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<br /> i CERTIFiCATE OF INSURANCE CERTIFICATE NUMBER <br /> '. 177750 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS <br /> UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS <br /> CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />Marsh, Inc. POLICIES DESCRIBED HEREIN. <br />1166 Avenue of the Americas <br />New York, NY 10036 COMPANIES AFFORDING COVERAGE <br />Telephone (212) 345-5000 COMPANY A: AI South Insurance CO. <br />INSURED COMPANY B: American Home Assurance Co. <br />SimplexGrinnell, LP COMPANY C: Illinois National Insurance Co. <br />4701 OAK FAIR BLVD <br />TAMPA, FL 33610 <br />United States COMPANY D: Insurance Company of the State of PA <br />COVERAGES. .Uti.i...... ....... Ci..;......... icy.. .. ....i' .....,; ....... ......... ..... .).C))?).... <if)"" <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE <br />AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY <br />PAID CLAIMS. <br />CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPI RATION LIMITS <br />LTR DATE (MMlDDNY) DATE (MMlDDIYY) <br />B GENERAL LIABILITY RMGL5473558 10/1/2004 10/1/2005 GENERAL AGGREGATE $15,000,000.00 <br /> ')( COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $15,000,000.00 <br /> C ~ CLAIMS MADE [K] OCCUR PERSONAL & ADV INJURY $7,500,000.00 <br /> OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $7,500,000.00 <br /> f-- FIRE DAMAGE (Anyone fire) $1,000,000.00 <br /> MED EXP (Anyone person) $10,000.00 <br />B AUTOMOBILE LIABILITY RMCA 1656703 (TX) 10/1/2004 10/1/2005 COMBINED SINGLE LIMIT $7,500,000.00 <br />B ~ ANY AUTO RMCA1656702 (AOS) 10/1/2004 10/1/2005 <br />B f-- RMCA1656704 (MA) 10/1/2004 10/1/2005 BODILY INJURY (Per person) <br />B ALLOWED AUTOS RMCA 1656705 (V A) 10/1/2004 10/1/2005 <br />f-- <br /> SCHEDULED AUTOS <br /> ')( HIRED AUTOS BODILY INJURY (Per accident) <br /> 7 NON.OWNED AUTOS <br /> I-- <br /> PROPERTY DAMAGE <br /> PROPERTY <br /> EXCESS LIABILITY EACH OCCURRENCE <br /> =i ~MBRELLA FORM AGGREGATE <br /> OTHER THAN UMBRELLA FORM <br />B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X I ~~~ATUTORY I I OTHEA ;;..,.......//!./.......:". <br />E EMPLOYERS' LIABILITY <br /> EL EACH ACCIDENT $2,000,000.00 <br />0 THE PROPRIETOR! <br />C PARTNERS/EXECUTIVE R INCL EL DISEASE-POLICY LIMIT $2,000,000.00 <br />A OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $2,000,000.00 <br /> OTHER <br />DESCRIPTION OF OPERATlONSILOCATlONSNEHICLESlSPECIAL ITEMS <br />Please see page 2 for additional insureds and any additional language. <br />CERTIFICATE:HOLDER :C 'r... , ,'iiC" ... < . .. <y...... <br />City of Zephyrhills SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE <br />5_3_3~_E:ighlb_S!r~eL_____ . INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER <br />---- -- -- -- ~~~~,?s~~~~I~F~~6~~~gJeO~~~. ~SC~G~~~'&~~~~~~~~~~.l6~~.f~~~s't~~~~I~i~Fc~~tl~-:~~~~Q~- ~--- <br />Zephyrhills, FL 33540-4312 <br /> MARSH USA INC. BY: ~~"h~ <br /> Larry Giambalvo, Casualty Program <br /> ..... . ,< MM1(3/02) VALID AS OF: 10/18/2004 ." . ..... <br />