CERTIFICATE OF INSURANCE (090)
THE FORDHAM AGENCY,INC.
P.O. Box 8 30 7 't" .', 'i-::J ~
St. Petersburg, Fla:.~"L~:1~"
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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
INSURED
JOHN W.
JOHN W. DANIELS
GOLDEN TRIANGLE
P. O. Box 20085
St. Petersburg,
CITY OF CLEAR
.
DANIELS, MARY LY
PAVING COMPANY &
ASPHALT PAVING CO.
LEITER
c
COMPANY D
LETTE R
Fl a.
33742
AND
COMPANY
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
POLO EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
POLICY NUMBER OATE IMM/OO/YYI DATE (MM/OOIYY) EACH
OCCURRENCE AGGREGATE
BODILY
INJURY $ $
804602-20189042 7-1-85 7-1-86
PROPER :v
, DAMAGE $ $
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PROOUCTS/COMPLETEO OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAO FORM PROPERTY DAMAGE
PERSONAL INJURY
BI & PO $ c;:
COMBINED 1 , 0 0 ;
AUTOMOBILE L1ABILlT'f
ANY AUTO
ALL OWNED AUTOS (PRIV PASS)
ALL OWNEO AUTOS (OTHER THAN)
PRIV, PASS,
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
760212-20140550
7-1-85
7-1-86
PERSONAL INJURY $
BODilY
INJURY $
(PER PERSON)
BODILY
INJURY $
(PER ACCIDEND
PROPERTY
DAMAGE $ 100
BI & PO
COMBINED $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
762112-71283517
7-1-85
7-1-86
BI & PO
COMBINED
STATUTORY
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
$
$
$
IE.ACH ACCIDENTI
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS
Insured field office, located,
portion of City property located adjacent to S.R. 580 near
CITY OF CLEARWATER
P. O. Box 4748
Clearwater, Fla. 33518-4748