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Ciient$i: RODDCON _ ACORD,. T F C t `E OF LIABILITY !NSW ONCE 5/07 /2010 /YYY ') PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lanier Upshaw, inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1115 US Hwy 98 South HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 468 Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Westfield Insurance Company 24112 Rodda Construction, Inc. INSURER B: Bridgefield Employers Insurance 10701 250 E. Highland Drive INSURER C: Lakeland, FL 33813 INSURER D: 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 BY THE 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'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD DATE (MMIDD LIMITS A GENERAL LIABILITY CMM4641613 12/31/2009 12/31/2010 EACH OCCURRENCE $1 AMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occ RENTED $150,000 _ CLAIMS MADE X OCCUR MED EXP (Any one person) $10,000 X PD Ded:1,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 POLICY PRO - JECT X LOC A AUTOMOBILE LIABILITY CMM4641613 12/31/2009 12/31/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS 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 $ A EXCESS / UMBRELLA LIABILITY CMM4641613 12/31/2009 12/31/2010 EACH OCCURRENCE $10,000,000 X OCCUR f CLAIMS MADE AGGREGATE $10,000,000 _ _ $ DEDUCTIBLE $ X RETENTION $ 0 $ B WORKERS COMPENSATION AND 83037282 01/01/2010 01/01/2011 X WC Y LIM STATUT IS ER - I 1 EMPLOYERS' LIABILITY TOR ANY OFFICCER/ME EXCLUDED? E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is included as additional insured with regards to the general liability as their interest may appear. Project: Sleep Lab / Pumonoiogist Office CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Florida Hospital Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN 7050 Gall Blvd NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Zephyrhills, FL 33541 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE ENTATIVE J"� I f 'A!' ACORD 25 (2009/01) 1 of 2 #S144343/M141214 c:11988 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JRW