CERTIFICATE OF INSURANCE (036)
COMPANIES AFFORDING COVERAGES
DAN TowNSEND & ASSOCIATES, INC.
P. O. Box 156
Haines City, FL
33844
B & M Construction Company, Inc.
P. O.Box 5468
Lakeland, FL
33803
COMPANY A NORTHBROOK PROPERTY & CASUALTY
LETTER
COMPANY B NORTHBROOK NATIONAL
LETTER
COMPANY C INTERSTATE INSURANCE COMPANY
LETTER
COMPANY 0 ROCKWOOD INSURANCE COMPANY
LETTER
COMPANY E
LETTER
NAME AND ADDRESS OF INSURED
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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.
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits of Liability in Thousands (
oCCt~~~NCE AGGREGATE
GENERAL LIABILITY
BODILY INJURY
$
A
~ COMPREHENSIVE FORM
~ PREMISES-OPERATIONS
~ EXPLOSION AND COLLAPSE
H~ARD d
~ UNDERGROUND HAZARD BPP 0 152 401
~ PRODUCTS/COMPLETED
OPERATIONS HAZARD
~ CONTRACTUAL INSURANCE
~ BROAD FORM PROPERTY
DAMAGE
~ INDEPENDENT CONTRACTORS
~ PERSONAL INJURY
PROPERTY DAMAGE
$
1/1/86
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$ 500,
PERSONAL INJURY
B
AUTOMOBILE LIABILITY
\XI COMPREHENSIVE FORM
\XI OWNED CA 0 152 482
[X] HIRED
!Xl NON-OWNED
1/1/86
BODILY INJURY
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
$ 500,
EXCESS LIABILITY
C
[Jg UMBRELLA FORM
D OTHER THAN UMBRELLA
FORM
55C 0032617
1/1/86
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
r2,OOO,
WORKERS' COMPENSATION
--n--
and
WC 417325
1/1/86
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES
General Contractor-Construction
Cancellation: Should any of the above des.<;.r;.L~.9 policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail ~ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
1
NAME AND ADDRESS OF CERTIFICATE HOLDER:
City of Clearwater
Building Dept.,
P. O. Box 4748
Clearwater, FL 33518
DATE ISSUED:
Dan Townsend & Associates, Inc.
Barbara