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<br />fl-.~Eeb'1B-D8 02:47p <br /> <br />Southern Site Works <br /> <br />- 0 -.Fee '1 p.~ i.: . <br /> <br />813-788-6156 <br /> <br />p,3 <br /> <br />- .:-;-F:e15- <br /> <br /> ACORD... CERTIFICATE OF LIABILITV'INSURANCE CSR SF I OA'tE rNMIOO/YNVYI.. <br />. SOUSI-l 0"5130jD7 <br />PRODUCER , ~- , THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION_ <br />. .Wallace Welch &; Willingham Inc ; 'p~' .ONlYANDCONFERS NO RIGHTS UPON THE CERTIFICATE <br />-~ <br />300 "First Avenue South, 5th Fl ' - HOLDER, 'THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 33020 . - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br />St. Petersburg FL 33733 <br />Phone: 727-522-7777 Fax:727-52~-2902 INSURERS AFFORDING COVERAGE NAIC# <br /> - , ..-_._..~... ,. ,- <br />INSURED INSURER A: Bitum:inous 02075 <br /> INSURER B: Federal Insurance Company 20281 <br /> -, <br /> Southern Site Works Inc INSURER C: <br /> ..-. <br /> 4639 Bouyh Rd INSURER D: <br /> Zephryhi Is FL 33541 INSURER E: <br /> <br />$1,000,000 <br />OS/25/08 $100, oq,~ <br />MED EXP IAny cn9 person) ,$ 5/_.000 <br />PERSONA~ & AOV INJURY I $ 1 , 000.,000 <br />.G.!~RALAGGREG"TE , $ 2,000,000 <br />PRl?DUCTS - COI/P/OP AGG i $2 , 000 , 0 Q~ <br />Em Ben. ! 1 000,000 <br /> <br />COVERAGES <br /> <br />THE FOLlCIES OF INSURANCE LISTED eELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR n-,E POLICY PERIOD INDICATED. NOTWITHSTANOII\G <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAT: MAY BE ISSUED OR <br />MAY PERTAIN, THE INSIJRANCE AFFORDED BY THE POL~CIES DESCRIB:C HEREIN IS SUa:ECT TO ALL THE TERMS, EXClUSIONS AND CONDITIONS OF Sl:CH <br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br />LTR TYPE OF INSURANCE POUCY NUMBER <br /> GENERAL LIABILITY <br />A X COMMERCIAL GENERAL LIABILI1Y CLP3242326 <br /> CLAIMS MADE X OCCUR <br /> X Contr Blk t Addl I <br /> POLICY Loe <br />A X ANY A"TO CAl?3513128 <br /> ALL OWNED AUTOS <br /> SCHEDUlED AUTOS <br /> HIRED AUTOS <br /> NON-OWNED AUlDS <br /> GARAGE LIABILITY <br /> ANY AUTO <br /> EXCESSIUMBRELLA LIABILITY <br />A X OCCUR C CLAIMS MADE CUP25752,8 <br /> DEDUCTIBLE <br /> .X RETENTION $10,000 <br /> <br /> <br />OS/25/07 <br /> <br />OS/25/07 <br /> <br />COMBINEO SINGLE LIMIT <br />OS/25/08 (El; accidento <br /> <br />BODIL Y INJURY <br />(Per person J <br /> <br />BODIL Y INJURY <br />(Per acclden:; <br /> <br />PROPERTY DAMI\GE <br />(Per accidenl; <br /> <br />AUTO ONLY - EA ACC ICENT ,$ <br />EAACC ; $ <br /> <br />OTHER T~AN <br />AUTO ONLY: <br /> <br />OS/25/07 <br /> <br />EACH OCCURRENCE <br />OS/25/08 AGGREGATE <br /> <br />WORKERS COMPENSATION ANO <br />EMPLOYERS' LIABILITY / <br />A ANYPRCPRIETORtPARTNERlEXECUTIVE WC3513127 OS/25/07 OS/25 08 <br />OFFICERlME....BER EXClUDED? <br /> <br />U~~~r~R~.)l~m~S telow <br />i OTHER <br /> <br />B ! Equipm.ent F~oater 06639832 OS/25/07 OS/25/08 <br /> <br />! Leased/Rented <br />DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> <br />ITQ8-'LlIMITS i ER <br />E,L, EACH ACCIDENT <br />E.L. DISEASE. Ell EMPLOYEE. <br />E.L. DISEASE - POLICY LIMIT <br /> <br />Per item <br />Deduct <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />LIMITS <br /> <br />~~_l, 000,000. ____ <br /> <br />'$ <br />i <br /> <br />1$ <br /> <br />$ <br /> <br />AGG, $ <br /> <br />: $l,OOO,-O.o~ <br />_ l$l,OOO,Oqo <br />.$ <br />$ <br />$ <br /> <br />$ 1000000 <br />$ 1000000 <br />$1000000 <br /> <br />$250,000 <br />$2500 <br /> <br />City of Zephryhills <br />Licensing Division <br />5335 8th St <br />Zephyrhills FL 33540 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POl.ICIES BE CANCELLED BEFORE THE ElCPlRATIO <br />DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER ItAMED TO THE ~EFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UP'ON THE INSURER, ITS AGENTS OR <br /> <br />CITYZEP <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br />lYE <br /> <br />@ACORD CORPORATION 19S <br />