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Ac K� CERTIFICATE OF LIABILITY INSURANCE �TE(MqUDDlYYYI�
<br /> �� ,o�,��„
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER3 NO RKiF1TS UPONTHE CERTIFICATE HOLDER.TFi1S
<br /> CERl1FICATE DOES NOT AFFIRMATIVEIY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE C01/ERA6E AFFORDED BYTNE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING IN3URER(3), AUTHORIZED
<br /> REPFtE3ENTATiVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the oertlflqte holder is an ADDITIONAL INSURED, the policy(les) must be endoned. H SUBROGATION IS WAIVED, subket to
<br /> the terms and eondRions of the poliry, xrteln policies may rcquirc an endorsement A statement on this xrtHicate does not eonfer rfghts to the
<br /> xrtkicate holder in Ileu of such endorsement(s).
<br /> PRODUCEH
<br /> Risk Transter Programs, LLC E�
<br /> 219 East Livingston Sireet PI10NE , 886-481'9363 F�
<br /> Odando, FL 32801 ��� No :
<br /> ADORE88:
<br /> INSU RER(S) AFFORDING COVEHAGE NAIC /
<br /> iNSUaEn �:CasUePoird NaUonal Insurance Com 40134
<br /> INSURED
<br /> AlphaStatt Group, Inc. Labor Contractor tor leased workers to: i�suttep e.Tower Insurance Com an ot New York 44300
<br /> Complete Climate Control IIIC. INSURER C.
<br /> 800 Corporete Drive
<br /> SUI19 600 INSUHER D .
<br /> FoA Lauderdale, FL 33334 INBUREN E.
<br /> INSURER F .
<br /> COVERAGES CERTIFICATE NUMBER:9REX9F7Z REVISION NUMBER:
<br /> THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDINO 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 ALITHE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INBR
<br /> LTR TYPEOFINSU(iANCE POLICYNUMBER P M/DD� P M/DD/YY P LIMRB
<br /> OENERAL IJABILITY
<br /> EACH OCCURRENCE $
<br /> COMMERCIAL GENERAL LIABILITV
<br /> PREMISES Es ocwrrence S
<br /> CLAIMS-MADE � OCCUR MED EXP (Arty aie rson) S
<br /> PEFSONAL 8 ADV INJURY $
<br /> GENERALAGGREGATE y
<br /> GEN'L AGGREGATE LIMR APPLIES PER PRODUCTS - COMP/OP AGG $
<br /> POLICV PR � LOC
<br /> $
<br /> AUTOMOBI LE LIABILT/
<br /> Ea acdder�
<br /> A �� T � BODILYINJURV(Perperson) E
<br /> ALL OWNED SCHEDULED BODILY INJUflY (PeracadeM) S
<br /> AUTOS AUTOS
<br /> HIREDAUTOS NON-OWNED
<br /> AUTOS Per accid nt �
<br /> S
<br /> UMBAEILA W18 OCCUR EACH OCCURRENCE
<br /> E
<br /> EXCE88 LUB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION
<br /> A WDRKERSCOMPENSATION VYSLTHPE00003407 07/01/2011 07l01/2012 WCSTA U- OTH- E
<br /> B ANDEIIAPLOYERSIUBItJTV Y�N 4VSLTHPE00014203 X
<br /> ANY PROPRIETOWPAFiTNERIEXECUTIVE
<br /> OFFICEWMEM9EREXCLUDED� ❑ N/A ELEACHACCIDENT y 1,000,000
<br /> �AA�ndMOry In Nil) 1,000,000
<br /> liyes describa under E L OISEASE - EJ1 EMPLOVEE $
<br /> DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY lIM1T � 1,000,000
<br /> S
<br /> $
<br /> $
<br /> $
<br /> DEBCRIPTION OF OPEHATIONB / LOCATIONS / VEHICLES (Att�ehACAqD 101, Additlontl qem�rka Sdiedule, H meroap�os ia mqulred)
<br /> Coverage is extended �o the leased employees of altemate employer (Alabama, Arkensas, Colorado, Connectiwt, Florida, Georgia, Illinois, Indana, Kansas, Kentudry,
<br /> Maryland, Michigan, Mississ�pi, Missouri, Nebraska, New Hampshire, North Carolina, Oklahana, Oregon, Pennsylvania, South Carolina, Tennessee, Texas and Virginia
<br /> Operations Only): Complete Climffie Control, Inc. #440104 (Effective 1/01/10)
<br /> This certificate only applies to Project# 1251
<br /> Chase Bank
<br /> 7800 Gall Rd
<br /> Zephyrhills, FL 33542.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> 3HOULD ANY OFTHE ABOVE DESCpIBED POUCIES BE CANCELLED BEFORE
<br /> THE EXPIRA710N DATETHEREOF, NOtTICE WILL BE DELNERED IN
<br /> ACCORDANCE W17H THE POLICY PROVI310N3.
<br /> City of Zephyrhills - Building Departrnent AUTHORQED REPqESENTATIYE
<br /> 5335 8th Street
<br /> Zephyfiill, FL 33542 ,�"�+a : ; :
<br /> ��. :.
<br /> Pape � ot � m 1988-2010 ACORD CORPORATION. All rights reserved,
<br /> ACORD 25 (2010/05) The ACORD name and logo are registered msrks of ACORD
<br />
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