INSURANCE CERTIFICATE (16)
COMPANIES AFFORDING COVERAGES
J. Smith Lanier & Co. of Atlanta
P.O. Box 80707
Atlanta, Georgia 30366
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
Reliance Insurance Company
NAME AND ADDRESS OF INSURED
t'
>
W.B. Johnson Properties, Inco
3414 Peachtree Road, NE, Suite 300
Atlanta, Georgia 30326
DE.e
C\,'l C\-ER~)!~--
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and arein 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.
- - ..._ . . I
GE::~~IN:~:~:I:Y - -l
[Xl COMPREHENSIVE FORM I
[Xl PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
H AZA RD
o UNDERGROUND HAZARD
[R] PRODUCTS/COMPLETED
OPERATIONS HAZARD
I]] CONTRACTUAL INSURANCE
I]] RROAD FORM PROPERTY
DAMAGE
[KJ INDEPENDENT CONTRACTORS
[X] f'EflSONAL INJURY
---pGtierNUMHER
_ POLJCY _
-- EXP-,RATION- DATE
I limits of liability in Thousands (000)
c- co,,,,,,,"",, .. ~c5~\!~ :;~"'M'.
H,OPERTY DAMAGE I $
---1----------.-
A
CI6787327
EFF: 11-6-8
EXP: 1-1-8
flODIL Y INJURY AND
PROI'ERTY DAMAGE
COMBINED
1,000
$ 1,000
f'FH'ONI,L INJUi1Y
EXCESS LIABILITY
~--'-_._-
1
I I :
~-~-:;;-PTY r;Mw~;~ --t;---
i---, ',11'11 I N!:iiiY -^Nr'-t-----~
I iJHU;)Uny D^MAl;[ $
__ --t------'-'dM BIN U,____
HODll Y INJURY i\Ni'
AUTOMOBILE LIABILITY
[J COMPREHENSIVE FORM
[] OWNED
o HillED
o NON-OWNED
o UMBRELLA FORM
o OTHEIHHAN UMBRELLA
FORM
PHOPE.RTY J.l',r,1t\Gf~
$
C(IM8:NU.'
IWORKERS' COMPENSATION
- - -and---- ------- -
EMPLOYERS' LIABILITY
-.---.-_._-~-----
OTHER
--t----
.-=-----+- ---------
I
DESCRIPTION OF OPEllATIONS/LOCATIONS/VEHICLES
Clearwater Surfside Holiday Inn, 400 Mandalay Ave., Clearwater Beach, Florida
The City of Clearwater, Florida is an Additional Insured with respect to all activities
onsored___~the Clearwater Surfside Holiday Inn that take pl_~~~__i~yu~~_i~~::_ce~~_~a-=,ement.
Cancellation: Should any of the above described policies be cancelled I)efore the expiration date ther-eof, the issuing CC}i~-'
pany will endeavor to mail ~ days written notice to the below named certificate holder, but failui"E' to
mail such notice shall Impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDlR.
City of Clearwater, Florida
P.O. Box 4748
Clearwater, Florida 33518
DATE ISSUED.~eCem~er i,--!J_?_~___~___
Sharon A.