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co v® • CERTIFICATE OF LIABILITY INSURANCE OP ID KH DATE(MMlDONYYY) .,,� 01/07/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER l.UIV I AL I NAME: Brown & Brown of Florida, Inc PHONE Kandee Hagelston FAX P 0 Box 548 Afc,No,Ext): 352- 796 -8200 (AIC,No): 352 - 799 -1395 273 North Broad Street AD kandeehagelston @bbbrooksville.com Brooksville FL 34605 -0548 PRODUCER CUSTOMER ID #: 5 STAR -1 Phone:352- 796 -8200 Fax:352- 799 -1399 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A : Westfield Insurance Company 24112 5 Star Refrigeration & Air INSURER B. FFVA Mutual Ins Co /USIS 10385 Conditioning, Inc. 16210 Aviation Loop Drive INSURER C Brooksville FL 346D4 INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR I ADDL Stitt "- --------- ._._._...... _ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE i INSR WVDj POLICY NUMBER LIMITS (MMfDD /YYYY) (MM/DD/YYYY) - GENERAL LIABILITY ! EACH OCCURRENCE $ 1 000 000 _PREMISE I X COMMERCIAL GENERAL L - - ..... �, LIABILITY (Ea occurrence) CWP4951483 09/18/10 09/18/11 PREMISES (Ea occurrrr ence) $ 150,000 i CLAIMS -MADE I , X OCCUR MED EXP (Any one person) $ 10,000 X Prop Dmg Ded $1,000 PER CLAIM i PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 POLICY [X I 'ET LOC $ AUTOMOBILE LIABILITY { COMBINED SINGLE LIMIT (Ea accident) 1 $1,000,000 A X I ANY AUTO ! CWP4951483 ;09/18/10 ; 09/18/11 BODILY INJURY (Per person) 1 $ ALL OWNED AUTOS i BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS Per accident) 1 X NON -OWNED AUTOS I $ . A X $ OCCUR CWP4951483 09/18/10 109/18/11 EACH $2,000,000 EXCESS L ABIAB I X ' AGGREGATE 1 $ 2 CLAIMS -MADE DEDUCTIBLE ,, X '. RETENTION $ 0 - 1 $ B WORKERS COMPENSATION I WC84000228222010A 10 /01 /10 1 O1 /11 1 X WC STATU- '.OfH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETORJPARTNER /EXECUTIVFri T E .L. EACH ACCIDENT $ 1, 000 , 000 OFFICER/MEMBER EXCLUDED? N f A (Mandatory in NH) ! EL , DISEASE _EA EMPLOYEE $ 1 000 , 000 yes, .L N under $ 1 , 000 , 000 DESCRIPTION OF OPERATIONS below El. . DISEASE - POLICY LIMIT A Leased /Rented Equi 1CWP4951483 09/18/10 1 09/18/11 Limit $50,000 Ded. $1,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI TYOFZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills Conttractor Licensing AUTHORIZED REPRESENTATIVE 5335 8th Street Zephyrhills FL 33542 © 0 1 RP i is reserved. ACORD 25 (2009/09) The ACORD name and logo are registe d rk of ACORD .