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JAN -27 - 2011 15 813 228 4997 P.02i02 24 WHOLESALE MARKETING ISSUE DATE • , ;,;, l,; ° , ; '-
<br /> CERTIFICATE OF INSURANCE o 71o2rzo , o ,. ,, :,
<br /> � .— v D'" issued as a matter of information only and s or alter the ' ' '
<br /> This certificate is , '
<br /> Holder. 1 {s Ceruficale does net amend, '- M," ; ;,
<br /> PRODUCER upon the Certificate , ,� �'� " :}
<br /> coverage afforded by the policies below.
<br /> P.O. S IFF. SEIBELS A. WILLIAMS, INC. , ,,, �; ... 1 r
<br /> COMPANIES AFFORDINO'CERAr*E
<br /> P.O. Sox am, ; °
<br /> A `,; i
<br /> 600 -4 7 ham, AL 35202 ,;
<br /> 76 -221, ,';‘,,,,,.2 • °' �,��
<br /> f300� is & Gas Ins. Svcs.
<br /> ComPanY Associated E{ecta' 1 4 9
<br /> INSURED ` fi,;,;
<br /> Peoples Gas System ; >;< „ r 1 ''
<br /> TECO Energy Inc, G , "; ,s '
<br /> P.0.6ax 111 y' .x"
<br /> Tampa, FL 33801 ° 'j- ",•' "7
<br /> Tame Company ° , ,,,;1' . fi , • D ,titt
<br /> l' . ,.
<br /> MdictiM Nolwilhs } �r
<br /> bi for o► may pe I the ted. Ahee a h3t51 t>71'; ' la' 1y, ∎ f
<br /> any is to ems that the ponds Of of contract n c or other oc have been issued why tInsured
<br /> is u certificate may herein for the t d by Patti afford • ; , ' i .
<br /> any roqulreme !bed herein �in condition
<br /> is i u je to all e San document with respect UM�g ee LIABILITY edu e d •
<br /> GENERAL UABIL by
<br /> the policies described herein is subject to all the terms, ,conditions and exclusions FFECTIO policies, Limits shown may
<br /> [1 TYPE OF INSURANCE POLICY NUMBER EXPIRATION S 1,000" `'� `'ti',' "'p " .;
<br /> ® 0521AIA,0 07!0112010 EACH OCCURRENCE ��� ;t:: ";
<br /> GER
<br /> ` 4
<br /> � Canmerael Gen• Liability Self- InBUnDd Retention p7f01/2011 FIRE DAMAGE
<br /> Mumma $1.000,000 MEDICAL EXPENSE �Ig {NG INJURY , i , > >.
<br /> elaim. Niacin 0 Mums D ACVE 'ii', 6'
<br /> ® lots' Miamian PERS. AN , ! T� r'G l"' „ /' � ��
<br /> 0 Owners' and Cenkae % r ” 1
<br /> p ER. Ail . '. , `' u , ' °`
<br /> O PRODUC S AND COMP. � �;
<br /> sb Llmh Ne6 Dee it, 1 ;. ; : ,;'
<br /> General LJ Pealed � S 1 OQQ ` , ,
<br /> 0 Pulley I]F.eealWn „n ,� . �. ? e
<br /> COMBINED SINGLE LIMIT '`�
<br /> X �A1A10 07101120,0 Y.r r
<br /> F RILE LIABILITY non 0710112011 Bf D •_ + = '= ° " Se- Invun3d Rete _ mobile $250.000 80.1 d A mebei A COMPREHENSIVE (.i i, . ed Aulereobles COLLISION 1777 "7M Irk ,';' .
<br /> WORKERS' COMPENSATION El EACH 14CCIDEh1T +; iY-
<br /> AND EMPLOYERS' LABILITY , ,,, _ „ • .. � °. Emipmmal ''';';�A • '
<br /> �, ,{ ::
<br /> 0710112010 EACH OCCURRENCE 2�0, , t ,,';;''4,;M
<br /> 07101/2011
<br /> X0521 Al A10 Z 'y.'�•'r c ; J :.;
<br /> EX ass LIABILITY ;i �"
<br /> ❑ Occun ®Claims Made +•y' } �l , : .
<br /> 0 710112010 , ,•r , r . ^ ;l, . I.
<br /> 5121A1A10 mployee for Disease I
<br /> EXCESS WC
<br /> 07/01/201 '
<br /> Essese Workers' Cempereaclan ;,•' 14 �C'
<br /> If- Insured Retention as stated above. �•'It
<br /> s of Peoples Gas System's Sa ;�°
<br /> Excess Liability policy provides insurance in excess , "r•; " " 'e
<br /> I •
<br /> CERTIFICATE HOLDER ' "' ; ', ! ,', . ,
<br /> SHOULD ANY OF THE ABOVE DESCRIBED G gtyRE CANCELLED
<br /> LL ENOEAVOR ?' Yr' ,;t1 "'y r
<br /> MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HO l
<br /> THE EXPIRATION DATE 'f THEREOF, ' ;l
<br /> ! -DER NAMED TO' n.E '.. >; ! `
<br /> LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO DBLIGATIO1d DR LIABILIT fy,F,',i i,t x`,y,
<br /> ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. ry r I!i '
<br /> Authorized Representative . ' ,
<br /> City of Zephyrhills , ', ,
<br /> 53:35 8th St. �"` i; ; i rt �•sc:
<br /> Zephyrll{Ils, FL 33540 \ , , 4
<br /> . , , . ;ti ,, y ° ',' ' '
<br /> TOTAL P.02
<br />
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