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09/16/2009 WED 08:14 FAX 8138881170 DIEBOLD INC Ci003 /004 <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIDOrWYy) <br /> v 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 10,00 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 - <br /> NAIC # <br /> INSU INSVRER A. Zurich American Insurance Co 16535 <br /> DIEBOLD, INCORPORATED <br /> 5995 MAYFAIR ROAD INSURER B• <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 OTIICR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br /> MAY BE ISSUED OR MAY NCRTAIN, THE INSURANCE AFFORDED BY THE PCLICI DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS. EXCLt191ONS AND <br /> CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> 1NSir ADO'L TYPE OP INSURANCE I POLICY NUMBER 1 I.QUe' a'pern v[ POUCYEKPIRATION <br /> 1 R INSRC PATE (mwoorY OATE(raeoorwyv) LIMITS <br /> LY <br /> A ENEWIL UABILnY GLO 9302935.07 03/01/2009 03/01/2010 EACH occ L 2,000.000 <br /> DAMAGE TO RENTED 1 000 <br /> X I COMMERCIAL GENERAL LIABILITY 000 <br /> II PRFMISESIEa Occurrence) $ <br /> 1 • J CLAIMS MADE nccuR I MEO EXP (Any one parson) $ 5,000 <br /> d PERSONAL a ADV INJURY $ 2.000.000 <br /> GENERAL AGGREGATE 4 <br /> GENERAL AGGREGATE LMI APPLIES PE PRODUCTS- COMP/OP AGG $ 4,000.000 <br /> 1 I POLICY 5T7 JEcr El LOC <br /> A AUTOMOBILELLABILRY BAP 9302929.07 ' 03/01/2009 03/01/2010 COMBINEDSINCLELIMIT <br /> ANY AUTO (Eaacxlr) s 5,000,000 <br /> low <br /> ALL OWNED AUTOS 1 BODILY INJURY $ <br /> SCHEDULED AUTOS (Pm' pw5Pn1 <br /> X HIRC) AUTOS " <br /> BODILY INJURY $ • <br /> X NON-OWNED AUTOS (Per sodden() <br /> x COMP. & COLLISION PROPERTY DAMAGE ' <br /> 1 SELF - INSURED I (Peracadenq IS <br /> GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY $ <br /> AGG <br /> EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR 17 CLAIMS MADE AGGREGATE $ <br /> — DCDUCTIDLC - $ <br /> $ <br /> - RETENTION S — "" <br /> 0 WORKERB COMPENSATION AND WC 9303933-07 (AOS) 03/01 /2009 03/01/2010 X WCSTATU- 0TH- $ <br /> C EMPLOYERS' LIABILT' WC 9302034.07 (KY,WI & MA) 03/01/2009 03/01/2010 TE 1 `R <br /> ANY PROPRIETORrvARTNEWEXECUTIVE Y r N e L EACH ACCIDENT S 1,000,000 <br /> A OFFICER/MEMBEREXCLUDED WC 9302937.07 (ID) 03/01/2009 03/01/2D1D <br /> (� C.L. DISEASE - EA EMPLOYEE$ 1.000.000 <br /> IuF.Indamry In NH M yey, describe under <br /> PECIAL PROVI�IONR twlnw E L DISEASE • POLICY LIMIT 1$ 1,000,000 <br /> OTHER <br /> I <br /> DESCRIPTION OF OPCKATIONSILOCATI0N9 /VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br /> L. I <br /> CERTIFICATE HOLDER CLE 002450518 - CANCELLATION <br /> SHOULD ANY OF THE ABOVE OE$CRIBEO POLICIES BE CANCELLED BEFORE THE <br /> CITY OF ZEPHYRHILLS BUILDING DEPT. ExPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 5335 671 STREET 3O DAYS WRrrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> ZEPHYRHILLS, FL 33542 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILrrY OF ANY KINO <br /> UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 1 <br /> AU7NOR2ED REPRE5ENYATIVC - I <br /> of MUnO USA Inc. .. ' �pwA r.G-til <br /> Licbeth Hartranft <br /> ACORD 25 (2009/01) O 1998 -2009 ACORD CORPORATION, All Rights Rosorvod <br /> The ACORD name and logo are registered marks of ACORD <br />