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Policy Number o830-36021 Date Entered: 4/1/2011 <br /> '`�`° CERTIFICATE OF LIABILITY INSURANCE �A����D1WYV� <br /> 4/i2�2oii <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 /> ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTiTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> �tEPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 certificate dces not confer rights to the <br /> certificate holder In Ifeu of such endorsement(s). <br /> PRODUCER CONTACT <br /> WorkComp Partners NAME: <br /> 702 Tillman Place PHONE (813�747-7490 a <br /> e-ana� - <br /> Plant City, FL 33566 AD6RESS: <br /> INSURER S AFFORDING COVERAGE NAIC il <br /> iNSURettn:Bridgefield Employers Insurance Company <br /> INSURED FRS Environmental Remediation, IIIC. INSURERB: <br /> DBA The FGS Group INSURER C. <br /> ZZO East MLK Blvd INSIIRERD. <br /> Tampa, FL 33603 INSURERE: <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW 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 WITH RESPECT TO WHICH TH�S <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIDNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ��7R TYPE OF INSURANCE AaDL S POIICY EFF POLICY EXP <br /> D POLICYNUMBER MMlUD/YYYY MIWDD LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE 8 <br /> COMMERCIAL GENE�AL LIABILITY � <br /> PREMISES Ea occurrence S <br /> CLAIMS-MADE � OCCUR MED EXP (Any one person� S <br /> PERSONAL 8 AOV INJURY E <br /> GENERALAGGREGATE S <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG E <br /> POLICY PRa LOC S <br /> AU70MOBILE LWBILIN COM IN SINGLE lIM1T <br /> ' I Ea acciderri b <br /> ANY AUTO ' BODILY INJURY (Per person) S <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY (Per accident) S <br /> NIREDAUTOS A�� S WNED PROPERTYOAMAGE S <br /> Peracddent <br /> S <br /> UMBRELLA LIAB p�CUR EACH OCCURRENCE E <br /> EACESS LIAB CLAIMS-MADE AGGREGATE g <br /> DEO RETENTION S $ <br /> WORKEftS COMPENSATION WC STATLL OTH- <br /> AND EMPLOYERS' LWBILITY Y � N <br /> p' OFFICERIMEMBER/EXCLUDED7 ECUTIVE ❑ N!A 0830-36021 /1/2011 /1/2012 E.L. ERCH ACCIDENT gS � OOO � OOO <br /> (Mandatory in NH) E.l. DISEASE • EA EMP�OYEE $1 , 000 � 0� � <br /> If yes, descfibe under <br /> OESCRIPTION OF OPERATIONS below E.L. DISEASE - POIICY LIMIT yl � OOO � OOO <br /> OESCRIPTION OF OPERATONS I LOCATIONS l VEHICLES (Attach ACORD 10�, Additional Remarks Sehedule, if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5335 8Th Street THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Zephyrhills, FL 33542 <br /> � AUTHORRED REPRESENTA7IVE <br /> 7�11 �Ct �,L'_�f.lL� u n �'ki ) <br /> aria L. Wetherington <br /> O 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br /> Produced usng Forms Boss Plus sdiwere www FormsBoss com; Impressrve Publishing 800-208-t977 <br />