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ACORD CERTIFICATE OF LIABILITY INSURANCE odiiiizoii' <br /> PHJDDUCER �305)822-7800 FAX (305) 558-4294 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Col l i nsworth, A1 ter, Fowl er & French LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 8000 Governors S uare Bl vd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> q ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Suite 301 <br /> Miami Lakes, FL 33016 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED Golden Sands General Contractors, Inc INSURERA: /��p'lSUre I115Yr'dflGe Co 19488 <br /> 2500 NW 39th Street iNSUaeaB: Amerisure Mutual Ins Co 23396 <br /> Miami, FL 33142 �n,suReRC: Federal Insurance Company 01295 <br /> INSURER D: <br /> INSUREF E. <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTW ITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY GL2066108 OZ�OZ�ZO11 OZ�OI�ZO12 EACH OCCURRENCE $ 1� OOO � OO <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ ZOO � OO <br /> CLAIMS MADE � OCCUR MED EXP (Any one person) $ ZO � OO <br /> A X BLANKET ADDTL INSD PERSONAL & ADV INJURY $ 1, 000, 00 <br /> X BLANKET WOS GENERAL AGGREGATE $ Z� OOO � OO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z� OOO � OO <br /> POLICY X PR � LOC <br /> JECT <br /> AUTOMOBILE IIABILITY CA2071489 OZ�OZ�ZO11 OZ�OI�ZO12 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $ i 000 00 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> A SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC $ <br /> OTHERTHAN <br /> AUTO ONLY� AGG $ <br /> EXCESS/UMBRELLA LIABILITY CU2066105 OZ�OI�ZO11 OZ�OI�ZO12 EACH OCCURRENCE $ S� OOO � OO <br /> X OCCUR � CLAIMS MADE AGGREGATE $ S� OOO � OO <br /> B $ <br /> DEDUCTIBLE g <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WC2066106 OZ�OI�ZO11 OZ�OI�ZO12 X WC STATU- OTH- <br /> EMPLOYERS' LIABILfTY y <br /> /� ANY PFiOPRIETOR/PARTNER/EXECUTIVE % E.L. EACH ACCIDENT $ 1� OOO � OO <br /> OFFICEFVMEMBER EXCLUDED? v E.L. DISEASE - EA EMPLOYEE $ 1� OOO � OO <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1� OOO � OO <br /> RIME 82214761 02/O1/2011 02/O1/2012 EMPLOYEE TNEFT $1,500,000 <br /> � PREMISES $1,500,000 <br /> $50,000. DED. IN TRANSIT $1,500,000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> C7 ty of Zephyrh i 11 s 3O DAYS WRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> Bu i 1 di ng Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 533 5 8th St reet OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Zephyrhills, FL 33542 AUTHORREDREPRESENTATIVE � <br /> Michael Nielson/SANDYS <br /> ACORD 25 (2001/08) OOACORD CORPORATION 1988 <br />