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<br /> <br />ADDrtioNAL INFORMATioN <br /> <br />CERTIFICATE NUMBER <br />177750 <br /> <br />PRODUCER <br /> <br />COMPANIES AFFORDING COVERAGE <br />COMPANY E: National Union Fire Insurance Co. <br /> <br />Marsh, Inc. <br />1166 Avenue of the Americas <br />New York, NY 10036 <br />Telephone (212) 345-5000 <br /> <br />COMPANY F: New York Marine & General Insurance Co. (Lead) <br /> <br />INSURED <br /> <br />COMPANY G: Noetic Specialty InsurancE' Company <br /> <br />SimplexGrinnell, LP <br />4701 OAK FAIR BLVD <br />TAMPA, FL 33610 <br />United States <br /> <br />COMPANY H: White Mountain Insurance Co. <br /> <br /> <br /> <br /> <br />WORKERS COMPENSATION POLICIES <br /> Carrier Policy Number EfL Date Exp. Date State <br />(B) American Home Assurance Co. RMWC5898786 10/1/2004 10/1/2005 CA <br />(E) National Union Fire Insurance Co. RMWC5898787 10/1/2004 10/1/2005 NV, OR <br />(D) Insurance Company of the State of PA RMWC5898788 10/1/2004 10/1/2005 AR, FL, MA, TN, VA <br />(C) Illinois National Insurance Co. RMWC5898789 10/1/2004 10/1/2005 IL, MI <br />(C) Illinois National Insurance Co. RMWC5898790 10/1/2004 10/1/2005 NY, WI <br />(A) AI South Insurance Co. RMWC5898791 10/1/2004 10/1/2005 GA <br />(B) American Home Assurance Co. RMWC5898792 10/1/2004 10/1/2005 All Other States <br /> <br />LIABILITY PROGRAM <br />The parties listed below are added as an additional insured for General Liability, but only to the extent of the <br />Named Insured's negligence. <br /> <br />Additional Insureds: JEFFREY J MCKINNIE <br /> <br />Project: Contractor Licensing <br /> <br />If there is a question regarding this certificate please contact Theresa Sauerwine <br />(Email: tsauerwine@tycoint.com Phone: 813-626-5482) <br /> <br />CERTIFICATE HOLJ)ER <br />City of Zephyrhills <br />5335 Eighth Street <br />Zephyrhills, FL 33540-4312 <br /> <br /> <br /> <br /> <br /> <br />