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/ ® DATE(MM/DD/YYYY) AJ►��o CERTIFICATE OF LIABILITY INSURANCE s/2/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Thalia Kin Adcock-Adcock Insurance Agency PHONE FAX 315 W. Fletcher Ave. A/c No Ext:813-933-6691 Alc No): Tampa FL 33612-3414 ADDRESS: thaliak@adcock-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:FCCI Insurance Co. 10178 INSURED 843 INSURERB: Ironshore Specialty Insurance Co. 25445 Fire Fighter, Inc P O Box 888 INSURER c:Auto-Owners Insurance Co. 18988 Land O Lakes FL 34639-1317 INSURERD:Evanston Insurance Co 35378 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:432975609 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF FOLIC EXP LIMITS LTR B X COMMERCIAL GENERAL LIABILITY RCS00002-07 9/6/2020 9/6/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) ccurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 X POLICY❑JPRO ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 ECT OTHER: $ C AUTOMOBILE LIABILITY 5300057700 9/6/2020 9/6/2021 COEaMBINED accident SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acciden tt PIP-Basic $10,000 D UMBRELLA LIAB X OCCUR REN OF XOBW8272819 9/6/2020 9/6/2021 EACH OCCURRENCE $2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DIED RETENTION$ $ A WORKERS COMPENSATION WC010005999101 9/6/2020 9/6/2021 XPER JOTH- AND EMPLOYERS'LIABILITY AND ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT $1,000,000 OFFICERWEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhilis St AUTHORIZED R FS N vE Zeph Zephyrhirhilis FL 33542 � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD