Laserfiche WebLink
From:Torinda Harris FaxID:Florida Insurance Ce Page 3 of 6 Date:7/G/2010 71 11 AM Page:3 of 6 <br /> �� CERTIFICATE OF LIABILITY INSURANCE OPID To DATE(MMIDDM'YY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. OH�g <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELQW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTMORIZED <br /> REPRfSENTATNE OR PRODUCER, AND THE CERTIFlCATE HOLDER. <br /> : f t e cert cate o er is an , t e po cy es must e en orse . su ect to <br /> the terms and condltlons of the policy, certaln policles may requlre an endorsemeM. A statemeM on this certlflcate does not corifer rights to the <br /> certiflcate holder In Iieu of such endorsement(s). <br /> PRODVCER <br /> NAME: <br /> Florida Insurance Center Inc (ac, ��o, exty: �ac, No�: <br /> 414 N Alexander Street ADDRESS: <br /> Plant City FL 33563 CUSTOMERID* LIt3HTNI <br /> Phone:813-754-3561 Fax:813-764-8402 INSURER(S)AFFORDINGCOVERAGE NAIC;E <br /> INSURED <br /> INSURERA: South�=n Owmts Insuz�nc� co 10j9Q <br /> Lightning Aluminum, Inc. <br /> John Foens INSVRER B : <br /> 5504 Orient Road INSURERC <br /> Tampa FL 33610 <br /> INSURER D • <br /> INSURER E <br /> MSURER F <br /> COVERAGES GERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY 7FWT THE POLICIES OF INSlR2ANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOG <br /> INDICATED NpNVITHSTANDING ANY REOUIREMENT, TERM OR CONDRION OF ANY CONTR4CT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE M4Y BE ISSUED OR MAY PERTAIN, T1iE INSURANCE AFFORDED BY 7tIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY H4VE BEEN REpUCED BY PAID CLAIMS <br /> LTR TYPE OF INSURANCE INSR POLICY NUMBER (MM/pD/YYYY) (MMIDD/YYYY) L�MR'S <br /> GENERAL LIABILfTY <br /> EACH OCCURREIJCE $ 1� OOO � OOO <br /> A X COMMERCIAL GENEFPL LIABI�ITY 052109 OS/21/30 OS/21/11 PREMI3ES (Ee occurrence) S SOO � OOO <br /> CLAIMSMADE a OCCUR MED EXP (My one person) $ j Q Q Q Q <br /> i <br /> �RSOruw a a,ov ir�,xHtr f 1, 000 , 000 <br /> GENERAL AGGREGAlE S 1� OOO � U OO <br /> GEN'l AGGREGA7E LIMIT PPPLIES PER. <br /> X POLICY jEa LOC PRODUCTS-COMP/OPAGG S 1� OOO � OOO <br /> AUTOMOBILE LIA8ILT' <br /> S <br /> COfv�INEO SINGLE LIMIT $ <br /> ANY AUTO fEa ecadeM) <br /> RLL 9WNED Ai_ROS BODIIY INJURV (Per pereunl S <br /> SCHEIX1lED AUTOS BODI�Y INJIIRY (Per eccident� S <br /> HIREDAUTOS PROPERTVDAMAGE $ <br /> (Per ecciderd) <br /> MJN-dJVNED AUTOS <br /> S <br /> b <br /> UMBRELIA IIAB OCCUR <br /> EXCESS LIAB EACH OCCURRENCE $ <br /> CLAIM^rMApE AGGAEGATE � <br /> DEDLICTIBIE <br /> RE7eM�oN g $ . <br /> � <br /> AND EMPLOYERS' LIABILITIf Y/ N TORY LIMITS ER <br /> ANY PROPR�Eh7F/PAR7NER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED7 ❑ ! A E L EACH ACCIDENT s <br /> (Mandatory In NH� <br /> II yes, descnbe under E L DISEASE - EA EIv�LOYEE $ <br /> DESCRIPTION OF OPERATIONS below <br /> E 1. DISEASE - POUCV LIMIT $ <br /> DESCRIPTION OF OPERATONS / LOCATIONS ! VEFqCLES (Attech ACORD 101, AddMtond Rsmarka Seh�dula, H more �pacs is raquired) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOIRD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Zephyrhills - Building Dept ACCORD'AN EOWR}ITHEPOLICYPROVIS NS.LBEDELNEREDIN <br /> 5335 8 St Zephyrhilis, FL 33542 <br /> S �. �-7 H O Z O AUTHORIZED REPRESEM'ATNE <br /> � C f5 f@5@fVBf�. <br /> ACORD 25 (2009/09) The ACORD name and logo are reglstered marks of ACORD <br />