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<br /> DATE �MM/Dp�YY`�'�)
<br /> '`'��..°.��° CERTlFlCATE OF L,tABIL{`�Y INSURANCE 031a8l11
<br /> TNIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORIIAATION ONLY AND CONFERS NO RIGHTS UP�N THE CBRTIFICATE HOLDEF2. THIS
<br /> CERTIFICATE DOES NOT AFFIRMA7IVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFDRbED BY THE POLICIES
<br /> O�LOW. TMIS CER7IFICATE OF fNSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRE3ENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy�IBS) must be endorsed. If SUBROGATION IS WAIVED, SuhJect to
<br /> the terms dnd conditions of the policy, certafn pollcfes may requlre an endorsement. A statement on this cenlficate doe5 not confer rights to the
<br /> certificate holdar in lieu of such endorsement s.
<br /> PROOUCER 863•682 NAME:
<br /> Wllliams-Hess Insurance 863-666-3051 P"�"E FAx
<br /> 1617 E. Gary Road g� y ., a�c No :
<br /> Lakeland, FL 33601 E-MAI�
<br /> 11DDRE99;
<br /> P. Brandeberry - A028697 PR ouc�a WAYNE-6
<br /> 1NSIJRER(5) AFFORD COVEPAGE I NAIC # __
<br /> INSURED Wayne Crawfard Construction In INSl1RER A: MICI^CO(1tI11C11t C7SU8I Co �23418
<br /> Walter Wayne Crawford, Pres ir�suaeR e —__
<br /> 4732 US HWY 9B N INSUREft C. __ ---
<br /> Lakeland, FL 33809 !
<br /> iNSUReR o • —
<br /> INSUft�R E ^ ��I —
<br /> INSIJRER F :
<br /> COVERAGES CERTIFICATE NUMBER: REVI510N NUMBER:
<br /> 7FIIS IS TO CERTiFV TriAT THE PoLICiES OF INSURANCE �ISTEG BELOW rIAVE BEEN IsSUEO TO THE INSURED NAMED t+00VE FOR THE POLICY PERIOD
<br /> iNUiCa7CD NOTWITHSTANDING ANY REQUIREMENT, TERM OF CONDI71oN oF AN�r CONTRAC7 OR OTHER DOCUMENT WITfI RESf�ECT To wl•IICH THIS
<br /> CERTIFICATE MAY 6E IS5LIED OR MAY PERTAIN TMIE INSURtiNCE A�FORDED BY 71•IE POLICIES DESCRIBED HER�IN IS SUBJEC7 70 ALl THE TERMS,
<br /> EXClUSI0N5 AND CONDITIONS OF SUCW FOLICIES LIMITS SFI01fVN MAY HAVE BEEN REDUCED BY PAIQ CLAIMS, _
<br /> IdSR' ' I��B I i POLICY E POLICY E7(P I LIMITS
<br /> TYPE OF INSURANGE POLICY NUMBER � MMIDDIYY 'i MMIODIYY
<br /> � GENERAL LIA6ILITY � � ''' I @ACH OCCURRENCE � �,OOO,OQO
<br /> - I�A�A -T�T��YE��
<br /> A x�� COM�IERCIAL ceNeRA� uaoiur 04GL000788475 I 0412B/10 0��8�� � � c�F ��gd acc��fe�f.?J $ ���,���
<br /> � �� - � �i MED EXP ian o�e erecn) � EXG�Uded
<br /> �, �.LAIMS•P4ApE x ' OCCUR i
<br /> '��,� X SOD PD D0d �� I _PG RSONAL 6 AOV IN JURY W ��OOO,OOO
<br /> I GENERA�0.GGREGA7E 3 2
<br /> ; GEN'L aGGREGqTE I.���hT APPLIES PER I � � PRODUCTS - COMPIOP AGG '� Z,OOO�OOO
<br /> � FOLICY �I PRG- � LpC � �
<br /> aUTOtnOBl�e uaetLirr � COMBINEp SiNOLE LIn9�T i y
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<br /> I�� aNr AUTG ��I, I . BODILY INJURY (Par pereon� '?�
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<br /> � AG� QLti�Fp ���� � �� � �i, � I FlOOILY INJURY (Por accldanll' 7�
<br /> I 5'�HEOULEO aUT��� � I rROPERTY DnMn�E r�
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<br /> i I, URI6RELLQ LIAP I� ����� �, � E.4CN OCCUR I I � _ ___I
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<br /> ��---- pl:CE3S 11AB i c � � AGGREGATE ,� 9�
<br /> I � CLA1�,S-MAD�_ , � I i
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<br /> � A�TF.yTipfJ S - -- — -- � �� WC�$7qTU. � 6TH-I y, '------..
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<br /> aND EMPLOYER3' LIaB U?Y ' I � '� ! TOR Y..IlP1 1T�„ — ----
<br /> :t•iY P�O�F"_TUF � i , � N ��� � � ' E.L EACH ACCI��N , �r �.— -
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<br /> IManditory in 4Hj �"� � I E.! . DISEASE EA EPAPI.CYEE ---- --M
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<br /> � GGSLRi.-710N OF OFEFATI��iJ te r�•, _� , E.L. DISEASF • FOLICV LIMIT ( 7:
<br /> � ��� -- ^ . _�_ _ —. � I —
<br /> ❑@SCR�P7!ON OF OPERa7;QNS � I.00AT10N5 � VEHiCLES (At[neu aCORD ��1, Addliionel qemarks Schedule, 11 mom apqeo Ia rcqulreU)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> CTY7_EPH
<br /> SHOUL.D ANY OF THE ABOVE DE3CR16ED POLICIES 9E CANCEL.L�D BEFORE
<br /> TNE EXPIRATI�N DATE THEREOF, NOTlCE WI�L BE DELIVERED IN
<br /> The Ctty of Zephy!hllls ,
<br /> I FAX 813-780-0021 ��COftDANCE WITH "iHE POUCY PROVISIOhS.
<br /> 5335 8th StrnQt �
<br /> Zephvrhifls, FL. 335A.'. auii+o��ze DFEFRHSENTATNE
<br /> , i �� Brande�5o�ry - A02B697 � . �� i
<br /> � _. y�_�- -- -., _ _._._...._._.. _..�._ _. ________._, �-- -------- -�
<br /> �'� 1996-2009 ACORD CORPO ATION. All rfght� ros Pd
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