|
May,'9. 2011 11;23AM AFFLE �IGN & AWNiNG No, 7�42 F. 1�'�2
<br /> B►ridgefzeld Employers
<br /> �Tnsurance Company�
<br /> Men'�bel' of �.�berty Mucv� Gro�p Ra�red A(Excellent) by A.M. 13est Company
<br /> summiiii nldi ng,e, cn���
<br /> CERTIFICATE OF INSURANCE
<br /> RE . 0830�44796 Producer , Brian C, Hunter
<br /> ISSUED TO ; City of Zephyrhilis Bldg Dept Company ; Autometic Data Processing
<br /> Insurance Agency
<br /> 5335 Sth street Address 1 ADP BLVO
<br /> zephyrh�lls, FL 33542 ROSELAND, NJ 7066
<br /> Phone ; (600) 524�7024
<br /> This is to certify that Apple Sign & Awn�ng, LLC, 1635 N DALE MABRY HWY STE 7 LUTZ, FL 33548-
<br /> 3000, being subject to the provisions o e ori a or erS ompensa ion aw, as secure e payment
<br /> o a workers' compensation benefits due by insuring their risk with the Bridgefield Employers Insurance
<br /> Company
<br /> POLICY NUMBER 0830-44796 Statutory Limits -- State of Florida
<br /> Employers Liability
<br /> �FF��71V� DATE: April 14, 2011 1,000,000 (Each Accident)
<br /> �,000,000 (Disease--Each Employee)
<br /> EXPIRA710N DATE. April 14, 2012 1,000,000 (Disease--Policy Limit)
<br /> This cerlificate is not a policy and of itself does not afford any insurance_ Nothing contained in this
<br /> certificate shall be construed as amending, extending, o� eltering coverage not afforded by the policy
<br /> shown above or affording insurance to any insured not named above.
<br /> The policy of insurance listed above has been issued to the named insured for the poliCy period
<br /> indicated Notwithstanding any requirement, term or condition of any contrect or Other document to which
<br /> this certi�cate may pertain, the �nsuranCe made available by the descnbed pollCy in this certificate is
<br /> subject to only the terms, exClusions and conditions of such policy, P2id Claims may have reduced the
<br /> shown limits.
<br /> If the policy described above is cancelled before the expiration date indicated, the �ssuing company
<br /> will ende2vor to mail 3p days' written notice to the certificate hplder named above, although if cancellation
<br /> is for nonpayment of premium, then the �5Suing company will endeavor to mail 30 days' written notice to
<br /> the certificate holder. In any event, the �ssuing company, its agents, and representatives accept no
<br /> obligation or liability of any kind for failure to mail such notice
<br /> ���� Date March 25, 2011
<br /> Autho�•izcd S�g»ature
<br /> Suuthwesl Region CurNorate Otflce SouLh�asti Regioo
<br /> Alrilwnl�rr, �1r{.qi��cia. Ln�Lri.�n,a, ,Ni.cri.r.eip�n Flnrl�M Qe�•n;rrr. A'rnrYi kc, N��rili Curnhnn� Snwrt f'un fF�mn��rr
<br /> P,O, Box 8�439 • Hn�on Rpuge, LA 7D998-0439 P,O. Box 48S • Lukclund, FL 338U2-0988 P,O, 8ox 60I1 • G�ine"�,Ilc. G� 3n5G3•C1600
<br /> (225) 926•326� • I-B00-�'_1�29a� (y6_Z} 665-6060 • I-600-283-7G1N 1678� 45U-SB?5 � I-SUO-97 i�6b7
<br /> F,�x (?��) 936-11p2 Fax (Sb3) 666-i95R Fux 1770) 5,i-i339
<br /> I�Yld,�c'�Ir.ld Euipiny, n InSuimirr C'nni��r�y i.<nn uf,�lini� nf,+��4 i� iq�rnn�pd (+i� $unrn�i�
<br /> wC 97.G56 �Rev. 31081 iirnn irAChidv� SuMimif C�»�<oll���Y InC nruf il; suHciAim•r�Y
<br /> LDI C01 258152-� +2 � 0
<br />
|