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CERTIFICATE OF LIABILITY INSURANCE DA 9/26/2018 <br /> 09/26r'201 B <br /> i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CONSTITUTEA 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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on <br /> this certificate does not confer rights to the certificate holder-in lieu of such endorsement(s). <br /> PRODUCER CONTACT ,Julie Hollingsworth <br /> NAME: <br /> Stahl&Associates Insurance Inc, PHONE (863)688-5495 1 FAX (863}688 4344 <br /> C No Fed: AMC No <br /> 91 Lake Morton Drive AAREss: julie.hollingsworth@stahlinsurance.00m <br /> P 0 Box 3608 WSURERt(S)AFFORDING COVERAGE NAIC N <br /> Lakeland FL 33802 INSURERA- Bridgefield EMPloyerS InS Co 10701 <br /> INSURED INSURER B <br /> State Fire Protection Inc INSURERC• <br /> PO BOX 5354 INSURER D: <br /> INSURER E: <br /> Largo FL 33779 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 18-19 WC Master 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 PERI00 <br /> INDICATED. NOTVVITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br /> CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, <br /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> I EXP <br /> 1TR TYPEOFWSURANCE VVVD POUCYNUMBER W EFF Wpm LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE OCCUR PREMISES Es occunencel 5 <br /> M ED EXP Any one person s <br /> PERSONAL&ADV INJURY S <br /> GEN'LAGGREGATE LIM17APPUES PER: GENERALAGGREGATE S <br /> POLICY JEOa F-1 LOC PRODUCTS-COMPIOPAGG $ <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 <br /> e accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accideml $ <br /> AUTOSONLY AUTOS <br /> HIRED NON4W4EO PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Peredenl <br /> 5 <br /> UMBRELLALIAB OCCUR EACHOCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE 5 <br /> DED RETENTION 3 5 <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY YIN STATUTE RH <br /> ANY PROPRIETORIPARTNERIEXECl1TIVE EL.EACHACCIDENT $ 100,000 <br /> A OFFICERIMEMBEREXCLUDEDT NIA 083028591 02I08/20t8 02/08120t9 <br /> (Mandatory InNIt EL.DISEASE-EAEMPLOYEE S 100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S SOO,OOD <br /> DESCRIPTION OF OPERATIONS 1.LOCATIONS!VEHICLES(ACORD 101,AddlMonal Remarks Schedule may beaKsched III more space is required) <br /> i <br /> i <br /> CERTIFlCATE HOLDER CANCELLATION <br /> SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 5335 Bth St <br /> AUTHORIZED REPRESENTATIVE <br /> Zephyrhills FL 33S42 <br /> 01988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(20161`03) The ACORD name and logo are registered marks ofACORD <br /> L-d £b99VULZL Out Uoi;Oa;OJd en j elelS d99:Z L 9 L LZ deS <br />