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MAR/23/2011/WED 10:49 AM �OMEGYS INSUkANCE FAX No,727 528 0626 P.001/001 <br /> ACO � CERTIFICATE OF LIABILITY INSURANCE 3/23/2011 ' <br /> `�� <br /> THIS CERTiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTiFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CER7IFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER�S), AUTHORIZED <br /> REPRESENTA7IVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certiflcate holder is an ADDI'iIONAL INSURED, the poHcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the <br /> certiflcate holder in Iieu of such endorsement s. <br /> PRODUCER � ME: R2bECCd Sengaroun <br /> CO�S Insurance Corner NC No E:�727� 521-21�� F AC No: (�Z��528-0626 <br /> Florida Contractor Insurance App� <br /> Oae Beach Drive S. E. Ste. 230 PROWCER A0034650 <br /> CUSTOMER ID i. <br /> saiat Petersbur EZ 33701 INSURER(S�AFFORDING COVERAGE NAIC i <br /> INSURED INSURERA NOr�l Poiate Casualt <br /> INSURER B <br /> Dave Camer Pl�binq Services Iac irisur�RC. <br /> PO Box 55 INSURERD. <br /> INSURER E <br /> Crystal Spriaqs EZ 33524 �N,qURERF. <br /> COVERAGES CERTIFICATE NUMBER:10/il GL 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 NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO VNiICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMRS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS <br /> �� TYPE OF INSURANCE POLICY NUMBER MM! ICY EFF MM� I��1P LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ SOO � OO <br /> X COMMERCIAL GENERAL LlA81LITY PREMISES Ea ocxurrence $ ZOO , OO <br /> A CLAIMS-MADE X� OCCUR 093000009 /3/2010 /3/2011 MED EXP (Any one person� $ 5, 00 <br /> PERSONAL & ADV INJURY $ 5OO � OO <br /> 6ENERAI AGGREGATE $ 1� OOO � OO <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1� OOO � OO <br /> X POLICY PR � LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea acadent) <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY (Per eccidenq $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per acadent) <br /> NON-OWNED AUTOS $ <br /> $ <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION VvC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y/ N <br /> ANY PROPRIETORIPARTNERIF�ECUTIVE E L EACH ACCIDENT $ <br /> OFFICERfMEMBER EXCLUDED? � N�A <br /> (Mandalory in NH) E L OISEASE - EA EMPLOYE $ <br /> Ifyes,descnbe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ <br /> DESCPoPTION OF OPERATIONS! LOCATIONS f VEHICLES (Attaeh ACORD 101, Addttlonal Rsmarks Sehedule, it more spacs is rsquired) <br /> CERTIFICATE HOIDER CANCELLATION <br /> SMOULD ANY OF TME ABOVE DEBCRIBED POLICIEB BE CANCELLED BEFORE <br /> TNE EXPIRATION DATE 7HEREOF, NOTICE WI�L BE DELIVERED IN <br /> C1t3( Of Zephyrhills ACCORDANCE WITIi THE POLICY PROVISIONS. <br /> 813-780-0021 <br /> AUTFIORIZED REPRESENfATIVE <br /> �TC11r10�S��R <br />