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05/11/2011 WED 14:09 FAX 813 637 8484 IOA_TAMPA (�001/001 ACORD,.., CERTIFICATE OF LIABILITY INSURANCE �ATE�MMIDDIVVri) 05/11/2011 THIS CERTIFICATE IS ISSUED AS A MAT'fER OF INFORMATION ONLY AND CONFERS N� RIGHTS UPON THE CERTIFICATE HOLdER. THIS CERTIFICATE DOES NOT AFFIRMATIVE�Y OR NEGATIVEIY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTlTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPOR7ANT: !f !he certificate holder is an AUDlTIONAI INSURED, the policy(ies) must be e�dorsed. if StfBROGATlpN IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Meif'JC SI10�E Insurance Office of America, inc. {ac,NO,ex�y (813)637-8877 ___ (�a N ,�_(813)637-8484 4915 W. Cypress Street A D DRE SS: Tanq�a, FL 33607 - - ---._... ._..._._...__.._ ........ ... ..._.. _..._.. .. ._._..__._._.._.._..---•---_ � PRODUG`ER -- �--.. ._ ��£LQM�IiJD�� ------- ---.. ._ _----------�---------� ----_.. .. .. __._...�._ _._..._... �N$Ul2ER(S�AFFORDlNG COVERAGE � NAtC M .._. ..... .._ ..._.. ... _...._.. ._..---.._---`---.._.__.._.._. .-°--. ..............__.._---..___-'-'----'-�---'-'— ------.._..-'---"---..�_. _.......__.._.. .._. INSURED INSURERA: F'll'SL M@I'CGI'y IttS Co 10657 -----------..._...__.__.._.__....--...- - ----__ _ . ......... ....._.. _. ._._. ... .._._._...__.,...r__-----------.. Critical System Solutions, LLC �NSUReRa: Auto-Owners Ins Co. 18988 ______...--- --......_..__.. ...... .. .. .. . . ..... ........__. _.. _. _;_. ._._._.�___.----- 2830 5cherer Drive �NSUReRC Conme & Industry Ins Co ].9410 ....r._—_ �_�_.___--------�--------___.._ ..__. ! _------- Suite 300 INS URERD Bridgefield Employers Ins Co } 10701 St.Petersbur FL 337I6 -- -----------�-----------�----------------._. .__..-. _•.__--------._.._-.... g f 1NSURER E : ._......____.. ._. .. .. ._ ... ... _. ._.. � -- --- ---' .. ..--`- _ ..._. INSURER P : _.._..._.._. COVERAGES CERTIFICATE NUMBER: 2010.2011 Master REVI510N NUMBER: THIS IS TO CERTI�Y 7HAT 7HE POL1ClES OF INSURANCE L1STE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE fOR 7HE POLICY PERIOD lNDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIQN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEI2EIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .---.._....._ ....._ _. ._ _. _.... ....__ INSR --- ri.pE Of INSURANCE ADOL SUBR �.��.._._.__..__.._...._. __...._. ...... EFF� ��POLICI' E7(P I--...��. UMITS I.TR i INSR WVO POLICY NUMBER MM1001YYYY MtAlDD/YYYY GENERAL LIABILiTY � FMMT008116 0814 5/2010 08N 512011 EACH OCCURRENCE $ 1� OOO � O� l...._.._. ' i I UAN�"A�GE�7�f'R�"t�PP�6 ---- �-------.-_.,.......___._._�._.__ ; X � COMMERCIAL GENERAL LiAB1iITY ! I � P12�MI,�ES�{��occur�gn��_ __$.._.. ..______ SO � OOO �--- -- ' : t --- ' J CIAIMS•MADE �X� OCCUR i ; � ; MEO EXP (My one person� $ S� OO� . _. -�-'-- � _ ._._.._..._._.._ .___... ....._...---� -� --�-�---------�---. _..._._....... ....- /� X LTO Contract . Li ab ' I i ; PERSONAL & ADV INJURY � S _�� OOO � �� _. . _ .............. ._._.._. � : � I °------------- ' I ; j i GENERAL AGGREGATE $ -------'- 2 � OOO � OO r----• -------.._.._...__. ._...... .-•------------ � � �.._._.._.__._.._...,._.�._. ! GEN L AG6REGATE LtM1T APPLtES PER: s I � 4 PRODUCTS_ COMPlOP AGG � S 2� OOO � OO I...._. � POUCY � X � JEC _...; LOC ` � � � i I I AU70M081LE I.IABILITY ; 4 4773205600� 08N5I2010 08/t5l2011 � COMBlNED SINGLE llMli i g ' � (Ea accident) , � � ; __ _ _ � 1 � Q�0 , �0� � � X; ANY AUTO ! i � � BODILY INJURY (Per person) `$ ---- � ALL OWNED AUTOS i � i i �--.--- ---------....... __. .._._._ ; ; BODILY INJURY (Per acdd6nl) h S B; � SCHEOULE� AUTOS { I � I i PROPERTY OAMAGE �___; x� 111RED AUTOS � j I (Per accideM) i ----: . _.._.._- _ _ , , --._. __..-- ------ — - -- ---, _... . -- --- ---- X� NON-OWNED AUTOS ( � ( I$ � ' --------------.__.___..._ _--------- ----- --- _ I � I� , UMBRELUI LIAB X j OCCUR � � BE06245 740� 08/1512010 � 08/1512011 F�qCFt OCCURRENCE � 5 �{ � Q�0 � Q0� ..._..._ . _....._.. .. -. ' I � -.__.._ ... ..-1'--'-'-'--- ! � EXCESS LIAB � CLAIMS MADE I ; AGGREGATE ; 5 4 OOO OOO I L_,� C �—•;--- -- ; � ; r------------�--..._..__. �_ � __. .; _. _.. - -- ' DEDUCTIBLE ! ; UMBRELLA FORM � ; ; $ , ; . ;..—._ ___.._........,.._ ....... .:........ .... ._..._. X � RETENTION $ 0 j � I � g �ANDEMPLOYRS�LABI � I ; 083039728 ;08115l2010 08J15l2011' X��T�I ER � ; Y!N i � � ; �._...�._ ... .... _r__.__..__._.._. ' ANY PROPRIETOR/PARTNER/EXECUTIVE ; ; ;_E _L. EACH ACCIOENT : S 1� OOO � QO O OFFIC£RlMEMBER EXCLtJDED? � I N 1 A � � • -- - �Ma�dafory in NH) ' � I � E.L. OISEASE - EA EMPIOYEE; S 1 OOO � �� I(yes. describe under I � � ; � �.....�. __. ._.__._. ..... .........._..._.;. DESCRIPTION OF OPEi2ATIONS beiow i ( i E.L. OISEAS£ - POLICY LIMIT ; 5 1 OOO OO I � i i ; � i . i � � � ' I DESCRlPTION OF OPERA710NS 1 �OCATIONS ! VEMICLE5 (ANach ACORD 101, Addittonal RemaAcs Schedule, If more space Is required) CERTIFtCATE HOLDER CANCELLATION FAX: 813.780.0021 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE THE EXPfRATION DATE THEREOF, NOTICE WILL BE DE�IVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clt of Ze h rhills Bui7din De t AU7NORIZEDREPRESEN7ATIVE � l� ^ Y p Y 9 P '�� e'..,.. v,-::. �.. a �.:_ 5335 8th Street Zephyrhills, FL 33542 Mark Shobe ELAZA 01988-2009 ACURD GORPORATION. All rights reserved. ACORD 25 (2099/09) The ACORD name a�d logo are �egistered marks of ACORD