11-12102 - Laserfiche WebLink

Browse Search

�...� . OP ID: JW A�RO CERTIFICATE OF LIABILITY INSURANCE DA og;21,, THIS CERTIFICATE IS ISSUED AS A NFATTER OF INFORMATION ON�Y AND CONFERS NO RIC3HTS UPON THE CERTIFICATE HO�DER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERACiE 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 C NTACT Florida Insurance Center Inc 813-754-3561 N ,�E ; Jud Wa ner AAI, AU, AIS, CPIW 414 N Alexander Street 813-764-8402 a E� : 813-754�561 __ � ja c Ha�: $13J52�794 Plant City, FL 33563 no�oRess: ��9ner oridainsurancecenter.com Fiorida Insurance Center, Inc. PRODUCER --- -- - CUSTOMERIDN:SUPER-J _ __ __ i INSURER(S AFFORDING COVERAG£ � NAIC iR INSURED Superior Unlimited Enterprises INSURERA United Fire & Casualty Company__ _____ __ �131 021 Inc. DBA: Cypress Signs I B F C C I I nsuranc e Co — 110178 160 Spirit Lake Road - --- --- ------ - - -------�--_._---- _--- �nter Haven, FL 33880 INSURERC � INSURER D 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 NAMED 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, EXC AND CON DITIONS OF SUCH POLICIES LIMITS SHOWN MA HAVE BEEN REDUCED BY PAID CLAIMS lTR TYPE OF INSURANCE N POLICY NUMBER � MNUDDIYYYY MM/DD E � I LIMITS GENERAL UABILITY I !' i 'I � EACH OCCURRENCE $ 'I�OOO�OO A X COMMERCIAI GENERAL LIABILITY I �sO3�716 ! 07/O1/11 07/01/12 pREMISES_(Ea occurrence __ $_ ___ �OO,OO I�_, CLA�MSMADE� i J OCCUR I � I i I ' MED EXP (Any one persOn) $ S�OO h -- --- — _ � , i PERSONAL & ADV INJURY $ �,OOO � , i —{— �'� ' I �� ! GENERAL AGGREGATE I $ Y�OOO�OO ---+��---- j GEN'L AGGREGATE LIM T APPLIES PER '��, ' I I PRODUCTS - COMP/OP AGG I$ Z,OOO�OO ---� POLICY X � PR4 ---- L � �, �I I --- $ -- AUTOMO&LE LIABILITY �' � i COMBWEp SWGLE IIMIT � � $ 500,00 A X� qNVquTO I '� i 60384716 07/01N1 O7l01/12 ��accideM _ _ i BODILY INJURV (Per persan) $ � ALL OWNED AUT03 ' — ----------- j � I BODILY INJURY (Per accideM) I$ SCHEDULEDAUTCS � � '� --------""�—" PROPERTY DAMAGE $ �X HIRED AUTOS I I I (Per acUdent) � � X NON-OWNEDAUTOS I ' � PIP ---------�- � ---,- $ -------- �� -- �'IO�OO '� � ----- — —�-$----------- UMBRELLA LIAB I F OCCUR , ' I EACH OCCURRENCE $ � EXCESS LIAB I CLAIMSMADE'� I ; i� I, � AGGREGATE ---�--- --- r -- -------- -- ------- I - - ---- � ----- DEDUCTBLE � I S �-- � � ------- ----�--�---�----------- RETENTION $ $ WORKERS COMPENSA110N ' � X WC STATU- X TH- AND EMPLOYERS' LIABILJTY � TORY L�MITS ER B ANY PROPRIETORJPARTNER/EXECUTIVE Y/ N �I OO� WC') � AB�HB 01105/11 01/05/12 EL EACH ACCIDENT �$ SOO�OO OFFICER/MEMBEREXCLUDED� ��NlA -- ,(Mandatory in NH) i , E L DISEASE- EA EMPLOYE $ SOO,OO If yes, descdbe urxler �-- —"-- --- DESCRIPTION OF OPERATIONS below I E.L DISEASE - POLICY LIM �$ SOO,OO A Install Floater 60384716 07/01l11 O7/01/12 Limit 2�.� � Ded DESCRIPTON OF OPERAT10Nfi / LOCAiIONS / VEHICLES (Attach ACORD 101, Additional Remarka Schedule, H more epace fa required) CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OP THE ABOVE DESCRIBED POLICfES BE CANCELLED BEFORE City of Zephyrhills '�E EXPIRATION DATE THEREOF, N07'�E WILL BE DELNERED IN 5335 8th Street AC�RDANCE WITH THE POLICY PROVISIONS. Zephyrhflls, FL 33542 AUTHORIZEDREPRESENTATVE 4� �-� O 1888-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD