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From: Jean Reynolds At: Ins By Ken Brown.inc FaxID: To: Riviera Pools Of Tampa Inc Date: 10/28/2009 12:21 PM Page: 1 of 2 <br /> DATE(MM /DD/YYYY) <br /> 111 CERTIFICATE OF LIABILITY INSURANCE RIVIE-3 10/28/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Insurance By Ken Brown , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> PO Box 948117 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Maitland FL 32794 -8117 <br /> Phone:321- 397 -3870 Fax:321- 397 -3888 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA Amerisure Mutual Ins. Co 23396 <br /> INSURER B Amerisure Ins Company 19488 <br /> Riviera Pools Of Tampa Inc INSURERC <br /> 14409 -B North Nebraska Ave INSURERD <br /> Tampa FL 33613 <br /> INSURER E <br /> • <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED FH . H- vE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR COI .I ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFF0RL ED Er THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHC WII b,ta1 Nt-.'. E BEEN REDUCED BY PAID CLAIMS. <br /> AULIL <br /> LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YYYY) DATE (MM /DD/YYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> UHNW <br /> A X COMMERCIAL GEfIE= A__I -LIU�- GL205488801 01/01/09 01 /01 /10 PR EMISes(EaE V RoLN a, enr -e) $ 100,000 <br /> CLAIMS MADE I X F MED EXP (Any one person) $ 5,000 <br /> X Contractual Liab PERSONAL a ADV INTLIPV $ 1,000,000 <br /> X Per Project GENERAL AGGREGATE $2,000,000 <br /> GENL AGGREGATE LIMIT AFF I PE= PRODUCTS- COMP /OP AG $ 2,000,000 <br /> POLICY 2__ L- <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ 1,000,000 <br /> A X ANY AUTO CA20548901 01/01/09 01 /01 /10 (Ea accident) <br /> ALL OWNED ALIT,:'a <br /> BODILY INJURY <br /> SCHEDULED AUTOO (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY ALIT) OTHER THAN EA ACC $ <br /> AUTO ONLY AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE <br /> OCCUR LV.IIL L ./ L E AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ :$ <br /> WORKERS COMPENSATION X TORY LIMITS 0 ER <br /> AND EMPLOYERS' LIABILITY Y I N <br /> B ANYPROPRIETOR /PAPTNER/F.F WC200609208 01/01/09 01 /01 /10 E L E A C H A C C P D E N T $ 1000000 <br /> OFFICER/MEMBER E%CLIJDED' <br /> (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1000000 <br /> If yes, $escnbe under <br /> SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 1000000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> fax 813 - 780 -0021 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> ZEPHYRH DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> City of Zephyrhills IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> Building Department REPRESENTATIVES. <br /> 5335 8th Street <br /> Zephyrhills FL 34248 AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />