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.04- 06 —'11 15:20 FROM— T -204 P0005/0006 F -462 A � C o RD CERTIFICATE OF LIABILITY INSURANCE q /6� p1 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 far. CT Lindsay Johnson Heritage Insurance Services PilN1 cm . (941)723-1400 ! a Ned: (My 723-1440 uamYO , 1009 10th Avenue West A� 1 P 00000040 Palmetto FL 34221 INSURERS/ AFFORDING COVERAGE NAIGI INSURED INSURERA:United SDeCialt y Insurance 12537 INSURE a :Cosner • _ • nd Indust Insurance Headway of NW Florida Inc INSURER C: 981 Highway 98 E INSURERO: Suite 3-261 INSURERE: Dentin FL 32541 -2525 INSURERF: . COVERAGES CERTIFICATE NUMBER:m. 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 IMTH 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. ILNTSR TYPE OF INSURANCE IM wyll POLICY NUMBER IM IMMMIUD EXP LIMNS GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABILITY PREMISES E S 100, 000 A I CLAIMS-MADE © OCCUR S.L 3492610 - 8/23/2010 8/23/2011 MED EXP (Any oneuereon) $ 5,000 PERSONAL BADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE UNIT APPLIES PER PRODUCTS - COMP/OP Asa S 2, 000,000 GE 1I POLICY f ,sa I I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Es ac de t) _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S _ HIREO AVYOS (Per accident) — NON -OWNED AUTOS S S X UMBRELLA LIAB OAR EACH OCCURRENCE $ 1,000,000 ... EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 _ DEDUCTIBLE Y .—... $ -M 8 RETENTION $ 13E044052654 3/9/2010 3/9/2011 C a WORKERS COMPENSATION I T A tic I I OT AND EMPLOYERS' UAa1LITY ANY FROPRIETOR/PARTNEIVEXECUTIVE YIN E.L. EACH ACCIDENT S OFFICER/MEMa4R N (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, 5 OES IDN OF OPERATIONS below E.L. DISEASE • POLICY UNIT S DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more Mace fe regulnd) CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephryhilis ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 5335 8th St AUTHOWZED REPRESENTATIVE _ Zephyrhills, FL 33542 David Clements /SARAH ACORD 25 (2009109) 61958-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD