|
<br />MAR-04-08 TUE 09:05 AM
<br />
<br />CUSTOM DR I LLI NG
<br />
<br />P. 04
<br />P.001/002
<br />
<br />FAX NO. 863 425 9620
<br />_03/~g008_ 16:00 Jefferson AUsopp Inc FAX 8636886417
<br />-AC'ORlJ." CERTIFICATE OF LIABILITY INSURANCE
<br />FAX (863)683-3790
<br />
<br />PATE (MMICOIVVVY)
<br />03/03/2008
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />~ TE~ THE COVERAGE AFfORDED BY THE PQ.L1CIES BELOW.
<br />
<br />PRODUCER (863)638-7691
<br />JEH f.RSON-ALLSOPP, INC.
<br />POBOX 3667
<br />439 S. FLORIDA AVE.. SUITE 201
<br />LAKHANI), H 33802-3667
<br />iN$URiiii tlJSt{)M.i)RHI.IN(j -SERVIcIs;-rNC
<br />100 KID ELLIS 1m
<br />MIJLBERRY, R 33360
<br />
<br />I INSURERS AFFORDING COVERAGE
<br />;;jSL;;ER-;- HARTFOR6-iNSURAN:E--GROOP-..--.-----.
<br />II~sijReR.e--.13RtDGEFIElD--Eiip LOVERS -jNs-c6~--- --
<br />ii~i:uR~ilc-.-AIG-.--- .__n.__.____ ------.--.---.----
<br />
<br />NAlC#
<br />
<br />,NSURr.H n
<br />
<br />FAX: 363-42S~9620
<br />..-...-----..
<br />CV GE _
<br />
<br />nlE POLICIES OF INSURANCE LISTED BE LON HAVE BEEN ISSUED TO mE ",$UREO NAMED ABOVE FOR THE POUCY PERIOD r-IDICArED. NOTWITHSTANDNG
<br />ANY REQUIRFMENT, Tf.f{M OR CONDITION OF ANY CONTRACT OR orHER DOCUMFI~T Wlnl RESPECT TO WHICH THIS CERnFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, 1t1E INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJEC"nOALL THE TERMS, EXCLUSIONS AND CONOITIO'lS OF SUCH
<br />POliCIES. ^GGRmAT~ UMITS 5HOIIVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />ffit ~I. C~N:;~:~~~ii~~c.<--.~.: :F:~:.~.~~L~ffJ~T~~~~~ .~~:~~:~;:~~
<br />
<br />x.] C')MI<ll"'C1AL ';J]Il~'~:t:^IJILITY I I
<br />r ]",1 AIM:: I~AII' Lx 1 '" .,,-,P,
<br />
<br />A ~t,;~,~,:,:,,;,',,:,,;;;,; I I
<br />J;'i.:i~j ~J~!".L b',i -----', 2uwf830431 04 ;15;i007 ../15 /200. ,~."" ,"0,,, ,""
<br />
<br />X .A!{( J\U!(.\ (Ea dCCI(JlJflt)
<br />--.--.---.-. ....-
<br />/It L 0'1'11<( () AI)T(,~' E~)DIL Y INJURY
<br />'" '1I[IJ~II.fJ> AI""OS I (Pe< po"on)
<br />
<br />IN~I)"'F.R.
<br />
<br />.__m ..._. .__ ...._....~..--.--.----.--._-..m--...-...---.. ..... __ _.. __.... .
<br />POUCV EXPIRATION LIMITS
<br />04/1 S /2008 l^(~1 Or;CU~RE:IKE $ 1. 000 :00
<br />'~~f[1~~J!i~~,~.~~.::: ! .:..~._:..:: 'j~~g))Q..
<br />
<br />MED EXP (AnyM. porsonl $ 10,00
<br />.'-'--- -.---. ------..-..--- ~ - -.. ..- ...-. ..---.-- .-..-... ----
<br />~H.:;':'NJ\L J, A!)IIINJ.'~'Y $ 1.000,00
<br />r..--..------- -,..-.--..,-.-.----
<br />I ,;fNH"" A(;~~~A1F.__ _. _~___._l-,.Q~QJ!O
<br />, PR_~'~J~:T_~ :..~M~'r:o.~~'.~;_ '!.___'?'!.QO.Q..,~Q._
<br />
<br />
<br />A
<br />
<br />X 1-1'llD Allf<:'.'~
<br />,.x' f\l(if\. ()WNE:f)Jllrr(<;
<br />
<br />IlODI L Y INJURY
<br />Wor 8cCloonll
<br />
<br />.- '1-
<br />
<br />PROPE:~11 DAMAGE:
<br />(pQ:r aCCtdc-rlt)
<br />
<br />GARAGE LIAIlILI1Y
<br />
<br />
<br />
<br />,t~;.;" U;;;~",- ,- ----'iiiiNiil27"
<br />
<br />..~] (I,; "'.Ill [.~. 1 ';L {'.: t,15 la,DE
<br />
<br />I OTHER THAt-:
<br />AL'TO ONLY
<br />
<br />AUTOONLY.fIlAC(.I[lfNl $
<br />---.. .,- - .--..-.-------. ....
<br />Ell Ace $
<br />1-G(, ,
<br />5:~~I.~O'C?~:~~_"__ ._.!...___.~!Q~~, ()Q.
<br />~..__._._4., !>QQ,9Q.
<br />$
<br />
<br />AG'3REG'TE
<br />
<br />
<br />04/15/2007 041f5/2oo3
<br />
<br />A
<br />
<br />I
<br />
<br />___u. -.------------fi6-2397Sl-l>4 /1 S/i007 04/1 S/2003
<br />
<br />
<br />(:':'i~:~ ..)IS!iDD7 '04/15/200.
<br />I
<br />
<br />[lEse ~ oi'oi>f.RAwNSiTOCATlON$1 VEHICLES I EXCI.USIONS AOO~O BY HIOOR~ENT I SPECIAL PROVISIONS
<br />
<br />. .J ll[L~-,r:T111Lr:
<br />.__.. ,.J.~,~r.~t~(:~~__ uL._..__
<br />WORKfiRS cnMP~NS,' TluN ANO
<br />E:Mi'LO\'EflS'LlAfllI.ITV
<br />n :~~i;ln~;~;:I:~t~;f~~~.~~I~[0i~~~.~'[.,( '..1 fiVt,
<br />
<br />~
<br />~----------- -. .-----------. .--------
<br />
<br />If)'{,!, d"I;'..rII":\lm1~-!'
<br />_... ~~~:~!~ ~~'~~YI.~.~J;~!~~~:~__.._ ___. _>.r._ A~___ _..____.
<br />
<br />$
<br />~ J1,~1.r~~JY~T:J!L~' __=_~.-.=h._.._..__.
<br />.~L~:'~H_~:::a(~L ~.____nJt~~JqQ_
<br />~.':.Cl_~.r~:!5~A_~_~~~O![}: .~ ..... .1.,9QQ.,_Cl9.
<br />fl lJISEASf' - POlll;Y LIMIT ~ 1 000 00
<br />-------ss-, 000 '-000 -
<br />$5,000,000
<br />S2S,000 DEDUCTIBLE
<br />
<br />OT~tl
<br />C LlIHION LIABILITY
<br />:CIJRRENCE fORM
<br />
<br />m;8lliJi~_ CANCELLAnON
<br />{ SIIOULO ANV OF TIlE ABOVE DESCRIBED POLICIES BE CANCB.LED BEFORE THE
<br />EXPIRATION DATE THEREOF, TliE ISSVING INSURER VII!.L ENDEAVOR T.O MAIL
<br />10 DAYS V\RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />~;'~;':;LURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR lIABILITY
<br />tHY OF ZEPHYR" ILLS OF ANY KINO UPON TIotE INSURER. ITS AG~S OR REPRESENTATIVES.
<br />sns 8th STREET A':THORlZEDREPRESENTATI'JE ('J . .I Lt./
<br />ZEPIIYRHILLS, FL 33542 DAVID W. SCOTT /DIANE ~..:t' /. (
<br />____._-- @lACOROCORPORA1ION 1988
<br />._.._~_........_-
<br />
<br />ACORD '5 (2001 (08)
<br />
|