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<br />ACOR.ll
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<br />CERTIFICATE OF LIABILITy INSURANCE 1 D~~~u;=1
<br />
<br />THIS Cr:RTlFICATc IS Issueo AS A MArlER OF INfOKMAllUI\I I
<br />: ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE :
<br />, HOLD~R THIS CERTIFICATE DOES NOT AMEND. EXTEND ~R '
<br />e-..AL TER THE COVERAGe Afo.FOROED BY _THE POhlCIES BEL W...:..~..,
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<br />iFI'\Ot:>L'C~~
<br />
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<br />Completa Coverage, Ino.
<br />PO Box 908
<br />Palm Harbor, FL 34682
<br />: 727-216-3509 _~ : INSURERS AFFOROING COVERAGE 'NAIC#.,
<br />~LII'IEe> Ace Alwn1num 6 Const;.ruce.i.on, LLC. ~":OIJ~"-H.:"..:-.~~n::",~~.I;;\.d ;J;n:S~~~_.i--_____-i
<br />. Richard Shaffer !~(JRE~__.__~_~__.: I
<br />4926 Airport Road ~'JRE'" c:
<br />Zephyrhills, Fl 33542 : IflSURER 0:
<br />! 1813-782-2616 : INSUR~.R 6
<br />CQVE;RAGES '_.
<br />THE I'Ol.ICIES Oft INSUftANCE LISTED Elf LOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PQUCY PERIOD IND!CAH:D. N01W1THSTA~OINC
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTIVICT O~ OTH~R DOCUMENT WITH RESPECT TO WHICH THS CERTIFICATS MAY BE Issueo 00
<br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POllCIl;.S DESCP-IBe:o HIl\FlEIN IS SU8JECT TO AI.. THE rEFWS. EXCLUSIONS AND COND'TIONe OF suc~ 'I
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BE!:,.. REDUCED BY PAID CLAIMS. I ,
<br />11N~~~ I --1 ~ICY ,"i=~ECTIVI: I ~OLJCYt;XPIRA"'IONT .L_j
<br />,lTII . *110 i . TYPE QF INSURANCE . _~ POLICY I.JUMIilF.R i. o",'f€ (1JIl\l/O!)/'fYl I OAre (MMI!lOIY'I'l : 1I~__+--_-j
<br />: GE"SRAL LI,\!l:LITV , i sI,e" OCC...rt,!E!"C" : e !..t ooo~ 000 '
<br />~~~ERCIALGENER~I,IABILITY I : ~~i~~~~~ri;~~~"~~~"'~r7.- _SO 1000:
<br />I . : Cl.AIMSMAOE L' OCCUR I !~:..DEXP;,MYM.pe,!OO) ! ~ 5 ~ 000-,
<br />I : _ I Binder I: 5/17/2008 i 5/1712009 ~R.J~~~v..'.~'.!:'.~~__.,i_~._LOQQjJLQJL:
<br />Ci I '~:5NE""'l AC;~IlE~ATE 1$ 1 i 000 i QOO I
<br />~N'l AGGRE.rG~E LIMIT AF'PLIE~ PER: l PRO:JI,;C"'$: CDMP/OP "'GG I $ 1_, OOQ.LQ.t;t9_;
<br />. ,PRO- I :
<br />I X f'OUeY I · r: "OC I I ~---J
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<br />~OM.O IilILI!L1ABILTY I. I COMMoIED.SIN. GLElTIMI~ 3_ 500 1000 I
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<br />f--- ::=.,"" I ~~,:" - -'-. - i
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<br />Gt SCfiF,iOULEO^UTOS !I! L?'.'P~'.on) __ $ --1-.__"':
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<br />Hi"EDAU70S Binder i:,.115/:1.7/2008 115/17/2009 'BODUIro.JURY T .:
<br />:- NON.OWNliOAUTOS , iPg,.""ident! I $ :'
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<br />L j 'li~O:>ERTY D',M.~GE ' $ -i--
<br />I (Po, ."",d<tnll I
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<br />I AUTO ONLY. fA ACCIDENT'S I
<br />I 1-._.........-.........---~
<br />I O")oIERTH.f,N _~AAC<:'_;.!.. ,
<br />. AUTO ONLY: !lOG I $ .....;----J
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<br />i I!ACH OCCU~~EI\ICe: i S ..__.... ~.___~
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<br />r-A~,~~f.,~.~~~._".._. ".m.. ,- $ "
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<br />: I x I \Al;5rAl"V~ OlH.1 --~
<br />i ~' T(>rlVllflJlITS. ---...i9-+------+----_~
<br />: E, EA;HAGCIDoNT ~ 100 I 000
<br />iI6/17/2008 : 6/17/2009 ~ISEASE-EAiiMPLO~~~OOi.OOO;
<br />I' ----1-!::':...!:!'tSl::AlS~ "'ULI.;? LIM" :. 100 f 000
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<br />I EXClISS/UMS...Eu.A L1AIlILrTY
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<br />Li OCCUR !_i ';L~IMSMI\DE
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<br />[=1 DEDl,ICTIBLE
<br />I : I ~ET!N'1'ION $
<br />i WCfl!KEflliSCOMPEr~SAl'IONAN"
<br />, EMPLOYERS' llA8lUTY
<br />i A~Y ;>J!lO,""lnOR/.A~rNEIlIE~6CUTI\>e
<br />A OFFlCEA"-'EMllER EXCUlOE::P
<br />g~~1::tiIk~~rrONS ~Iow
<br />i OTHER
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<br />I I . '__ ,i --___----.L.-______ _
<br />I DE8C~I;>T'ON OF OPERATIONS ILoeAr'Or~S/ VEHICLES i EXCLL.S':JNS "'ODED 8'( ENDCRSellllONT I SPECIAL PROVISIONS
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<br />Cove;r;ag-e inc~udeilfo IUcna.:;-d Shaffe:;- Lic8nS@# CllC1329266
<br />
<br />. 516883
<br />
<br />CERTIFICATI!! HOI.DJIJ!R
<br />
<br />CANCELLATION
<br />: S~ULO ANY O~ Ti'li IIBOVIO O.SCRIBF.D POL,ClES e. CANCELLED ~E;(\RE THE EX?I~ATION I
<br />. . . I
<br />: MTe THEREOF, THE l$SlING INSU~eR VldLl ENOE'WOR TO MAll~ DAYS WRITIEN .
<br />~C-;-IC.E TO '..HE CF..rm~'CATE HOLDEP NAMED "'0 THE LEF7 BUT FAilUfolE 10 DO S~ SHALL
<br />IMPOSE NO OBu:....TION or, LIABiLir( OF ANY KI~ID UPON Tf1E INSURER, ,rs r.GE~TS OR
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<br />I AJTHOR'ZED Re"'~eS!!N.Ailve _ ..;-. ~.
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<br />~ACORD CORPORATION ~!}S8
<br />
<br />-r---
<br />
<br />City of Zephyrhills
<br />5.335 e~h St
<br />Zephyrhills, Fl 33542
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<br />ACORO 25(2001/08)
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