CERTIFICATE OF INSURANCE FOR CONTRACT 88-13 (2)
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P. O. Drawer 988 · Lakeland, FL'33802 · 813/665-6060
CEmFICAIE Of mSURABCE
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ISSUED TO:
City of Clearwater
P.O. Box 4748
Clearwater. FL 34618
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This is to certify that Overstreet PavinR: Company. Inc.
1390 Done~an Road LarR:o. FL 33540
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of the
compensation by insuring their risk with the
EMPLOYERS SELF INSURERS FUND
COVERJ1.GE NUMBER:
830-3926
Statutory' State of Florida
Employers' Liability
5500,000 (Each Accident)
5500,000 (Disease . Each Employee)
5500,000 (Disease. Policy Limit)
EFFECTIVE DATE:
Feburary 5. 1986
EXPIRJ1.TIONDATE:
March 31, 1990
REMARKS:
Contract 88~13
CANCELLATION: Should the above described policy be cancelled before the expiration day thereof, the issuing
company will endeavor to mail 30 days written notice to the above named certificate holder, but failure
to mail such notice shall impose no obligation or liability of any kind upon the company.
This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate
shall be construed as extending coverage not afforded by the policy shown above or as affording insurance
to any insured not named above.
DATE: June 7. 1989
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BY:
Summit Consulting, Inc.. Administrator
Employers Self Insurers Fund