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04- 06 -'11 15:20 FROM- T -204 P0006/0006 F -462 Acaforr CERTIFICATE OF LIABILITY INSURANCE DATE 106 /O O DIYYYY 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 OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BEWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the poiicy(ies)must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require and enddorsement. A statement on this certificate does not confer rights to the certificate holder in Lieu of such endorsement(s). PRODUCER Risk Concepts Corporation CONTACT NAME: 410 43rd Street West Suite N PHONE NUJO E• 877 -746 -2208 IPAx ' No): Bradenton FL, 34209 PRODUCER Cl/voile:9m INSURERS AFFORDING COVERAGE MCI INSURED INSURER A r Rc,ullWn Fehr. Incur nce (:"Want( 10151 Administrative Concepts Corpora tion INSURER B ; Alters A AA 319082e 406 43rd Street West INSURER 0 I Amlin Bermuda A AA 1480019 Bradenton FL, 34209 INSURER o r Aspen,iryTUranos UK Ltd. A AA 1120337 INSURER 5; Cam Bermuda ' A AA 3194161 I NSURFdt F : Uoyds of London A ,AA- 1122000 COVERAGES CERTIFICATE N R : 4 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, INbK • F OF WAN .. NM NUM EPF POLICY EXP PEA KW NIMAFR LIMITS GENERAL LIABILITY — COMMERCIAL GENERAL LIABILITY EA CC R_ S --'1CLAtM9 J OCCUR MEN ERP m one wr _ PERSONAL R ADV INJURY s ZiERLA GENERAL AGGREGATE s — � POLIcYn 7 .. PRODUCTg.COMP/OP A40 s 111 S AUTOMOBILE LIABILITY COMBINED SINCE LIMIT ANY AUTO (Ea aoddenq S — ALL OWNED AUTOS BODILY INJURY (Per Parson) $ SCHEDULED AUTOS MULELT INJUNT(Yen _ HIRED AUTOS E (Pe NON-0NAJEO AUTOS 5 — — _ s ...... 5 UMBRELLA Le IA OCCUR EACH OCCURRENCE S _ EXCESS LIAR CLAIMS MADE AGGREGATE 5 DEDUCTIBLE 8 $ RETENTION $ �� — s A WORKERS COMPENSATION • $• OTK AND EMPLOYERS• LIASILITY �' X iuTATVu.ve TORY JJ 1 i e N ANY PROPRIETERIPARTNP CUTNE N /A El. EACH =away OPFICEWMEMeER w eXCDEGV 2011 02882 - 000 01/01/2011 12/31/2011 S 1.000000.00 (M'nMSNfy In NN) E.L. DISEASEEA EMPLOYEE $ 1.000.D00.00 n F yes roirrn describe ender n EL DIEEASE•POuCv UMIT $ 1.00000908 ccralrrnnu no no►anT,nus ...1,,,,., B C Workers Compensation Please note that Soumem EvO a Insuranoe Company has reinsured it's fiabSbOe in axeass of $250,000 under the poheies a D E Excess Coverage Insurance listed above will the underwriters limed A- or better at the time of placement of such reinsurance. Such Mirturance 8 are subiect to their own terms, oondftlons and Omits. TIM it for iMOnnafional purposes and nothing shall create a v note( under such relnsuranae. DESCRIPTION 08 OPERATIONSI Lacs:nor / VEHICLES (AMMO *COR0 101, Additional Romans Schedule, If more spats Is raga wee) Effective•. Coverage is Wended to the leased employees of alternate employer (Florida Operations Only): 09/17/2010 081416 Headway of NW Florida, Inc. DISCLAIMER: This Certifiers* of Irw a nee does not Constitute a contract between the issuing Insurer(s), authorized representative or producer. and Me oeni$vate holder, nor does If alamlafiwly or negaINay amend, exIend or alter mo coverage afforded by the pohdea Ilsted mason. CERTIFICATE HOLDER CANCELLATION City Of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE mu. BE DELIVERED IN ACCORDANCE WITH TIE POLICY PROVISIONS. 533513th Street AUTHORIZED REPRESENTATIVE ZephybillS FL, 33542 __ `., Fax1t: (813) 780 -0021 ACORD 25(2009/09) 751 - 20110406 •