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From, 888-883-8680 To; 18137800021 Page; 2!3 Date; 3/4J2011 8.32;23 AM <br /> N �'�''" r �M C�RTIFICATE OF LIABILITY INSURANCE °"'�""�°°"""' <br /> 03/04/2011 <br /> THIS CERTIFICATE IS ISSUED AS A MATT.ER OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICATE HOLDER, THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND, EXTEND OR ALTER THE COVERAOE AFFORDED 8Y THE POIICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIME A CONTRACT BETWEEN THE ISSUINO INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br /> IMPORTANT; If the ced' cwte holder is An ADDITIONAL IN U E0, the policy(ie9) muot be endor�ed, If SUBR04ATION IS WAIVED, subject to <br /> the term9 and conditiona of the policy, certain policiea may rcquire an endorsemeM, A�tatemeM on thi9 certificate does not confer ripM9 to the <br /> certific�te holder in lieu of such endorsemer�(9), <br /> PRODUCER � Patsy Smith <br /> Lassiter-Ware Insurance N , E : C407)628-3441 x154 N , ; (Sa8)883-8680 <br /> of Orange/S�ninole, Inc. �� <br /> PO 8ox 940159 <br /> Maitland, FL 32794-0159 INSURER(S)AFFORDINGCONERAGE wuc� <br /> INBURED �NSU�R�: Mid Continent Ca�ualty Company 23418 <br /> Ovat i on Const ruct i on Company IN8URER B ; Essex Ins Co 39020 <br /> 786 5. Lake Cl a i re Ci rcl e INBURER C ; <br /> Oviedo, FL 32765 iNSUr�RO: <br /> irreur�a E ; <br /> iNeur�a F ; <br /> COVERAGES CERTIFICATE NUM6ER: 2010GL/UMB 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. N0IWITHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TFIE INSURANCE AFFORDED BY TFIE POLICIES DESCRIBED NEREIN IS SUBJECT TO ALL TNE TERMS, <br /> EXCLUSIONS AND CONDITIONB OF SUCH POLICIES. LIMITS SNOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> �� TYPE OF INSURANCE � POLICY NUMiER �yp Nyp LIMITS <br /> ceN�r��uei�mr 04GL 79356 06118/2010 OB/1A/2011 EACHOCCURRENCE s 1,000,00 <br /> X COMMERCIAL GENERAL 1IA81LrtY PR MI rt n S 1� � <br /> CLAIMSMADE � OCCUR MED EXP {Any one Do�on) a Excl ude <br /> A PERSONAL & ADV INJURY S 1 OOO � OO <br /> GENERAL AGGREGATE S Z OOO � OO <br /> GEN'L AGGREGATE LIMR APPLIES PER: PRODUCTS - COMPlOP AGG S 2 OOO OO <br /> X POIICY j��'7 LOC s <br /> AUTOMOBILE LWBILI'TY �Ee eB�Ja D�SINGLE LIMR S 1 OOO OO <br /> ANYAUTO 04GL00079356 08l19/2010 08/19l2011 BODILYINJURV(Perpereon} s <br /> ALL OWNED AUTOS BODtLY INJURY (Per accltlerrtJ S <br /> A SCHEDULED AUTOS <br /> PROPERT'DAMAGE $ <br /> X HIREO AUTOS (Par accidorrt) <br /> X NON�0IMNED AUTOS S <br /> S <br /> X UMBRE�u►�u►e X oCCUR XO�/AZ8881 08l19l2010 08119/Z071 EACHOCCURRENCE S 5 ��� �� <br /> B ExCESS �u1B CLAIMSMADE AGGREGATE S 5� OOO � OO <br /> DEDUCTIBLE S <br /> RETEN110N S S <br /> AN� EMPLOYERS' LIA8ILRY y� N T L ER <br /> ANY PROPR�TOR�PARTNERIEXECUTIVE ❑ E.L, EACM ACCbENT S <br /> OFFICERIMEMBER EXCLUDED9 N 1A <br /> (M�ntl�tery In NM) E.L. DISEASE - EA Eh�'LOYEE S <br /> I�f�e es ribe under <br /> DE I�ON OF P RAT1 NS b low E.L. DISEASE • POLICY LIMR S <br /> OESCRIPTION OF OPERATIONS f LOCATONS ! VEMICLES (AaaEh ACORD 101, AtltlllMMtl IR�muln Seh�tlul�, M meM �pu� I� Mquln� <br /> CERTIFICATE I10LDER CANCELLATION <br /> FAX� 813.780.0021 <br /> 9HOULD ANY OF TFIE ABOVE DE9CRI8ED POLICIE9 BE CANCELLED BEFORE <br /> TFIE EXPIRATION DATE TNEREOF, NOTICE VYILL 8E DELNERED IN <br /> ACCORDANCE WITN THE POLICY PROVISIONS. <br /> City of 2ephyrhill s AUTMORIZEOREPRESENTATIVE � � <br /> 5335 8th Street � <br /> Ze hyrhills, FL 33542 Am Green AMYGRE <br /> � 1988-2009 ACORD CORPORA ION. All rights reserved. <br /> ACORD 25 (2009/08) The ACORD name and logo are registered marks of ACORD <br />