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1 • <br /> ACORD � CERTIFICATE OF LIABILITYINSURANCE DATE (MM/DD/YYYY) <br /> L� i 09/15/2009 <br /> PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 200 PUBLIC SQUARE, SUITE 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> CLEVELAND, OH 44114 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 11111 - SHORT - .TERM - 09/10 ANTR INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED - -- - -- -- -- - -- - - -- <br /> wSURER A: Zurich American Insurance Co 16535 <br /> DIEBOLD, INCORPORATED — — - <br /> 5995 MAYFAIR ROAD INSURER B: T <br /> NORTH CANTON, OH 44720 -1594 INSURER C: American Zurich Insurance Co. <br /> INSURER D- <br /> INSURER E: <br /> COVERAGES — 2 -- <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br /> MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br /> CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INS ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR INSRL DATE IMMIDDPYYYY) DATE (MM/DD/YYYY) <br /> A GENERAL LIABILITY GLO 9302935 -07 03/01/2009 03/01/2010 EACH OCCURRENCE $ 2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 000 000 <br /> PREMISES(Ea occurrence) $ <br /> CLAIMS MADE , I OCCUR MED EXP (Any one person) i $ 5,000 <br /> PERSONAL & ADV INJURY $ 2,000,000 <br /> _ —._ -- —.— GENERAL AGGREGATE $ 4,000,000 <br /> GENERAL AGGREGATE LIMIT APPLIES PERT <br /> i t PRO- n <br /> POLICY PRODUCTS - COMP /OP AGG $ 4,000,000 <br /> -- - <br /> JECT ,� LOCI <br /> AUTOMOBILE LIABILITY BAP 9302929 -07 03/01/2009 03/01/2010 <br /> A I I I II COMBINED SINGLE LIMI <br /> X 1 $ 5,000,000 <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS '� (Per person) <br /> I HIRED AUTOS <br /> X _ BODILY INJURY $ <br /> X NON -OWNED AUTOS (Per accident) <br /> X COMP. & COLLISION PROPERTY DAMAGE <br /> SELF- INSURED (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: $ <br /> AGG <br /> EXCESS ! UMBRELLA LIABILITY EACH OCCURRENCE I$ <br /> OCCUR r - CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> $ <br /> RETENTION $ <br /> C WORKERS COMPENSATION AND WC 9303933 -07 (AOS) 03/01/2009 03/01/2010 X WC STATU- OTH- $ <br /> C EMPLOYERS' LIABILITY ] WC 9302934 -07 (KY,WI & MA) 03/01/2009 03/01/2010 TORY I IMITS FR <br /> ANY PROPRIETORJPARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 <br /> A OFFICER/MEMBEREXCLUDED? WC 9302937 -07 (ID) 03/01/2009 03/01/2010 - -- <br /> N I ! =.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br /> (Mandatory in NH) Eyes, describe under <br /> SPECIAL PROVISIONS below F.L. DISEASE - POLICY LIMIT j $ 1,000,000 <br /> OTHER <br /> � I <br /> DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CLE 002450518 - 02 CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> CITY OF ZEPHYRHILLS BUILDING DEPT. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 5335 8TH STREET 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> ZEPHYRHILLS, FL 33542 <br /> BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br /> UPON RE THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> of H REP i-„ (1 _ tc - `_' <br /> Liz ` xJ``� PIw.a ^+^"� <br /> ACORD 25 (2009/01) © 1998-2009 ACORD CORPORATION. All Rights Reserved <br /> The ACORD name and logo are registered marks of ACORD <br />