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<br />- " 'Vii'from Melinda Sponder At: Waites & Foshee Insurance FaxlD: Waites:and Foshee:1 To: Karen <br /> <br />Date: 2/512008 09: 13 AM 'Pag:e:,i2 :efi!h?::-:: '.; <br /> <br /> ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 S~ DATE (MMIDDNYYY) <br /> SOUTH-S 02/05/0S <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Waites & Foshee Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. O. Box 4S03 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Macon GA 3120S <br />Phone: 478-743-05S8 Fax:478-743-05S9 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A Colony Znsurance Company <br /> INSURER B Progressive Casualty Insurance 24260 <br /> Southeastern prot svcs of FL INSURER C FFVA Mutual Insurance Co. l1S6S <br /> Patrick Russell <br /> P. O. Box 1197 INSURER D <br /> Altamonte Springs FL 32715 <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 TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />'LTR Nslle TYPE OF INSURANCE POLICY NUMBER DA';!~ (~Mnf~m)~ DATE' (MMIDD/VYI LIMITS <br /> GENERAl LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> t-- 10/01/07 10/01/0S I ':'CM"~'=- <br />A X COMMERCiAl GENERAl LIABILITY 01116123 PREMISES (Ea occurence) $ 100,000 <br /> :=0 CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 <br /> X Waiver of Subroga BLAJIKET ADDTL %II$D CG2010 PERSONAL & ADV INJURY $ 1,000,000 <br /> t-- . $ 2 ,000,000 <br /> X $1000 deduct~ble GENERAL AGGREGATE <br /> t-- <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 <br /> I n PRO- nLOC <br /> POLICY JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> - $ 1,000,000 <br />B ANY AUTO 2434633-S OS/02/07 08/02/0S. (Ea accldenl) <br /> - <br /> AlL OWNED AUTOS BODILY INJURY <br /> - $ <br /> ~ SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS BODILY INJURY <br /> - $ <br /> X NON-OWNED AUTOS (Per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per aCCIdent) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONL Y AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 4 ,000,000 <br />A ~ OCCUR D CLAIMS MADE UM141140 10/01/07 10/01/0S AGGREGATE $4,000,000 <br /> $ <br /> R DEDUCTIBLE $ <br /> X RETENTION $10,000 $ <br /> WORKERS COMPENSATION AND X ITORVtIMI'T'S I IVER <br />C EMPLOYERS' LIABILITY WCS400015960200SA 02/01/0S 02/01/09 $ 1,000,000 <br />ANY PROPRIETORIPARTNERlEXECUTIVE E L. EACH ACCIDENT <br /> OFFICERlMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $1,000,000 <br /> If yes, describe under $ 1,000,000 <br /> SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br /> CITYZEl SHOULD /W'( OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> - <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />City of Zephyrhills IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br />5335 Sth Street <br />Zephyrhills FL 33542 REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> Harold D. Foshee, III <br /> <br />ACORD 2S (2001/08) <br /> <br />iSlACORD CORPORATION 1988 <br />