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09-9949
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09-9949
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Last modified
1/19/2011 3:28:53 PM
Creation date
1/19/2011 3:28:50 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
09-9949
Building Department - Name
PRIMERICA GROUP ONE
Address
7810 GALL BLVD
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_ ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/09/yyYYl <br /> 12/15/09 <br /> PRODUCER 1- 630 -773 -3800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR <br /> Two Piero* Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Itasca , IL 60143 - 3141 <br /> Morgan Dudsik 630 - 285 - 4439 INSURERS AFFORDING COVERAGE NAIC# <br /> — <br /> INSURED NSURERA: LM INS CORP 33600 - <br /> Ieon identity Solutions Inc <br /> ABA as Imagecare Maintenance Services INSURER B:LXBERTY INS CORP 42404 <br /> 1418 &lmhurat Road INSURERC:BT PAUL FIRE & MARINE INS CO 24767 <br /> Elk Orovo Village, IL 60007 INSURER D:LIBERTY MOT FIRE 108 CO 23035 <br /> INSURERS PIR8k' NE FUND IND CORP 11380 <br /> COVERAGES <br /> THt POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADD'L POLICY EPfCCTrve POLICY EXxPIRATION <br /> 17F1 IN9RO TYPE nF INSI IRANer POUCY NUMBER DA IM DAT8 rnWfODn'YI Lean <br /> A GENERAL T85141336181039 03/28/09 03/28/10 EAOHOCCURRCNCE 91,000,000 <br /> DAMAGE it) KILN t <br /> X COMMERCIAL GENERAL LIABILITY PREMISES (Es oteurence) 5500,000 AL <br /> CLAIMS MADE I OCCUR MED RAP (Any one person) $ 10, 000 <br /> PERSONAL &ADVINJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> , GEN 'LAGGREGG LIMIT AFFUEE5 PRODUCTS- COMP /OPAGG 52,000, <br /> P O L I C YT A 1 1 ° LOG <br /> �H AUTOMOBILEUABILITY AS7141436181029 03/28/09 03/28/10 <br /> COMBINED SINGLE LIMIT <br /> © ANYAUTO (E. acaden) $1,000,000 <br /> • <br /> ■ ALL OWNED AUTOS <br /> BODILY INJURY <br /> SCHEDULED - (Par person) 9 <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X I NON - OWNED AUTOS (Par accident) <br /> • PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY — AUTO ONLY -EA ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY; AGO 9 <br /> C I EXCESSIUMBRELLALIABILIty Q106803107 03/28/09 03/28/10 EACHOCCURRENCE $ 25,000,000 <br /> X OCCUR 7 CLAIMS MADE AGGREGATE $ 25,000,000 <br /> 8 - <br /> DEDUCTIBLE <br /> RETENTION $ 10,000 <br /> D WORKERS COMPENSATION APO MC2141436181019 03/28/09 03/28/10 X I WCSTATU OTn. <br /> EMPLOYERS' LIABILITY TORYUMITS FR <br /> ANY PROPRIETOR /PARTNER/EXECUTIVE E.L EACH ACCIDENT 91,000,000 <br /> OI PICER/MEMSEREXCLUDED? <br /> lives. oeecnbe EL DISEASE - EA EMPLOYEE 91,000,000 <br /> SPECIAL PROVISIONS below DISEASE - POLICY LIMIT $1,000,000 <br /> OTHER <br /> E Sxceas Liability 98100082184110 03/28/09 03/28/10 Occ /Agg 10MNx25M <br /> DE8CRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES / 5XCLUBIONE ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br /> *See Attached for Additional Insured Informations <br /> CERTIFICATE HOLDER CANCELLATION 10 Days Notice of Cancellation for NonPayment <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> city of Zephyrhills, FL GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS wanTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO 714E LEFT, BUT FAILURE TO DO SO SHALL <br /> 5335 8th street IMPOSE NO OBLIGATION OR UABIUTY OP ANY KIND UPON THE INSURER ITS AGENTS OR <br /> REPRESENTATNES. <br /> Zephyrhille, FL 33542 AI/THORI2 DREPREBENTATIVE — <br /> U8A <br /> ACORD 25 (2001/08) j heath m `e4 -..*.. V. .4.^ <br /> 13836951 ACORD CORPORATION 1988 <br />
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