CERTIFICATE OF INSURANCE (187)
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ISSUE DATE (MM/DDIYY)
4-11-89
PRODUCER
Frank B. Hall & Co. of FL
Post Office Box 23545
Tampa, FL 33623
(813) 884-8470
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
t~~~~NY A FLORIDA CHAMBER
CODE
SUB-CODE
INSURED
Miller Brothers of Florida, Inc.
Employees Leased From National
Staffing Services, Inc.
Post Office Box 1098
Riverview, FL 33569
t~~~NY B
f~~~~NY C
COMPANY D
LETTER
COMPANY E
LETTER
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,
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DD/YY)
ALL LIMITS IN THOUSANDS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
GENERAL AGGREGATE
s
CLAIMS MADE
OCCUR,
PRODUCTS-COM PlOPS AGGREGATE $
PERSONAL & ADVERTISING INJURY S
OWNER'S & CONTRACTOR'S PROT,
EACH OCCURRENCE
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
FIRE DAMAGE (Anyone fire) S
MEDICAL EXPENSE (Anyone person) $
COMBINED
SINGLE
LIMIT
BODILY
INJURY S
(Per person)
BODIL Y
INJURY
(Per accident)
PROPERTY
DAMAGE
EXCESS LIABILITY
EACH AGGREGATE
OCCURRENCE
S $
OTHER THAN UMBRELLA FORM
A
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
1100041
9-1-88
9-1-89
S
S
S
STATUTORY
100,OQQ
500,000
100,000
(EACH ACCIDENT)
(DISEASE-POLICY LIMIT)
(DISEASE-EACH EMPLOYE )
OTHER
DESCRIPTION OF OPERA TlONS/LOCA TIONSNEHICLES/RESTRICTlONS/SPEClAL ITEMS
City of Clearwater
P. O. Box 4748
Clearwater, FL 33518
AUTHORIZED REPRESENTATIVE
Christine Sciera LaFe
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