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<br /> 0;t;(5 :.Jf'.:l " .r--1J <br /> l <br />ACORD CERTIFICA~ ~E OF LIABILITY INSURANCE I DATI! (MIIIODIYYVVI <br /> 71Il , 06/27/2007 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Bauer & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />12210 US Highway 301 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Dade City, FL 33525 <br />(352)567.3702 INSURERS AFFORDING COVERAGE NAIC tI <br />INSURED JOHN SMITH INSURER A: AUTO OWNERS INSURANCE <br /> 4240 COATS ROAD INSURER B: <br /> ZEPHYRHILLS, FL 33541 INSURER C: <br /> (813)782-0470 INSURER 0: <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE liSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERUS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DO' POLICY NUMBER POLICY EFfeCTIVE POLICY EXPIRATION LIMITS <br /> ~NERAL LIABILITY EACH OCCURRENCE $ 300 000 <br />A X COMMERCiAl GENERAL lIABiliTY 20632794-07 05101/07 05101/2008 DAMAGE TO RENTED s N/A <br /> f-- ~ CLAIMS MADE [K] OCCUR MED EXP IAnv one a.-son) S 5,000 <br /> f-- PERSONAL & ADV INJURY S 300,000 <br /> f-- GENERAl AGGREGATE S 600,000 <br /> ~rAGGRFE liMIT APnS PER: PRODUCTS - COMPIOP AGG S 600,000 <br /> POLICY ~~,P.,: LDC FIRE DAMAGE $50,000 <br /> r-!!!TOM08ll.E LIABILITY COMBINED SINGLE lIMIT $ <br /> ANY ALrrO (Ea ac:ddenl) <br /> I- <br /> I-- All OWNED AUTOS BODILY INJURY <br /> S <br /> SCHEDULED AUTOS (Per person) <br /> t-- <br /> I-- HIRED AUTOS BODilY INJURY <br /> S <br /> NON-oWNED AUTOS (Per accident) <br /> - <br /> - PROPERTY DAMAGE S <br /> (Per aa:idenl) <br /> ~E lIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANYALrrO OTHER THAN EA ACC S <br /> AUTO ONLY: AGG S <br /> 5ESSlUMBRELLA LIABILITY EACH OCCURRENCE S <br /> OCCUR [J CLAIMS MADE AGGREGATE $ <br /> $ <br /> ==1 DEDUCTIBLE $ <br /> RETENTION S $ <br /> WORKERS COMPENSAnON AND I ~~r~#~ I IOJ~- <br /> EMPLOYERS' LIABILITY E.l. EACH ACCIDENT <br /> ANY PROPRIETORlPARTNERlEXECunVE S <br /> OFFICERlMEMIIER EXCLUDED? E.l. DISEASE - EA EMPLOYEE $ <br /> I g~~l~~ribe under !low E.L. DISEASE - POLICY LIMIT $ <br /> OTHeR <br />DESCRIPTION OF OPERATIONS IlOCAnONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />GENERAL CONTRACTOR <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />CITY OF ZEPHYRHILLS SLOG OEPT <br />5335 8TH ST. <br />ZEPHYRHILLS, FL 33540 <br /> <br />SHOULD IUl'f OF THEABOI/E DESCRI8ED POLICIES BI! CANCI!LlI!D BI!FORE THE eXPIRATION <br />DATE THEREOF, THE ISSUING INSURER Will ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />NOTICE TO THE CERnFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAlL <br />IMPOSE NO OBLIGATION OR LIABILITY OF IUl'f KIND UPON THE INSURER, ITS AGENTS OR <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br /> <br />TOO~ <br /> <br />"JNI 'JOSSV ~ H30Va <br /> <br />~~~O~ZSZS~ XVd ~~:TT LOOZILZ/90 <br />