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From. FAXmaker To City Of Zephyrhills Page 2/2 Date. 5/31/2011 1�06�00 PM <br /> ��'� � CERTIFICATE OF LIABILITY INSURANCE 05/31/20�11� <br /> THIS CERTIFlCATE IS ISSUED A5 A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGNTS UPON THE CER?1FICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFlRMAl1VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S� AUTFIORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERIIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subJect to <br /> the teims and condftions of the policy, certaln policies may require an endorsement A statement on this certHicate does not cor�fer rights to the <br /> cer[Ificate holder in Ileu of such endorsement(s). <br /> �woouc� <br /> NAME: <br /> Mark van Wert � N � 353-5304 ext. 239 F '�' X N :{$$$� ZZS-4049 <br /> c% Willis of Florida, Inc. �� <br /> 3000 Bayport Drive, Suite 300 '�E�� <br /> Tampa, FL 33607 IN3UREA(S) AFFORqNG COVERAGE NAIC # <br /> iNSUr� n: Rmerican Zurich Insuranoe Company 40142 <br /> r+su�o <br /> IN3URER B • <br /> Employee Leasing Solutions, Inc. Aft. Emp: Wendle Sheet Metal Inc iNSUa�c: <br /> 1401 Manatee Avenue West Suite 600 <br /> Braderrton, FL 34205-6708 IN3URER D: <br /> IN3URER E - <br /> IN3URER F : <br /> COVERAGES CERTIFICATE NUIIABER:10FL079807766 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR POLICY EFF POLICY D(P <br /> LTA TYPE OF NSURANCE POLICY NUYBEH Y LYRS <br /> GENERAL W161LI7Y EACH OC(XIRRENCE $ <br /> COMMERCIAL GENERAL LIABILRY PREMISES Ea occurrence $ <br /> CLAIMS-MADE [] OCCUR MED EXP (My me peraon) $ <br /> PERSONAL &ADV INJURY $ <br /> GENERALAGGREGATE $ <br /> GEN'L AGGREGATE LIMR APPLIES PER: PRODUCTS - COMP:OP AGG $ <br /> POLICY PRO- LOC $ <br /> AUTOAIOBILE LIABILRY <br /> Ea acctlent <br /> ANYAUTO BODLY INJURY (Per person) $ <br /> ALL OWNED SCFIEDULE� <br /> q�7pg p�pg BODLY INJURY (Per accdenp $ <br /> HIRED AUTOS <br /> NON-OMINED PROPERTY DAMAGE <br /> A�T� Per eccbent $ <br /> $ <br /> UYBRELLA LIAB OCCUR <br /> EAqiOCCURRENCE $ <br /> IX � uA CLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COIAPENSA710N X <br /> AND EMPLOYERS' LWBILITY Y/ N <br /> ANYPROPRETOR�PARTNER;'EXEIXI'fIVE E.L.EACHACCIDENT $ 1,000,000 <br /> A OFFICERlMEMBER EXCLUDED? � N/ A WC 90-00-81 &00 12/31/2010 12/31 /2011 <br /> (Yardetory In NH) E.L. DSEASE - EA EMPLOYE $ 1,000,000 <br /> IF yea, descrlbe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE - POIICY LIMff $ 1,000,000 <br /> Locatlon Coverage PeHod: 12/31/2010 12/31/2011 Cllem#: 052712 <br /> DE3CRIPTION OF OPEFtAT10N3 / LOCATIONS/ VEHICLES (Attach ACORD 101, Addltiorrel Rerrrerks Sehedule, H mae space Is requlred) <br /> Coverage is provided for Wendle Sheet Metal Inc <br /> onythose employees 335 N Buena Vista Dr <br /> leased to but not Lake Alfred, FL 33850 <br /> subcontractors ot: <br /> CERTIFICATE HOLDER CANCELLATION <br /> City Of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLIpES BE CANCEL�ED BEFORE <br /> 5335 8th Street 7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Zephy�hllls, FL 33540 ACCORDANCE WITH THE POLICY PROYISIONS. <br /> AUTHORI�D REPRE3ENiATNE <br /> ������� <br /> � 1988-2010 ACORD CORPORATION. All rlghts reserved. <br /> 7his fax was sent with GFI FAXmaker fax server For more information, visit: http.//www gfi.com <br />