CERTIFICATE OF INSURANCE (016)
SUNCOAST INSURANCE ASSOCIATES, INC.
1408 N. Westshore Bl,vg'J )?'Llite 1008
Tampa, Florida 33607
MILLER BRO'I'HERS OF FLORIDA, INC.
P.O. Box 1098
Riverview, Florida 33569
.. . . ...
ISSUE DATE (MM/DDIYY)
4/13/84
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO flIGHTS UPON THE CERTIFICATE HOlDER. THIS CERTIFICATE DOES NOT AMEND,
exTEND OR AL TER'THE COVERAGE AFFORDED !!IY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER UNITED FIDELITY
COMPANY
LEllER l]\:AL
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 INDICA TED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MA Y 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
GENERAL LIABILITY
X COMPREHENSIVE FORM
X PREMISES/OPERATIONS
X ~~~~~~~KtMflXx
X PROOUCTS/COMPLETED OPERATIONS
X CONTRACTUAL
X INDEPENDENT CONTRACTORS
X BROAD FORM PROPERTY DAMAGE
X PERSONAL INJURY
MP 046509320
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS (PRIV. PASS,)
ALL OWNED AUTOS (OTHER THAN)
PRIV, PASS,
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
BAP 036190781
EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
MN 036535
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
1904089840
OTHER
DESCRIPTION OF OPERA T10NSlLOCA TIONSNEHICLES/SPECIAL ITEMS
of Clearwater
P.O. Box 4748
Clearwater, FL 33518
POLICY EFFECTIVE POLICY EXPtRA TION
DATE (MMlDDIYY) DATE (MMlDDIYY) AGGREGATE
BODILY $ $
3-31-84 3-31-85 INJURY
PROPERTY $ $
DAMAGE
BI & PD $ $
COMBINED 500 500
PERSONAL INJURY $ 500
BODilY $
INJURY
3-31-84 3-31-85 (PER PERSON) 250
BODilY 500
INJURY $
(PER ACCIDENT)
PROPERTY $ lea
DAMAGE
BI & PD $
COMBINED
3":31-84 3-31-85 B1 & PD $ 5,000
COMBINED
STATUTORY
3-31-84 3-31-85 100 (EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYEE)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL_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 KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
George Conn1ey/jp