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<br /> aco ��' CERTIFICATE OF LIABILITY INSURANCE �ATE(MMlDDlYYYy)
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER7IFICATE HOL ER.
<br /> CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CER7IFICATE OF INSURANCE DOES NOT CONSTiTUTE A CONTRACT BETWEEN THE ISSUING INSURER(SJ, AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER, AND THE CER7IFICATE HOLDER.
<br /> IMPORTANT: Ii the certiflcate holder is an ADDI710NAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subJect to
<br /> the terms and conditions of the policy, certain policies may requfre an endorsement. A statement on this certificate does not confer rlghts to the
<br /> certiflcate holder In Ileu of such endorsement�s).
<br /> PRODUCER
<br /> NAME:
<br /> Mal'Sh USA IfiC. PHONE FAx
<br /> 1 166AvenueoftheAmericas A/C No Ex :(212� 345-5000 A!C No:
<br /> New York, NY 10036 ADDRESS:
<br /> INSURER AFFORDING COVERAGE NAIC /
<br /> INSURED INSURER A. AGCS Marine Insurance Company (Allianz) 22837
<br /> INSURER B: CHARTIS CASUALTY COMPANY 40258
<br /> ADT Security Services, Inc. INSURER C Commerce 8 Industry Ins Co. �gq�p
<br /> 32100 US Hwy 19 N INSURER D� Illinois National Insurance Co. 23817
<br /> Palm Harbor, FL 34684-3727 INSURER E. NaYI Union Fire Ins Co. of Pittsburgh, PA 19445
<br /> United States INSURER F• New Hampshire Ins. Co. 2��
<br /> COVERAGES CERTIFICATE NUMBER:934148 -A 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 qNY CONTRACT OR QTHER 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ��R TYPE OF INSURANCE POLICY NUMBER POLICV EF POLICY %P
<br /> F GBJERAL LIABILIN MM! M! LIMRS
<br /> GL 2449607 (Primary GL) 10J1/2011 10/1/2012 EACH OCCURRENCE $ $2,000,000.00
<br /> X COMMERCIAL GENERAL LIABILITY
<br /> CLAIMSMADE X❑ OCCUR PREMISES Ee ocaRence 3 $1,000,000.00
<br /> OWNER'S S CONTRACTOR'S PROT
<br /> MED ExP (Any one person) $ $10,000.00
<br /> PERSONAL $ ADV INJURY $ $2,000,000.00
<br /> GENERAL AGGREGATE $ $4,000,000.00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER
<br /> X POLICY PR � LOC PRODUCTS-COMPlOPAGG $ $4,000,000.00
<br /> AllTOMOBILE LIA81LfTY $
<br /> E CA3506468 (Vq) 10/1/2011
<br /> E X CA 3508484 (AOS) 10/1/2011 10/1/2012 Ea accident $7,500,000.00
<br /> ANY AUTO BODILY INJURY (Perperson) $
<br /> E AlL OWNED SCHmU�ED CA 3506465 (MA) 10/1/2011 10/1/2012
<br /> F nU70s ,aUTOS Cq 3508466 H
<br /> X HIRED AUTOS X NON-0WNED M)(Primary ,qL) 10/1/2011 10/1/2012 BODILY INJURY (Per atadent) S
<br /> AUTOS
<br /> Pe�eccident AMAG $
<br /> UMBRELLA LIAB X NEW HAMPSHIRE CSL $ $250,000.00
<br /> OCCUR
<br /> F x EXCESSLIAB aAIMS-MADE CA3506467(NH)(ExcessAL) 10/1/2011 10/1/2012 EACHOCCURRENCE $ $5,500,000.00
<br /> GL 2449608 (Excess GL) 10/1/2011 10/1/2012 pGGREGATE PROwCrs - g $11,000,000.00
<br /> DED RETENTION $
<br /> B WORKERS CoMPENSAT1oN C 0158840 5( T,GA,PA,SC NEW HAMpSHIRE (CSL) ; $7,250,000.00
<br /> APD EMPLOYERS' LIABILITY � 10/1/2011 1 O/1/2012 X W S A U- H_
<br /> C Y! N wc o� 5ssaoos �F��
<br /> ANYPROPRIETORiPARTNER/ExECUTIVE WC015884008 10/1/2011 10/1/2012
<br /> D OFFlCERlMEMBER E:-:CLUDED9 � N! A (MI} E L EACH ACCIDENT $ $2,000,000.00
<br /> E (Mantletory in NH) WC 015884004 (CA) 10/1/2011 10/1/2012
<br /> F If y es, destribe under WC 015884007 (MA, ND, OH, WA, � 0/1/2011 10/1/2012 E L DISEASE - EA EMPLOYEE $ $2,000,000.00
<br /> DESCRIPTION OF OPERATIONS below wl 10/1/2011 10/1/2012
<br /> E L DISEASE- POLICY LIMIT $ $2,OD0,000.00
<br /> A Builder's Risklinstallation/Contract Works OC & OCW 9112ggpp 10/1/2011 10/12012 USD $1,000,000.00 perjobsite
<br /> A Rental Equipment/Contractors Equipment OC & OCW 91128600 10/1/2011 10/1/2012 USD E1,000,000.00 perjobsite
<br /> A Blanket Transit OC & OCW 9112g600 10/1/2011 10l1/2012 USD $1,000,000.0p per conveyance
<br /> DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Akach ACORD 101, Addklon� Rsmvks Seheduls, If more apace is requintq
<br /> Jo6 Number: town 174 Customer Number: town 174 Town Number: town 174
<br /> Please refer to attached ACORD 101 for further remarks.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Zephyrhills
<br /> 5335 Eighth Street SHOULp ANY OF TNE ABOVE DEBCRIBED POLIpEB BE CANCELLED BEFORE
<br /> Zephyrhills, FL 33540�312 7'1�E EXPIRATION DA7E THEREOF, NOTICE WIIL BE DELIVERED IN
<br /> United States ACCORDANCE WITN THE POLICY PROV1810N8.
<br /> AUTHORIZED REPRESENTATNE
<br /> 'i �
<br /> �M�� INC. BY� ��� � �
<br /> Lynthis IGm, Cawelty Pmgrsm Frenklin Ndlock, GbbA M1�me
<br /> Trenai[P nm
<br /> ACORD 25 (2010/05j The ACORD name and logo are registered marks of ACO D ORD CORPORATION. All rights reserved.
<br />
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