE OF INSURANCE
POLICY NUMBER
COMPANIES AFFORDING COVERAGES
c
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
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 the
terms, exclusions and conditions of such policies.
POLICY
EXPIRATION DATE
Limits of Liabilit in Thousan
EACH
OCCURRENCE
A
GENERAL LIABILITY
BODIL Y INJURY
ZL0703843
B/01/B~
600
$ 600
[j COMPREHENSIVE FORM
[j PREMISES-OPERATIONS
[j] EXPLOSION AND COLLAPSE
HAZARD
[j] UNDERGROUND HAZARD
[j] PRODUCTS/COMPLETED
OPERATIONS HAZARD
[j] CONTRACTUAL INSURANCE
[j] BROAD FORM PROPERTY
DAMAGE
[j] INDEPENDENT CONTRACTORS
[i] PERSONAL INJURY
$ 100
$ 100
PROPERTY DAMAGE
BODIL Y INJURY AND
PROPERTY DAMAGE $ $
COMBINED
PERSONAL INJURY $600
B/Ol/85 BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE $
BODIL Y INJURY AND 500
PROPERTY DAMAGE $
COMBINED
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
B
AUTOMOBILE LIABILITY
00 COMPREHENSIVE FORM
[i] OWNED
[i] HIRED
[i] NON.OWNED
ZA0703844
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
D
WORKERS' COMPENSATION
and
EMPLOYERS' LIABILITY
OTHER
$100
ZC0703B47
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES
Druid Road and Bypass Drive Storm Sewer (83Q4)
Cancellation: Should any of the above descri.Qli..d 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
mall such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER
1984
v
DATE ISSUED:
city of Clearwater
P. O. Box 4748
Clearwater, FL 33518