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Aco ® CE RTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmw) <br /> `...� NCE 1/3/2011 <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. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT pact King Y g #E131203 _ <br /> PrimeGroup Insurance Services, Inc. Luc o Exh: (813) 890 -0415 FAX No (813)885 -4311 <br /> 5440 Beaumont Center Blvd. ADDDR : ek i ng @primegroupins.com <br /> Suite #445 PR UCER n00005778 <br /> CUSTOMER K) (F ' <br /> Tampa FL 33634 INSURER(S) AFFORDING COVERAGE NAIC # <br /> INSURED INsuRERABridgefield Casualty Ins. Co. <br /> INSURER B : <br /> Mar -Lin Quality Finishes, Inc, <br /> INSURER C : <br /> 8509 Sunstate St, Ste 202 INSURERD: <br /> INSURER E : <br /> Tampa FL 33634 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:CL1091007889 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 POLI CIES. LIMITS SHOWN MAY HAVE BEEN REDU CED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POUCY EFF POUCY EXP <br /> LTR INSR WVD POUCY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) UMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> PREMISES (Ea occurrence) $ <br /> CLAIMS -MADE OCCUR MED E:XP (Any one person) $ <br /> — <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'LAGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OPAGG $ <br /> POLICY n JECT n LOC <br /> AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY (Per accident) $ <br /> SCHEDULEDAUTOS PROPERTY DAMAGE <br /> HIRED AUTOS (Per accident) $ <br /> NON -OWNED AUTOS $ <br /> UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ — <br /> EXCESS LIAR CLAIMS -MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> A WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' UABIUTY Y / N X TORY I IMITS ER <br /> ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 100 000 <br /> OFFICER/MEMBER EXCLUDED? N / A <br /> (Mandatory in NH) 0196 -16757 10/31/2010 10/31/2011 E.L. DISEASE - EA EMPLOYEE $ 100 , 000 <br /> If yyes desaibe under ERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 <br /> DESG�RIPTION <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Bldg. Dept. <br /> 5335 8th Street AUTHORIZED REPRESENTATIVE <br /> Zephyrhills, FL 33542 <br /> E Ellsasser #A077187/ y •o <br /> ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. <br /> INS025 (200909) The ACORD name and logo are registered marks of ACORD <br />