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* 12/30/2009 10:21 (813- 909 -8743 Paragon Risk Management Jean Shuff -►City of Zephyhills 2/3 Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ��- 12/29/2009 PRODUCER (813) 949 -8636 FAX: (813) 909 -8743 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Paragon Risk Management ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 203 Crystal Grove Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lutz FL 33549 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. FCCI Insurance Group 33472 Banko Overhead Doors, Inc. INSURERS Bridgefield Employers 10701 5329 W Crenshaw St INSURER c. Travelers INSURER D Scottsdale Ins Co Tampa 1 FL 33634 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LI POLICY EFFECTIVE POLICY EXPIRATION LTR INSW TYPE OF INSURANCE POLICY NUMBER DATE (MM /DDIVYYYI DATE IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN X COMMERCIAL GENERAL LIABILITY PREMISES Ea occur ence) $ 300 , 000_ A CLAIMS MADE X OCCUR CPP0003205 -06 1/1/2010 1/1/2011 MED EXP (Any one person) _ $ 10,000 X Blanket Contractual PERSONAL & ADV INJURY $ 1,000,000 X Coverage is Primary GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG , 1,000,000 POLICY PRO- ,IFCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 C X ALLOWNEDAUTOS 3709P468 1/1/2010 1/1/2011 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 $ D DEDUCTIBLE XLS0064191 1/1/2010 1/1/2011 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION W STAT U- OTH- AND EMPLOYERS' LIABILITY proprietor /partners /exec X TOR YLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE a officers incl E L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 0830 -31494 1/1/2010 1/1/2011 E . DISEASE - EA EMPLOYEE $ 500,000 I y es, describe under S PECIAL PROVISIONS below E . DISEASE - POLICY LIMIT _ $ 500,000 A oTHERproperty - BPP CPP00032055 1/1/2010 1/1/2011 ded $500 $600,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (813) 780 -0021 Ph: 813- 780 -0020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Zephyrhills - Building Dept. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 5335 8th Street Zephyrhills, FL 33542 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ((,, Nathan Jensen /JEANS �e —. S ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD