CERTIFICATE OF INSURANCE (168)
PRODUCER
EASON AGENCY, INC.
P.O. BOX 1097
DUNEDIN, FL. 34697
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
f~~~~NY A AMERICAN STATES INSURANCE COMPANY
f~~~~Y B FLORIDA HOME BUILDERS SELF INSURANCE FUND
LYMAN K. WHEELER DBA
A-I SECURITY ROOFING
1478 S. MISSOURI AVENUE
CLEARWATER, FL. 34616
COMPANY C
LETTER
COMPANY D
LETTER
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, TERMOR 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 POLICY EXPIRATION ALL LIMITS IN THOUSANDS
DATE (MMIDDIYY) DATE (MM/DDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 500
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPS AGGREGATE $ 500
CLAIMS MADE [X] OCCURRENCE 01-ML-251201-7 08/24/88 08/24/89 PERSONAL & ADVERTISING INJURY $ 500
OWNER'S & ~ONTRACTORS PROTECTIVE EACH OCCURRENCE $ 500
FIRE DAMAGE (ANY ONE FIRE) $ 50
MEDICAL EXPENSE (ANY ONE PERSON) $ 5
AUTOMOBILE LIABILITY
ANY AUTO CSL $
ALL OWNED AUTOS BODILY
INJURY
SCHEDULED AUTOS (PER PERSON) $
HIRED AUTOS BODILY
INJURY
NON,OWNED AUTOS tER $
CCIDENTl
GARAGE LIABILITY PROPERTY
DAMAGE $
EACH
OCCURRENCE
$
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION $
AND 100
EMPLOYERS' LIABILITY 860-11742 03/01/88 03/01/89 $ 500
$ 100
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I RESTRICTIONS I SPECIAL ITEMS
Roofing Contractor - State of Florida
CITY OF CLEARWATER
C/O CITY CLERK
112 OSCEOLA AVENUE, S.
CLEARWATER, FL. 34616
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX.
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AU~ REPRESENTATIV~
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