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<br />From: Kit'"" Ferris At Greene-Haze' & ;>,sso:, FaxlD: Tc:::ty ofZe"hyrhiils
<br />
<br />Date: 412S12J08 01 :3J PM Page 2 of 2
<br />
<br />ACORD~
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />DATE rMM'DDIWYYI
<br />
<br />OP ID KF
<br />KENNE-3 04/28/08
<br />THiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />AL TER THE COVEMGE AFFORDED BY THE POLICIES BELOW,
<br />
<br />PR:'Dl,CER
<br />
<br />Greene-Hazel & Associates ,Inc.
<br />lO~39 Deerwood Park Blvd, #200
<br />Ja~ksonvi~le FL 32256-2873
<br />Phone: 904-398-1234 Fax:904-396-7432
<br />
<br />INSURED
<br />
<br />I
<br />! INSURERS AFFORDING COvERAGE ! NAIC '#
<br />
<br />~-~-~~lF;' _. .~.:Ilt.ti.ld :nS1.l.rl,nc$ C~.pU'lY -------~-112.---
<br />r~~'~~fr.:-;;--cNA_~n~~ran_~~compa_nies --=;-02I86~~-'
<br />
<br />Kennedy Contractors. Inc.
<br />At tn: f:I.r. Michael Carp'
<br />1495 Forest Hills BlvQ ste A
<br />West Palm Beach FL 33406
<br />
<br />~~:::~~c---___n-'---_---------+-------
<br />, --------~-_____-J...-_____...~______
<br />i II\J~J'EF E
<br />
<br />COVERAGES
<br />
<br />iH:: ~()L1Cit::::. ()F It j:~,U::A',(:E L: STELl b::LOv'.j r"jA',ic_ BEE ' '::;:;'::;1.;[:..[; TU TH= t' i:'Uf.:ED t'J.L",iJ1~LJ ,..l.,bl)',/t: F')~ I-c. P(_li.; "FlRI0L', ~~L'I_AT=D 1'4(":\1 111-:~:i,.u.f\JDi!'i'_~
<br />Nb' RF.:)I_, REt,.1Ef'r TERM ','R:':::lr":',T!CN OF ;:)..J'!.... C:,,'JT::;A':7r ::IP ('i:HF:R COCUr'Il::;'JT ',,",1,-.., RESPECT T') VI/Hie:!; THI:3 ':EPT'FI,:::j;-'~ r,il._y 8E3:3UEC OR
<br />~1A" PEP-'Ai!.,) THE ~JSUf'\,6N~::-E~.FFOR:'E[,' :;'( THE p")L C'ES :)ESCRIBED l-l=REil< '::"3JE,.'E:r':(.' ,A,L_ Tf-:E TfP",1S E/;CLUSiV<::i.l.f\:D ::::>~"~,;OITlutJ:~ ~:,l= SUCH
<br />PCLiCIES .c.',:'l:,R::(.:>C:-;-E. L!~,.1,TS ',:-:HC)-:"m ~J1A( L..l.,L,V'=: ::E.Ef'J h'ECI.i:'EO 8'1 i='t-" 0 l.::t,t;,lt,,:,~,
<br />
<br />
<br />A
<br />
<br />, ,..----.----.-------..,-----------.-----.-
<br />", r;ps; OF 1'.S'.IR"'t-lCE i _ PO~ICV NUMBER
<br />, GEt.ERA~ ~IAB,LiTY
<br />4:0"M=RC'AL "E"EI'".LL,~8UI'
<br />I I i '-:L /~ t'rl:; \l;Df: 'X ! -.{Yj j~
<br />r--'''';---' '-....J
<br />
<br />06/01/07
<br />
<br />-------ro1JCr CffcC, ,VE
<br />~TE (MM/l)Dr(Y)
<br />
<br />I Cl:1I11642516
<br />
<br />I
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<br />r
<br />-~
<br />
<br />,
<br />,
<br />~~~jL-;;:~E(.ATE Li~'.I;T ,~;~~E::' PE;~
<br />~~-l ~(J! 1'- l' ~X-" --I oJD?l' I' '.'Y..:
<br />:--..." 1 ,...<... ,
<br />
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<br />
<br />: ;"UTDMOBlLE U:.BIlI1"\'
<br />l~
<br />I X ' Moly PUTC,
<br />~ '.
<br />~.~ ~'~_' ,:"'l':'!'ED~1 n )::;
<br />1 ':;l_H::DUL[:.D ,-,-1,:-1:1:"";
<br />;-----1
<br />, : HiREI- -"_ ~O= I
<br />
<br />~ ~~;:v~[[~~~: Damage I CMl>11642516
<br />I I -1-
<br />
<br />I QARAGE LICo8'LlTY :
<br />r---' 1
<br />L----i ;l,J~y AUT('
<br />
<br />, I
<br />
<br />06/01/07
<br />
<br />! Cl:1I>11S42516
<br />I
<br />,
<br />
<br />06/01/07 I
<br />
<br />A
<br />
<br />A
<br />
<br />E"CESS;UM8REL~'" lIA81L1TY
<br />[~ r):CUR CJ !:L/-Jrv:~ M,.o.DE
<br />
<br />r=l 'l[[J'XTIE<LC
<br />X I REk',TI(N i 0
<br />
<br />I -
<br />
<br />I Cl:1I>f1642516
<br />I
<br />
<br />06/01/07
<br />
<br />WORKERS COlIIPENSATION AND
<br />EMP~OYERS' LIABILITY
<br />
<br />e A!\jY PRCPRIET:JRlp.c,RT\[RiE:-:.ECUT V[
<br />eFr, :':E';'(.'ME~/,Bt+. Ei_LLJ]E:C',
<br />
<br />2083385468
<br />
<br />06/01/C7
<br />
<br />f Y~'" d"",,::Tit'e ;J;'jer
<br />SPEOA_ PFKlVi~I::'f'i'3 091(1\,','
<br />OTHER
<br />
<br />,
<br />I
<br />06/01/07 i
<br />
<br />B Leased/~ented 12083385437
<br />
<br />Scheduled I
<br />DESCRlPTIC,N OF OPERATIONS/LOCATIONS I VEHICLES / E(C~"'SIONS ADDED BY ENDORSEME',IT / SPECI;lJ. PRcvrSIOt.S
<br />City of Zephyrhills is named additional insured.
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />SHOULD Al-N OF THE ABO',!; e'ESCRIBED POLICIES BE CAN'CE~lED BEF'JRE THE E)PIRATI::>I'J
<br />
<br />oMS wRITTE' :
<br />
<br />ZEPH~lUf
<br />
<br />I P&k'feY(~W;~".,,~~, i-- --------;:I~I~;- ~----~ ----
<br />I I F",H ,)C,:UP'EiK,f ! ; 1,000,000
<br />I H"Tr'~'TE[' I ____..._
<br />I 06/01/08 l~PEI~lsEi,:.E.-';'U~el'O. _ [il_50,()00
<br />: r-/,ErJ f__xP It~I-,1o (In", ppr~l" '1 i $ 10 , 000
<br />~W~'W'"n~ o[ / cU.:"! _~ i i, 0.0 0 _,O~O:' ~~
<br />~=fJERAl~:'OF'~,~=F_~~~~~__
<br />: P~'ODU'::-TS - C(i~,tP/oP .:.o.,G,: : i .2 , 000 ! 000
<br />1------ - - ---- -- - - !--- -- 'n_~._
<br />
<br />, C )HEn~EC'r ,'~.."~ .II--IT
<br />OS/01/0a i '':'aaCc'lcent'
<br />~--_.
<br />
<br />I! 1,000,000
<br />
<br />--i-.--------.
<br />
<br />
<br />06/01/08
<br />i ~t~~!~~~~~ri:,,;'~1h?F $
<br />i 1 ..
<br />L::::'T') '~J~~:'.A(C.I,)H~_____
<br />I "" ;':c r I
<br />, ~._,----,-
<br />i').,l~I-~ I,{
<br />
<br />---r~~,., I-Fr,JC.~':': : 5 000-000"
<br />~ -' '. .' J ____ I-< '"{ .. t: : -f, I
<br />05/01/08 C~~?~E~~,~~_____'_~~-=-~~~ 0 9 LP~6~o'--
<br />: I ;
<br />~--~-_.~~~ Ji-'=-~:
<br />II
<br />! X hj~-/U~Jfi I (lE~ i
<br />~-----_.._~----------------..
<br />06/01/08 I E':.l'.~,~; '<CI~~_-l; 500~0..?____n_
<br />rE [:oE~:SE - Et, flc,H':E I,; 500 ,000
<br />'--------,------.-
<br />i E" C'oE"SE-P')LCY _'IVT I; 500,000
<br />I
<br />
<br />I
<br />I
<br />:
<br />I
<br />i
<br />-r---
<br />
<br />06/01/0a I
<br />!
<br />
<br />~ent/Leas
<br />SchedUled
<br />
<br />50,000
<br />42,500
<br />
<br />OATS; THEREOF THE 'sSU...,G N3URER WI~~ ENDE,<,VOR TO MA'~ 10
<br />
<br />City o~ Zephyrhills
<br />Fax: 813 7800005
<br />5335 8th Street
<br />Zephyrhills FL 33540-4312
<br />
<br />r'!OTICE TO THE CERT1FIC,~TE HO~OER ~;AMED TO THE ~EFT, BUT FAI~URE T::> DC SO ShA,.L
<br />iMPOSE t,JC OBLIGATION OR lIAB'LITY OF ,vw Klf.m UPON TI-IE It~S\J'ReR. ITS AGa-.lTS e"R
<br />
<br />
<br />ACORD 25/2001/08)
<br />
<br />j,EJ;Wrl\'li
<br />,/lPU-
<br />
<br />@ACORD CORPORATION 1988
<br />
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