CERTIFICATE OF INSURANCE (095)
THE FORDHAM AGENCY,INC.
P. O. Box 8307
St. Petersburg, Fla. 33738
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 BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
AUTO-OHNERS
INSURED
JOHN W. DANIELS, MARY LYNN DANIELS,caMPANY C
J 0 H N W. DAN I E L SPA V I N G COM PAN Y & LETTER
GO L DEN T R I AN G LEA S PH A L T P A V I N G CO. COMPANY D
P.O. Box 20085 LETTER
St. Petersburg, Fla. 33742 and CaMPANY.E.
C I T Y 0 F C LEA RW ATE R, F LA. ADD I T ION ~TT!~ S lJl{ E D
COMPANY B
LETTER
l..l>k4>""_~-_""'.'
THIS IS TO CERTIFY THAT 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 CONDI-
TIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDNY)
POLICY EXPiRA nON
DATE (MMIDDNY)
LIABILITY LIMITS IN THOUSANDS
OCCG~~~NCE AGGREGATE
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY OAMAGE
.. PERSONAL INJURY
BODILY
INJURY
$ $
804602-20189042
7-1-86
7-1-87
PROPERTY
DAMAGE
$ $
BI & PD
COMBINED
$1,000 $ 1,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV, PASS)
ALL OWNED AUTOS (OTHER THAN)
PRIV, PASS.
HIRED AUTOS
NON, OWNED AUTOS
GARAGE LIABILITY
760212-20140550
7-1-86
7-1-87
PERSONAL INJURY $
BODilY
INJURY $
(PER PERSON)
BODilY
INJURY $
(PER ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED $
BI& PD $ $
COMBINED 5 , 0 0 0
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
762112-71283517
7-1-86
7-1-87
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY
$
$
$
(EACH ACCIDENT)
(DISEASE,POllCY LIMIT)
(OISEASE,EACH EMPLOYEE
OTHER
DESCRIPTION OF aPERATlaNS/LOCATlaNSNEHICLES/SPECIAL ITEMS
INSURED FIELD OFFICE, LOCATION
OF CITY PROPERTY LOCATED ADJACENT TOS.R. 580
CITY OF CLEARWATER
P. O. Box 4748
Clearwater, Fla. 33518-4748
Att: William C. Baker