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<br />ACORD". <br /> <br />PRODUCER (954) 943-5050 FAX: <br />Frank H. Furman, Inc. <br />'1314 East Atlantic Blvd. <br />P. O. Box 1927 <br />PODlDano Beach <br />INSURED <br /> <br />CERTIFICATE OF LIABILITY INSURANCE ~7nMnoor> <br /> <br />THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTlRCA TE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />. THE. POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />vc go:': '....,...,.., ...... <br />INSR ADD'L TYPE OF INSURANCE POUCY NUMBER ~~:~ "8i'fl EXPIRAllON <br /> <br />~NERAL UABIUTY <br />~rf2,MMERClAL GENERAL LIABILllY <br />I I CLAlMSMADE [!] QC90R GL01lJ.078 <br />I k <br /> <br />(813)780-0005 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELl.ED BEFORE THE <br />City of Zephyrhills EXPIRA1l0N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />5335 8th Street !Q..... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />Zephyrhills, FL 33542 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br /> INSURER. ITS AGENlS OR REPRESENTATIVES. <br /> AUTHORIZED REPRESENTAllVE ~~# ;L.-.--~~_ <br /> Frank Furman, Jr/JC <br /> <br />(954) 943-5417 <br /> <br />FL 33061 <br /> <br />Longwood <br /> <br />FL 32752 <br /> <br />INSURERS AFFORDING COVERAGE <br />INSURERA:Crum & Forster SDecialtv <br />INSURERB:North River Insurance <br />INSURER C: Steadfast Insurance Co <br />INSURERD:FRSA Self Insurer Fund <br />INSURER E: <br /> <br />NAIC# <br />44520 <br />21105 <br />26387 <br />10023 <br /> <br />. <br /> <br />Collis Roofing Inc. <br />POBox 520668 <br /> <br />LIMITS <br /> <br />A <br /> <br />NN= $ <br />" DAMAGE TO RENTED $ <br /> <br />.,) MED EXP 'A~ one ~\ $ <br /> <br />P~~"'~".' . .~VI"'" RY $ <br /> <br />"""'",,.,, A $ <br /> <br />DR"""I"'T<: _ 1'11....."'p "I'J>. $ <br /> <br />1/1/2008 <br /> <br />1/1/2009. <br />:..r,. / <br />V/ <br /> <br />B <br /> <br />~LAGGR~E LIMIT A~ES PER: <br />I POLICY I X I ~~ I ILlY <br />~OMOBlLE LIABILITY <br />..!.. ANY AUTO <br />_ AlL OWNED AUTOS <br />_ 5O-IEDULED AUTOS <br />...!. HIRED AUTOS <br />..!.. NON-QWNED AUTOS <br /> <br />BODILY INJURY <br />(Per ac:cident) <br /> <br />COMBINED SINGlE LIMIT <br />(Ea accident) <br /> <br />1/1/2008 <br /> <br />1337250375 <br /> <br />1/1/2009 <br /> <br />BODILY INJURY <br />(Per person) <br /> <br />PROPERTY DAMAGE <br />(Pet accident) <br /> <br />GARAGE UABILITY <br /> <br />R ANY AUTO <br /> <br />AUTO ONLY - EA ACCIDENT S <br /> <br />OTHER THAN ".. 4f'''' $ <br />AUTO ONLY: <br /> <br />EXCESSlUMBRELLA LIABILITY <br />jJ OCCUR 0 ClAIMS MADE <br /> <br />C ~DEDUCTBLE AUC914077101 <br /> <br />"x1 R~J:NTIOtJ !: 0 <br />D WORKERS COMPENSATION AND <br />EMPLOYERS' LIABIUTY <br />ANY PROPRIETORIPARTNERlEXECUTIVE _. / <br />OFFICERlMEMBEREXCLUDED? H~/ 870033379,// <br />I ~~,~ribe under (__. _::/ <br /> <br />OTHER <br /> <br />AGG S <br />I~ <br /> <br />1/1/2008 <br /> <br />1/1/2009 <br /> <br />AGGREGATE S <br />$ <br />S <br />s <br />X I WCSTATIJ- IO~- <br /> <br />E.L EACH ACCIDENT S <br />1/1/2008.-<'1/1/20_09 .... E.L. OISEASE-EAEMPLOYEE $ <br /> <br />'- -=>-..,-,--' <br /> <br />E.L. DISEASE - POLICY LIMIT $ <br /> <br />DESCRIPTION OF OPERATJONSlLOCAllONSNEHICLESlEXCLUSIONS ADDED BY ENDORSeMENTlSPECIAL PROVISIONS <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />ACORD 25 (2001/08) <br />INS025 (0108).08a <br /> <br />1,000,000 <br />50,000 <br />Excluded <br />1,000,000 <br />2,000,000 <br />2,000,000 <br /> <br />$ <br /> <br />1,000,000 <br /> <br />$ <br /> <br />$ <br /> <br />$ <br /> <br />3,000,000 <br />3,000,000 <br /> <br />I <br />r <br />I <br />I <br /> <br />1,000,000 <br />1,000,000 <br />1,000,000 <br /> <br />@ ACORD CORPORATION 1988 <br />Page 1 of2 <br />