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b _ <br /> � � � _ ,-__ - - ._��_� DATE(MMIDDIYYYY) <br /> A�° CERTIFICATE OF LIABILITY INSURANCE - -�--09/30/2015 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTAC <br /> A.KILBRIDE INSURANCE INC. NaME: <br /> �ao�w.eusch a�vd. P"o"E , g13-931-7467 aC No: 813-932-7336 <br /> Tampa,FI 33612 A o"R'ESS: certificate akilbride.com <br /> 813.931.7467 Phone <br /> 813.932.7336 Fax INSURER S AFFORDING COVERAGE NAIC# <br /> INSURERA:At�dlltlC Casualt Insurance <br /> INSURED INSURER B: <br /> Luper,Amos dba On-Line Electric <br /> 210 West Powhatan Avenue iNSU�R c: <br /> Tampa, FL 33604 INSURER D: <br /> INSURER E: <br /> INSURER F. <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. <br /> INSR TypE OF INSURANCE ADDL SUBR pOLICY NUMBER M�LDDY� MM/LDDY� LIMITS <br /> LTR <br /> GENERAL LIABILITY EACH OCCURRENCE $ Z,OOO,OOO <br /> ✓ COMMERCIAL GENERAL LIABILITY PR M SES EaEoccu ence $ �OO,OOO <br /> A CLAIMS-MADE �oCCUR L0300034224 9/12/15 09/12/16 MED EXP(My one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GENERALAGGREGATE $ 2,000,000 <br /> GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> � POLICY PR� LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> ALLOWNED SCHEDULED BODILYINJURY(Peraccident) $ <br /> AUTOS NONAWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESSLIAB CWMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N�A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 107,Additlonal Remarks Schedule,if more space Is requlred) <br /> Electrical Contractor#EC13001753 <br /> License Qualifier: Horst Odparlik <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills <br /> rJ33rJ$th St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Ze h rhills, FL 33542 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> P Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> derek.phs@gmail.com � <br /> Fax(813)780-0021 AUTHORIZED REPRESENTATIVE <br /> O - 010 ACORD CORPORATION. All rig s reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />