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� 8/25/2011 10:36 Paragon Risk Management Whitney Word-►City of Zephyrhills 1/1 <br /> � � DATE (MMIDDMlY1� <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE 8,25i2o11 <br /> `....�" <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTiTUTE A CONTRACT BEIINEEN THE ISSUING INSURER�S�, AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGA110N IS WAIVED, subject to <br /> the terms and conditions of the policy, certain polfcies may require an endorsement. A statement on this certiflcate does not confer rights to the <br /> certiflcate holder in Ileu of such endorsement�s�. <br /> PRODUCER � ME: Whitney Word <br /> Paragoa Risk Mauaqe�ent PH�� .(813) 949-8636 (813)909 <br /> AfC No : <br /> 203 Crystal Grove Blvd .whitneyw@paragonrisk.com <br /> INSURE S AFFORDING COVERAGE NAIC • <br /> Luta EL 33549 �NSUr�aa:Graaada Iusurauce Co. <br /> iNSU�o INSURER B . <br /> Coruerstone Air Conditioaiug i Heatinq, Iuc INSURERC. <br /> 3800 Land O Lakes BZVd. IN3URERD: <br /> INSURER E . <br /> Land O Lakes FL 34639-4916 INSURERF. <br /> COVERAGES CERTIFICATE NUMBER:11-12 Liability CERT REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED NOTWITHSTANDING 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 SHOYVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> �N� POIICY EFF POUCY EXP LIMITS <br /> TYPE OF INSURANCE POIICY NUMBER MlDDfYYYY MlDDN <br /> GENERAI LIABILtTY EACH OCCURRENCE $ 1� OOO � OOO <br /> $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ �.00 , OOO <br /> A CLAIMS-MADE � OCCUR 185FL00020919 /ZO/2011 /20/2012 MED EXP (Any one person) $ 5 , ��� <br /> PERSONAL & ACV INJURY $ S. � OOO � OOO <br /> GENERAL AGGREGATE $ 2� OOO , 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPIOP AGG $ 2, OOO , OOO <br /> S POLICY PR � LOC $ <br /> AUTOMOBILE LIABILITY Ea accident <br /> ANY AUTO BODILY INJURY {Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY (Per ecadent) $ <br /> AUTOS AUTOS $ <br /> NON-OWNED Per acudent <br /> HIRED AUTOS AUTOS <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> E%CESS LIAB C�AIMS-MADE AGGREGATE $ <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILRY <br /> ANY PROPRIEfORIPARTNERlEXECUTIVE Y f N E.L EACH ACqDENT $ <br /> OFFICERRv1EMBER EXCLUDED� � N f A <br /> (Mendetory In NH) E L DISEASE - EA EMPLOYE $ <br /> If yes, descnbe under <br /> DESCR�PTION OF OPERATIONS bebw E L DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES �Attaeh ACORD 101, Additlonal Remarks Sehedule, If maro space is requiro� <br /> Dana Goldsborough <br /> License # CAC1816647 <br /> CERTIFICATE HOLDER CANCELLATION <br /> (813) 780-0021 SNOULD ANY OF THE ABOYE DEBCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NO710E WILL BE DELIVERED IN <br /> The Clty of Sephyrhills ACCORDANCE WITN TME POLICY PROVI810N8. <br /> Buildiag Department <br /> 5335 8th Street AUTHORIZEDREPRESENTATIVE <br /> Sephyrhills, FL 33542 <br /> Nathan Jensen/WHITNE �__ <br /> ACORD 25 (2010105) O 1888-2010 ACORD CORPORATION. All rigMs reserved. <br /> INS025 �zotoos� o� The ACORD name and logo are registe�ed marks of ACORD <br />