10-10795 - Laserfiche WebLink

Browse Search

RO® CERTIFICATE OF LIABILITY INSURANCE OPtD CL DATE(MM /DD/YYYY) SOUTH08 07/06/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Headock Insurance - Lakeland HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lakeland FL 33802 Phone: 863- 683 -2228 Fax: 863- 683 -3309 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Nationwide Insurance INSURER B: Guarantee Insurance Company Southern Comfort Enterprises Thomas Lachance INSURER C: 4109 County Road 656 INSURER D: Webster FL 33597 — I 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. INSW UD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YYYY) DATE (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE I O H N I Eu PREMISES (Ea occurence) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ — 7 POLICY PRO- - JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300000 A X ANY AUTO ACPBAPD5904194228 11/12/09 11/12/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR I I CLAIMS MADE AGGREGATE $ DEDUCTIBLE • $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER B OFFICER/MEMBER PROPRIOR /PAR NER /E ECUTIVI 605500251110 07/01/10 07/01/11 E.L. EACH ACCIDENT $ 100, 000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100 , 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500 , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYZEP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE it DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND L' JN YHE INSURER, ITS AGENTS OR City of Zephyrhills REPRESENTATIVES. 5335 8th St. A 1 SENTATIVE Zephyrhills FL 33540 ACORD 25 (2009101) ©1988 - 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD