CERTIFICATE OF INSURANCE (060)
C E R T I r I CAT E 0 r INS ~ RAN C E
This certificate is issuel as a matter of informatiot only and confers no righ s
upon the certificate holder. This certificate does no't, amend~ extend or alter
the coverage afforded by the policies listed below.
Name and Address of Agency
Let,ter A
Companies Affording Coverage
Great American Ins. Co.
FERQUERON & ASSOCIArES, INC
21215th AVENUE NORrH
ST.PETERSBURG FL 33713
Letter B
REc"'-r'VED
1:.. .. ,
Letter C
Name and Mai I ing Address of Insured
G.A. Food Services of Pinellas
County, Inc.
12200 32nd Court North
ST.PETERSBURG FL 33702
Letter D
JUN :\ 1981:;
Letter E
Clrx: CL2rtK
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.
Co. Type of
Insurance
GENERAL LIABILITY ---------------------------____________________________ _
A (X) Comprehens i ve
(X) Premises & Ops.
(X) Exp f. Co II apse
<X) Underground
<X) Products
(X) Contractual
<X) Broad Form PD
<X) Contractors
(X) Personal Inj. Personal Injury $300
---- AUTOMOMBILE LIABILITY -----------------------------______________________ _
A <X) Comprehensive BA629818901 10/01/85 B.I. /Person
~~; ~7~:~ ~:~: /Acc i dent jl
<X) Non-Owned CSL $300 '
---- EXCESS LIABILITY I
A (X) Umbrella Form PR06475413 09/28/85 B.l. & P.O. Combined
( ) O.T. Umbrella $2.000 $2,000
WORKERS COMPENSATION ------------------------____________________________ _
W.C. WCP 6475414 09/28/85 STATUTORY
E m p I 0 y e r s L i a b._La c hAc c ide n t $ 1 00
OTHER -------------------------------____________________________________ _
Po I icy {I
Po I icy
Expirat,ion
Limits of Liability (000'5
Each Occur. Aggregate
BP 4308675
09/28/85
B. I .
P.o.
CSL
$300
$300
A
Description of Operations/Locations/Vehicles
CANCELLATION: Should any of the above described pol icies be cancelled
before the stated expiration date thereof, the issuing company wi I I
endeavor to mai I 10 days written notice to the certificateholder
named below~ but, failure to mai I such notice shall impose no obligation
or I iabi I ity upon the company.
Name and Address of Certificate Holder
City of Clearwater, Florida
PO Box 4748
Clearwater
Florida 33518
/.) Date Issue~: 05/30/85
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