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A ° °e CERTIFICATE OF LIABILITY DATE(MM/DD/YYYY) <br /> TY INSURANCE 15/18/2010 <br /> THIS CERTIFICATE IE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CON IAC <br /> Buhl Insurance Agency Inc. P " M E: <br /> P.O. Box 152698. A (( E 7 , J E E,d): 813- 876 -0057 I Fa .N,):813 -877 -8540 <br /> DDRE SS: <br /> Tampa, FL, 33684 -2698 PRODUCER <br /> CUSTOMER ID*: <br /> INSURED INSURER(3) AFFORDING COVERAGE NAILS <br /> RITE TEMP AC SERVICES INC INSURER A: Old Dominion Insurance Company <br /> INSURER B : <br /> 15051 LOMA AVENUE INSURER C: <br /> SPRING HILL, FL 34610 INSURERD: <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADM SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSR MD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> I GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 500,000 <br /> j CLAIMS MADE X OCCUR MED EXP (My one person) _ $ 10,000 <br /> IA MPG75925 12/28/09 12/28/10 PERSONAL BADVINJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> � PRO- PRODUCTS - COMP /OP AGG $ 2,000,000 <br /> $ <br /> I POLICY I I JECT ri LOC — <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANYAUTO (Ea accident) $ <br /> ALL OWNED AUTOS BODILY INJURY (Per person) $ <br /> SCHEDULED AUTOS BODILY INJURY (Per accident) $ <br /> PROPERTY DAMAGE <br /> $ <br /> HIRED AUTOS (Per accident) <br /> NON -OWNED AUTOS <br /> $ <br /> $ <br /> UMBRELLA LIAB OCCUR <br /> EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS -MADE — <br /> AGGREGATE $ <br /> _ DEDUCTIBLE — <br /> $ <br /> RETENTION $ - — <br /> WORKERS COMPENSATION - $ <br /> AND EMPLOYERS' LIABILITY WC STATU- 0T- <br /> H <br /> EXECUiIVE I Y � ! ' N <br /> ANY PROPRIETOR/PARTNER/ �I I TORY LIMITS I I ER <br /> OFFICER/MEMBER EXCLUDED? I I N/A E.L. EACH ACCIDENT $ <br /> (Mandatory in NH) <br /> K es, describe under E.L. DISEASE - EA EMPLOYEE $ <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br /> 1 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Zephyrhills, FL. 33542 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ••`- <br /> 01988 -2009 ACORD ORPORATION. All rights reserved. <br /> ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD <br /> '()a <br />