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Client#: 1408579 131 ATLANTOW ACORD CERTIFICATE OF LIABILITY INSIJRANCE °6;02�20„�' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 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 BB&T - J. Rolfe Davis NAME: ac e:e : 407 691-9600 a �, N , : 888-635-4183 PO Box 4927 _ � Orlando, FL 32802-4927 ADDRESS: 407 691-9600 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA Colony Insurance Company 39993 Atlantic Tower Services Inc dba ATS INSURER B ��S Surplus Insurance Company 26620 1019 28th Street INSURER C �nsurance Company of the State 19429 Orlando, FL 32805 _ INSURERD Wausau Underwriters Insurance C 26042 INSURER E INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED {JAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFiCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TR TYPE OF INSURANCE � POLICY NUMBER MM/DD� MMIDD E � LIMITS A GENERALLIABILITY AR4360149 12/14/2010 12N4/2011 EACHOCCURRENCE $�,QQQ,QQ� X COMMERCIAL GENERAL LIABILITY PREMISES� a occurrence $SO,OOO CLAIMS-MADE a OCCUR MED EXP (Any one person) $Excluded X BIlPDDed:S PERSONAL&ADVINJURY $'I�OOO�OOO GENERAL AGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPL�ES PER: PRODUCTS - COMP/OP AGG $Z�OOO�OOO POLICY PRO- LOC $ p AUTOMOBILE LIABILITY ASJZ91455132010 8/23/2010 08/23/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $� 000 000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS BODIIY INJURY (Per accident) $ PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) _ X NON-OWNED AUTOS $ _— $ — B UMBRELLA LIAB X OCCUR EAU756669012 12/14/2010 12/14/2011 EACH OCCURRENCE $s QQQ QQ� EXCESS LIAB _ CLAIMS=MADE AGGREGATE $s�OOO�O DEDUCTIBLE " - - $ RETENTION —�--- ---- — --- C WORKERS (:OMPENSATION 6986265� WC STATU- OTH- $ AND EMPLOYERS' LIABIIITY Y � N 2N 9/2011 02/19/201 X OFFICER/IV E ER EXCLUDED? ECUTIVE� N/A E.L. EACH ACCIDENT $� �OOO�OOO (Mandatory in NH) --- If yes, describe under E.L. DISEASE - EA EMPLOYEE $�,�0�,�� DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $'I �OOO,OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attaeh ACORD 107, Additional Remarks Schedule, if more spaee is required) CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5335 8th Street Zephyrhills, FL 33542 AUTHORIZED REPRESENTATIVE Il�6 1/: I7PA�ra.t.�� 0 1 988-20 09 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #5692�J020/M6849769 EMTU