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05/31/2011 1�:05 8138551246 SCHMALZ INSURANCE PAGE 91/01
<br /> '4� R�vA CERTIFICATE QF LIAB�LITI( INSURANGE s�3i j o '
<br /> TH13 CER1'IFICA7'E IS 19SUE� A$ A AAATi'�R OF INFORMATION ON�Y ANC CONFER9 NO RIQHTS UPON 7HE C�RTI�ICATE HOLDER 1'NfS
<br /> CERTIFICA7E DOE9 NOT AFKIRMA'nVELY OR N�GATIVELY ANIEND, EXTEND OR ALTER 7'M� COVERAGE AFFOROEO BY THE pQ�,1Q�@S
<br /> BE60W, 1'NIS C�R7IFICATE OF INSURAINCE pO�S NOT CON9TiTUTE A�NTRACT BETWEEN T}IE I$g(JN�Ip fNgIJRER{S�, AUTHORIZEp
<br /> R�PRESENTATIVE 0(t PRODUCER, AND TME CERTIFICA7E NOI.DER,
<br /> nY1PORTAN7: If tne �xrqllcat�O holdor is en ADbrnow4L INSUREp, Nio pol�cy(In) mu,t bo ondorsatl. If SueROGATION IS WiuV�p, subje�t ec
<br /> M�e terms and contlltlons o� thp poNry, eartaln potkle9 mey �qul�e �n •ndoraement A spRomant on tnte certlqcaitQ doeo not confc� Aghes to the
<br /> cerqlleate holaer In Ncu of such .ndoraemenry.).
<br /> PRODUCER nll�ME Johrl 3�ha�a.1
<br /> Soha�a,lz Izxaura�ncp Agency w�; 8 ,,, g13-855-6639 ,e,� �:813-555-12�46
<br /> 3894 Ta�� Road, � Sua.be 8 Ap , Johasal�ma,�,��b ab�, , rr. com
<br /> 01d�mar, FL 3�67,►
<br /> ���1 AFFORONV. CoVERAeI! NAICA
<br /> '" Tobal Plun►bS.ng So1u��.ox�s, Iac IN8URERA:�`Ci1e= Iaaur2unce C am
<br /> A�attihem Clapp �NSURea e: �rogreas ve
<br /> 10218 08i,]��e�� Aveaue INSURER C , Gommeree & i�qdus r a inpux�aace co
<br /> Ta�a, FL 3 3 61,2 INSURBR D:
<br /> 813-935�,2733 INSURERE:
<br /> INSURER F •
<br /> COVERAGES CERTIFICATE NiJMBER: RENISION MUMBER:
<br /> THIS IS TO CERTIFY THAT TH& POLICI�S OF INSURANCE I,ISTED SELOW NAVE B�EN ISSUBD TO THE INSURED NqMED AHOVE FOR TH� POLICY PERIOD
<br /> �NDrcATEp, N0T1NffWStANbIMO ANY R�QUIREIVFENT TERM OR CONDITION OF ANY CONTRACY OR OTWER DpCUMENT WITH R�SP�CT 70 WHICH THIS
<br /> CERTIFICqTE MqY B� ISSUEO OR MAY PQRTAfN, THE MiSURANCE AFFORDED BY TH� POUCIES DESCRIB�D HEREIN IS SUBJECT TO ALl THE TERM3,
<br /> EXClUSIONS AND CONDITION$ QF SllCN POLIC�S, 61MRS SMOWN MAY HAVE BEEN R�DUCED BY PAID CLAIMS,
<br /> L�TR TYPE OF INSURANCr: NeR wVO POLICY NUMBER
<br /> Q6NERAL LU181LRY LIMfTS
<br /> encw xcura�eNCe a 1, 0 0 0, 0 0 p
<br /> � COMMERCIAL pENERAI LI/�BILf1Y PItEMIS S EA oavrrence S 7.00 � OOO
<br /> CLAMA3M/IDE � pCCUR MED E%P ( on9 pefeon) i S, O O O
<br /> A C6LAD008Q6-10 7/22/107/22/1 aeasowa.aa�v�ruu�v a 1, 000, 000
<br /> �E��L AGC�EC,nrE � 2. O O O.O O O
<br /> GEN'1. AflGRECw4TE UMIT APPLIF.S PBR; PRODUCt9 • COMP/OP A(iQ a 2 r 000 � O D O
<br /> X Pouc,r PRO- I,GC s
<br /> nuroMOei�E une��.m coMerM�o saua�� �mnn
<br /> ANYAUTO (Ee IllxWM1� f �. � O O O� Q � 0
<br /> N.L ONMED AU'I'bS
<br /> BOD�.Y MuURY (Par perwnl s
<br /> a R 9CHEDUtED nuTOS 07 619 54 5� 0 B/ 31 / 10 8/ 3�/ 1 � OON ' Y ��� tPer °xaent� g
<br /> R HIR�O AUTpS PROPERTY DAMAGE �
<br /> (Per ncsldent)
<br /> � NON-OWNED AUTOS �
<br /> S
<br /> UMBRBLLA LIAB OCCUR EACH OCCI�RENCE s 1 � � 0 0� 0 Q �
<br /> `, g EXCE38 LIAB CLAIMS�MnDE AGGREGl1TE � 1 r 0 fl � 0 �
<br /> oEOUCT�ets 7.104�9708 5/4/10 5/�k/11 S
<br /> REfENTION S
<br /> !
<br /> WORKEltB COMPENSIITION YVI:3 A• O•
<br /> � �'l0YER5 UABILTTY v�N
<br /> ANY PROPRIETOWPAATNERIF�CUTI��E
<br /> OCflOEpf�AEMBER EXCI,I�pEpp ❑ M/A �� EACHACCIbENT $
<br /> � 1° � E.L. bI3EASE . F�A EMPI,OYEE !
<br /> M yss tkseryEOVfitl9r
<br /> 06S�qIP'110N OF OPERA7fON3 bblaw E.L DISEqS6 . pp�fCY UNIIT S
<br /> DESCRIP'�'ION OF OPERA110N3 / LdCAT10NS ! VEMICLES (/dMeh ACORO 101, AtltllHmlp� Ramqrka 8chedule, H more epsce le roquM�etl)
<br /> CHRTIFICATE HOLDER CANCELLAT'ION
<br /> C�.'t�/ O� /7+E��X'Y��.��.i9 SHOULD ANY OF THE A8p1/� DESCRIBED POUCIE3 BE CANCELL�D BEFORE
<br /> 5335 B�tl 5�:. TH8 EXP�RATION DMTE 1'HEREOF, NO110E 1AfILL BE DELIVERED IN
<br /> Zepbxyh� z 1, �, Fx„ 3 3 5� 2 ACCORDANCE WITH TWE POLIGY PROVI310NS.
<br /> �a��ex�-aso-ooz�.
<br /> �UTHORP,Ep R6P ATIVE
<br /> �i
<br /> 1988-2009 ACORO COI�PORATION. AII rlghb reserved.
<br /> ACbRD25(2009/09) The ACORD name and logo are reglstered merks of ACORD
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