Laserfiche WebLink
" Certificate of Insurance Page 1 of 1 <br /> 1 <br /> B Employers <br /> Insurance Company,. TM 1-800-282-7648 <br /> P.O. Box 988 (863) 665 -6060 <br /> Lakeland, FL 33802 -0988 Member of Liberty Mutual Group Fax (863) 666 -1958 <br /> CERTIFICATE OF INSURANCE <br /> RE: 0830 -44796 Producer: Brian C. Hunter <br /> ISSUED TO: City of Zephyrhills Bldg Dept Company: Automatic Data Processing <br /> 5335 8th street Insurance Agency <br /> zephyrhills, FL 33542 Address: 1 ADP Blvd. <br /> Roseland, NJ 07068 -0000 <br /> Phone: (800) 524 -7024 <br /> This is to certify that Apple Sign & Awning, LLC 1635 N DALE MABRY HWY LUTZ FL 33548 -3000, being <br /> subject to the provisions of the Florida Workers' Compensation Law, has secured the payment of any workers' <br /> compensation benefits due by insuring their risk with the Bridgefield Employers Insurance Company. <br /> POLICY NUMBER: 0830 -44796 WC Statutory Limits - -State of Florida <br /> Employers Liability <br /> EFFECTIVE DATE: April 14, 2010 1,000,000 (Each Accident) <br /> 1,000,000 (Disease - -Each Employee) <br /> EXPIRATION DATE: April 14, 2011 1,000,000 (Disease -- Policy Limit) <br /> This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this <br /> certificate shall be construed as amending, extending, or altering coverage not afforded by the policy shown <br /> above or affording insurance to any insured not named above. <br /> The policy of insurance listed above has been issued to the named insured for the policy period indicated. <br /> Notwithstanding any requirement, term or condition of any contract or other document to which this certificate <br /> may pertain, the insurance made available by the described policy in this certificate is subject to only the <br /> terms, exclusions and conditions of such policy. Paid claims may have reduced the shown limits. <br /> If the policy described above is cancelled before the expiration date indicated, the issuing company will <br /> endeavor to mail 30 days' written notice to the certificate holder named above, although if cancellation is for <br /> nonpayment of premium, then the issuing company will endeavor to mail 30 days' written notice to the <br /> certificate holder. In any event, the issuing company, its agents, and representatives accept no obligation or <br /> liability of any kind for failure to mail such notice. <br /> Date: April 26, 2010 <br /> J1 <br /> Authorized Signature <br /> Bridgefield Employers Insurance Company, rated A (Excellent) by A.M. Best Company, is an affiliate of and is managed by Summit. <br /> Summit includes Summit Consulting Inc. and its affiliates. <br /> wu'u'.sun <br /> https://www.summitholdings.com/summitweb/secure.nsf/coi coiaddprint?openfonn&polic... 4/26/2010 <br />