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,acoRD� CERTIFICATE OF LIABILITY INSUR�4NCE DATE(MM/DD/YYYY)
<br /> ��- ,on3izo,s
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICAT[ DOiS 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 /> REPRESENT,4TIVE 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 CONTACT
<br /> M8fSI1 U$A If1C. NAME:
<br /> 701 Market Street,Suite 1100 PHCNNo Fvc No:
<br /> St.Louis,MO 63101-1830 A DR�ESS:
<br /> Attn:StLouis.CertRequest@marsh.com Fax:212-94&0811
<br /> INSURER S AFFORDING COVERAGE NAIC#
<br /> BHN iNsuRER A.Old Republic insurance Company 24147
<br /> INSURED iNsuRER e.ACE Property and Casualty Insurance Company 20699
<br /> Charter Communications,Inc.
<br /> 12405 Powerscaurt Drive INSURER C:
<br /> St.Louis,MO 63131
<br /> , INSURER D:
<br /> INSURER E:
<br /> INSURER F.
<br /> COVERAGES CERTIFICATE NUMBER: CHI-006598100-03 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. NOTIMTHSTANDING 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 7ypE OF INSURANCE ADDL SUBR pOLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY MWZY 305715 11101/2015 12/01/2016 EqCH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE �OCCUR P EM SES�a oNcu ence $ 500,000
<br /> MED EXP(My one person) $ 10,000
<br /> �� PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENER,4L AGGREGATE $ 2,000,000
<br /> X �� PRO-
<br /> POLICY�I��ECT � LOC PRODUCTS-COMPlOP AGG $ 2,000,000
<br /> OTHER:� $
<br /> A AUTOMOBILE LIABILITY NNVTB 305710 11/01/2015 12IO1/2016 COMBINED SINGLE LIMIT g 2,000,000
<br /> g Ea 2ccident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY Per accident $
<br /> AUTOS AUTOS � )
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS Per accident $
<br /> � $
<br /> B X UMBRE,i�LwB X OCCUR XOOG28119616001 05/18/2016 05/18/2017 EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED �I RETENTION$ $
<br /> A wORKERS COMPENSATION MWC 305714 01 11/Ol/2016 12/01/2016 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y�N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000
<br /> OFFICER/MEMBER EXCLUDED9 � N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 2,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIP�IT $ 2,000,000
<br /> I�
<br /> I
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additlonat Remarks Schedule,may be attached i(more space Is required)
<br /> Certificate holder is included as additional insured—permits as respects general liability coverage.
<br /> ,�
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<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ,�
<br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Building Departrnent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 5335 8th SVeet ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Zephyrhills,FL 33542
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA Inc.
<br /> � Manashi Mukherjee _�c��,,�a,�w.: �;r�,t.��.e,�
<br /> ' O 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ,
<br /> ,i ,
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