09-9220 - Laserfiche WebLink

Browse Search

06/09/2009 TUE 10:50 FAX 352 686 0081 MEM Resources `) 0001/002 • ACORD , CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY) 06/09/2009 PRODUCER Phone: 352. 686.0986 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE M & M Insurance and Financial Solutions HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4115 Mariner Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spring Hill, FL 34609 INSURERS AFFORDING COVERAGE _ NAIC # INSURED _ INSURER , Atlantic Casualty _ ......._.— _- w......,— ......._� Steven M. Dubois Roofing of Pasco, Inc. mo INSURER B: License #CCCO577681 -- INSURER C: _....- __�.__.. 15348 Green Glen Lane - -...' _— ......_... — _......... INSURER Ot _ _ _ Spring Hill, FL 34610 I p INSURER E: I 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REO UCED BY PAID CLAIMS. " _ ` " " " "`_' - - POLICY EFFECTIVE POLICY EXPIRATION LTR INSRn TYPE OF INSURANCE — - - INS 'R�OO"'ll POLICY NUMBER DATE IMMIDDIM DATE (MMIDDren LIMITS A GENERAL LIABILITY L039001204 -0 08/14/2008 08/14/2009 EACH OCCURRENCE ._ � S 1,000,000 ...,._..•._ ..._ - —• .' _ __ ` - bAMAGE'TOTtE17TEli X COMMERCIAL GENERAL LIABILITY 1 a ocirance) 5._.5.0,000__. — .... _ —! J CLAIMS MADE Ix 1 OCCUR 5 , 9 0 0 PERSONAL & ADV INJURY S 1,000 000_ GENERAL AGGREGATE ___S LQQO OOP ... ,...._ - _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG S 1,000 000 .. PRO 1 1 X...l POLICY — I JFCT L. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - I (Ea accident) ANYAUTO _.__.._..._.._..__ ............_ ._....__.._.. _. ALL OWNED AUTOS BODILY INJURY 5 - (Per person) SCHEDULED AUTOS ___._._..._. ._.v_........._- -- ....._.______ HIRED AUTOS I BODILY INJURY S (Per accident) NON -OWNED AUTOS _._._............__�.____....� _..__.....,.._..__..__ PROPERTY DAMAGE 5 ._.._ ......_ I (Per accident) GARAGE UABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO ' OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S 7 OCCUR Li] CLAIMS MADE AGGREGATE S 5 _I DEDUCTIBLE ( S RETENTION 5 I 5 I I WC STATU- 10TH - WORKERS COMPENSATION AND ... iLORY.UMLTS._.._..... 1 ER -- ,.__......__..- ........ —..... EMPLOYERS' LIABILITY E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S 'ayes, desaibe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 5 1 OTHER DES I RIPTION OF OPERATIONS l LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Zephyrhills Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 5335 8th Street IMPOSE O OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Zephyrhills, FL 33542 REPRES AUTHPRRIZE)REP ESENTATIVE ,/\ } / 1 U\ i RS�.S i.( A _- L .. (it LU / Y�;J t• I { ? \j (LMM) ACORD 25 (2001/08) 0 ACORD CORPORATION 1988 Printed by LMM on June 09, 2009 at 10:46AM