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15x2TcL2 CERTIFICATE OF LIABILITY INSURANCE 1 7/7/2010 <br /> THIS CERTIFICATE IS 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. Astatement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> RODUCER `NAME: L.I HAY SAM GEORGI <br /> CENTRAL STATE INSURANCE PHONE _ FAx 407 339 - 959 <br /> ADDRESS: <br /> 1113 E Altamonte Dr {{ac ND, csinsurance@ cfl . rr . co (ac No): (407)339-959F. ' <br /> Altamonte Springs, FL 32701 -5000 PRODUCER ID #A095539 <br /> INSURER(S) AFFORDING COVERAGE NAIC# <br /> ISURED METRO AIR TECH, INC. INSURER A: AMERICAN VEHCILE INS CO. <br /> INSURER B: OLD REPUBLIC SURETY <br /> 118 N. ORANGE BLOSSOM TRAIL INSURER C : <br /> ORLANDO, FL 32805 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> :OVERAGES 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 /> SR ADDL SUBR POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE INCR INNS POLICY NUMBER MM/DD (MM/DD/YYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( <br /> X COMMERCIAL GENERAL LIABILITY PREMISES (E occurrence) $ 100,00( <br /> I CLAIMS -MADE Fill OCCUR MED EXP(Anyoneperson) $ 5,00( <br /> A GL0511048171 s 02 -28 -11 PERSONAL B ADVINJURY $ 1,000,00( <br /> GENERAL AGGREGATE $ 2,000,00( <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,00( <br /> — I POLICY I JECT n LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANYAUTO BODILY INJURY (Per person) $ <br /> ALLOWNED AUTOS BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> HIRED AUTOS (Per accident) $ <br /> NON -OWNED AUTOS $ <br /> $ <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS -MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> _ RETENTION $ $ <br /> WORKERS COMPENSATION 1 W C Y LAT 1 I OTH <br /> AND EMPLOYERS' LIABILITY Y!N ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N /A <br /> (Mandatory In NH) E.L DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE- POLICY LIMIT $ <br /> B BOND W150040051 11 -06 -09 11 -06 -10 $5, 000 <br /> ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br /> C INSTALLATION & REPAIR. <br /> : ERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills building dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5335 Eighth Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Zephyrhills, FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> TEL:813- 780 -0020 AUTHORIZED REPRESENTATIVE <br /> FAX:813- 780 -0021 1k �" •h <br /> JBOGES @CI.ZEPHYRHILLS.FL.US <br /> 1 <br /> © 1988 -2009 ACORD CORPORATION. All rights reserved. <br /> ■CORD25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />