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m:LaPlante Agency To:Certiflcate of Insurance_ML Moody Inc (18137600021) 13:52 10I04I11GMT-05 Pg 02-02 <br /> Phone: (813)780-0020 Fax: �813�780-0021 <br /> Aco ' CERTIFICATE OF LIABILITY INSURANCE DATE�MWDDfYYYY) <br /> 40/04/ 011 <br /> TH13 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> (�RTIFlCATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POlIC1ES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED <br /> REPRESENTATNE OR PRODUCER, AND THE CERTifICATE HOLDER. <br /> IMPORTANT: If tha certificate holder is an ADDITIONAI INSURED, the policy(iss) must be andorsed. If SUBROGATION IS WANED, subjsct to <br /> tha tsrms and conditions of the policy, certain policies may require an endorsemenL A statemant on this ceRificate does not confer rights to the <br /> certificate hoider in lieu of such endorsemerK(s). <br /> vaoouc�i �E � Patsy Penn <br /> LaPlante Agency PHONE 2 ies-e5ss � N: iv �st-�at2 <br /> 2T15 State Rd. 580 E �"'� ts la Iantea �n .com <br /> Clearvvater, FL 33761 iNSUR S AFPORD�IG COVERAGE N,vc r <br /> n+wReR,,: Mid-Caitinent Casual Grou <br /> � piSURER B : <br /> M� Moody �r1C INEURER C: <br /> PO Box 40983 qiSURER D; <br /> SaiM Petersburg, FL 33743 MSURERE: <br /> M8URER F . <br /> COVERAGE8 CERTIFICATE NUMBER: 00000965-0 REVISION NUMBER: 1 <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE IISTED BELOW HAVE BEEN ISSUED TO THE lNSURED NAMED ABOVE FOR THE AOLICY PERIOD <br /> lNOICATED. NOTVYITHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM&. <br /> �L � T1'PE OF iNfURANCE �� pOLICY NUMBER �� � POLICY EXP Li1R8 <br /> A 6ENERALW181UTY N N 04-GL-000806938 11/2�/Z01� �1/20I2�11 �EACHOCCUi2RENCE $ �� QQQ <br /> X COMMERCIAI GENERAL LIABILfTY PREMISEB�Ea o�cawrence S � OO OOO <br /> CLAIMS-MADE � OCCUR MED EXP (Arry o�ce person) S EXCIUdt� <br /> PERSONAL 6 ADV INJURY S � OOO OOO <br /> GENERAL AGGREG/1TE S Z OOO OOO <br /> GEML A(`�REGATE LIMR APPLIES PER PRODUCTS - COMPlOP AGG S Z OOO OOO <br /> X POLICY PR LOC <br /> S <br /> A(JTOMOBILE LYIBIUTY <br /> Eo ecci eM <br /> ANY AUTO BODILY INJURV (Per person) S <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILYlNJURY(Perecudent) E <br /> HIRED AUTOS NON-04VNE0 P OPERTY AMAGE <br /> AUTOS PerecadeM S <br /> S <br /> A X �""�«^ � X occua N N 04XS169347 11/20/2010 11120/2011 EACH OCCURRENCE s 5,000,000 <br /> IXCESE UAB CL/�IMS-MADE AGGREGATE 5 S�OOO�OOO <br /> DE� R TION 5 <br /> WORKERf COMPEriSAT10N WC STATU- OTH- <br /> AND EMPLOYERS' IIABIIRY Y 1 N <br /> aNY PROPf8E70RIPARTNERfEXECU'i�vE E l EACH ACCIDENT 5 <br /> OFFICERIMEMBER EXCLlAED7 � N f A <br /> pA�nd�tory in NH) E L DIS£ASE - EA EMPLOYE S <br /> tlyes desuibe w�der <br /> DESCRIPTION OF OPERATIONS bebw E L DISEASE - POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEMICLES (Alud� ACORD 101. Addkional Rrnarks �q, @ mon spae� ls nquNW) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SNOULD ANY OF THE A80VE DESCRiBED POLIGES BE CANCELLED BEFORE <br /> Cih/ Of IRpllj/rF11II5 �£ �p�T�� DATE TNEREOF, NOTICE YYILL BE DELNERED IN <br /> ACCORDANCE NRTN TNE POLICY PROVISIONS. <br /> 5335 8th St <br /> Z�I��/�I11IIS� FL 33542 A REPRESEN7ATNE <br /> e�`�" --� PJP <br /> � 1968-2010 ACORD CORPORATION. All rights reserved, <br /> ACORD 25 (2010I05) The ACORD name and logo are registered marks of ACORD <br /> Printed by PJP on October D4, 2011 at 01 _07PM <br />