INSURANCE CERTIFICATE
A.~..I!I~
09/30/98
ED AS A MATTER OF INFORMATION
ONLY AND CONFERS 0 RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
A TH CO F DE BY THE POUCIES LO.
COMPANIES AFFORDING COVERAGE
PRODUCER
LAPLANTE AGENCY
2531 LANDMARK DR, STE. E104
CLEARWATER, FL 34621
INSURED
HOWARD R JIMMIE, INC.
609 SEMINOLE STREET
CLEARWATER, FL 34615
COMPANY AMERICAN SURETY & CASUALTY COMPANY
I ~ANY FCCI MUTUAL !NSURANCE COMPANY
~ .....~-
I~ANY
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE POLICY EXPIRATION UMITS
LTR I DATE (MMIDDIYY) DATE (MMIDDIYY)
GENERAl LlABIUTY GENERAL AGGREGATE $ 600,000
A X COMMERCIAL GENERAL LIA8ILlTY CP4024761-04 10/16/98 10/16/99 PRODUCTS - COMPIOP AGG $ 300,000
CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ 300,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 300,000
FIRE DAMAGE (Any one fire) $ 100,000
.---.
MED EXP (Any one person) $ 5,000
AUTOMOBILE UABlLlTY
COMBINED SINGLE UMIT $
ANY AUTO
ALL OWNED AUTOS $
BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS I
BODlL Y INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LlABlUTY AUTO ONLY - EA ACCIDENT $
ANY AUTO I OTHER THAN AUTO ONLY:
I EACH ACCIDENT $
I
AGGREGATE $
EXCESS LIABILITY $
UMBRELLA FORM $
OTHER THAN UMBRELLA FORM $
WORKER'S COMPENSATION AND
B EMPLOYERS' LIABILITY 001-WC98A-37071 03/01/98 03/01/99 EACH ACCIDENT $ 100,000
THE PROPRIETOR! INCL DISEASE - POLICY UMIT $ 500,000
PARTNERSIEXECUTIVE
OFFICERS ARE: X EXCL DISEASE - EACH EMPLOYEE $ 100,000
!1!~M/'li~TEflQtbE..
CANCEll.ATION
SHOUlD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE S IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE
CITY OF CLEARWATER
100 S MYRTLE
CLEARWATER, FL 34616
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