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�� OP ID: DI ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM/YY) 04/18l11 THIS CER7IFICATE 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 CER7IFICATE OF INSURANCE DOES NOT CONS7ITUTE 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(les) 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 certi�cate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER 727-d47-6481 CONTACT NAME: eouchard-Clearwater 727-449-1267 PHONE F,vc 101 Starcrest Drive ac No eM : ac No : P O BOX 6090 A DRESS: Clearwater, FL 33758-6090 PRODUCER Dru Cameron Wilson cusr nneR io u: BAYAR08 INSURER S AFFORDING COVERAGE NAIC q INSURED gay Area DKI INSURERA:SteB(�fBSt IIISUr'dflC@ COfl'1 an JEMM of Pinellas INSURERB American States Insurance Co 19704 MrMark Spicola INSURERC Zurich American Insurance Co 390 Scarlet Boulevard Oldsmar, FL 34677-3018 INSURERD. 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. INSR 7ypE OF INSURANCE A � POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ') �OOO�OO A X COMMERCIAL GENERAL LIABILITY GPL655839101 11/25/10 11/25/11 pREMISES Ea occurrence S 3�0,0� CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � 0,�� PERSONAL 8 ADV INJURY $ 'I,OOO,OO GENERAL AGGREGATE $ Z�OOO,OO GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPlOP AGG $ 2,000,00 POLICY PR � LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B X ANY AUTO 01 CI4098701 11/25l10 11I25/11 �Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUT6S BODILY INJURY (Per acGdent) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ B X NON-OWNEDAUTOS $ g X COMPREHENSIVE DEDUCTIBLE a1 000 S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S�OOO,OO EXCESS LIAB CLAIMS-MADE AGGREGATE $ S,OOO�OO A SE0655839201 11/25/10 11/25/11 DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABIIITY Y � N X RY LIMIT R C ANYPROPRIETOR/PARTNER/EXECUTIVE WC655839801 'I'IIZS/'IO 11/25H1 E.L.EACHACCIDENT $ ��OOO�OO OFFICER/MEMBER EXCLUDED? ❑ N f A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ �,��,�� If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 'I ,OOO,OO q Pollution CPL GPL655839101 55,000 DED 11/25/10 11/25l11 Per Occ 1,000,00 Per Agg 2,000,00 DESCWPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, iT more space fa required) CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ZEPHYRHILLS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5335 8TH STREET ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATNE \ � O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD