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<br /> � -- -- -- _� �_ _� �a�N�� �„ 01.3 ?°'_ _��86 P.l�1;GJ1
<br /> '`�` °��� �ERT�FiCA�"� �F LiABiL.iTY 1NS�JRANC� OATE(MMlDQ/YYY'�
<br /> oa��s��� �
<br /> THIS CER7lFICATE !S 1S8UED AS A MATiER OF INFORMAT]ON ONLY AND CONF�RS NO RIGHTS UPON THE C�RTIFICATE HOLDER. THI$ '
<br /> CERTIFICATE �QES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, �XTEND OR ALTER Tti� COVERAGE AF�ORDED 6Y THE POLICIEB
<br /> BELOW. TH18 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CON7RACT SETWEEN THE ISSUING INSt1f2ER(5), AUTffORlZEQ
<br /> REPRESE►JTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br /> INlPORTANT. if the cert►flcate holder is an ADDITIONAL INSURED, the policy(ies) must be endof5ed_ ff SUBROGATION IS WAIVED subJect to '
<br /> the terms and conditions of the poflcy, certeln policfes may require dn endorsement. A stat9ment on this certlfEcate does not confer right9 to the j
<br /> certificate holder In lieu vf such endorsement s.
<br /> GRODUCER CpNTACT
<br /> Hockman lnsurance Agency, Inc. 813-636-4000 H��, Gafl Walunas _
<br /> 3438 Cotwe(I Avenue 813 PHONN E�ct ac No : B'13-28'1-108B
<br /> Tampa, FL 33614 aooR�ESS:
<br /> HoCkman lnaurance AgenCy, Inc. - — -...- _. ..__
<br /> _, W3URE A�9� AFFORDING CDVE _ NA{C 71 '
<br /> _. IN8llREfiA:N01*fi pOlflt@ �fl$�Jr'd1
<br /> - ... .,,,.
<br /> iN9u�zED Randall Mulllns Construction �nsuaea a
<br /> InC., S Randall Mulfins 1NSURERC: V
<br /> 9351 Delray Dr _.._ _.... ..— ...
<br /> New Port Rlchey, FL 34654-b655 INSURERd; __ ^
<br /> iNSURER E
<br /> INSURER F : V V
<br /> COVERAGES CERTIFICATE NUMBER� REVI510N Nl3MBER:
<br /> THIS �5 TD CERTIFY THAT THE POLICIES OP IN9URANCE LIS7E0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AeOVE FOR THE POLICY PER{OD ;',
<br /> INDICAT�D N�TWI7HSTANDING ANY REQUIREMENT TERM OR CON�fTION OF ANY GONTI2ACT OR OTHER DOCUMENT WITFi RESPECT TO WHIGH 7HI6
<br /> CERTIFiCATE MAY eE ISSUED OR MAY RERTAIN, TIiE INSURANCE AFFORDED 8Y THE POUCIES �ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
<br /> EXCLUSIONS AND CONDCTIONS OF SUCH POLIG�ES. LIMIT5 SHOWN MAY HAVE BE�N REDUCED SY PAID CLAIMS,
<br /> IN3R I SUB � --' '-' P E'FF POUCY .• ���� -- --
<br /> T' IYPE OF IN6URANCE POLICY NUM9ER I MMIOD/YY MM/DD/YYri LIMIT$
<br /> OEN�RAL LIAEIUTY �, I � EACH OCCURRENCE � S 1�OQB�
<br /> A X � coM�eaCiAL OENER.aI, uAeiufv � AUD624201'1R126124 06/24l11 Q6/24112
<br /> ��---) ;� I I I PREMI3E3 EB ooc� ca 5 � �� .„
<br /> �" �LAIb1S-MADE ' .t I O..CUR I
<br /> _,� `' I i MEO ExP ( ons peraan) �� g SqQ ..
<br /> .--_; __._ i i, ' PEFS 3 ADV �NJUR � S ��O
<br /> � —� � I i GENERALAGGREGATE i1 Z,D
<br /> GEN'L AGOREGAT6 LIMi7 ;.pp�tES AER. !, i Pf30DUCTS - COMPIOP AGG 5 Z,OfI�
<br /> .�.. � PRa- r ' I � � •_'_,__,,{
<br /> POUCY ! I J^ � LOC I I I
<br /> AUTOMD9ILE LIABILITY — � � I � i�L�BTNED SINGLE LIMIT
<br /> f fEaumieentl _. .,__ �
<br /> ' ANY �1�T0 I � BObiLY INJURY (Per pereon) S
<br /> ' ALL OWNED �'' SCNEDU�EO I �� I -• .
<br /> _ AU703 ,_,_, AUTOS i i i HODILY INJURY (Por �ccidenl) � S ,
<br /> �-- -•._
<br /> NON-0WNED ' PROP �A � AGE
<br /> _� HiRED AUTOS _ AUTOS I �I i� J__ W �
<br /> I Pcr oecidenO
<br /> i I I r 1 �
<br /> uMeRELIa uA0 � � OCCUR I EACFt OCCt1RRENGE ' 3
<br /> i ' 'cXCES6 l.�/+B — j CLAIMS-MADE� � ± AGGREGJ+TE I$
<br /> oED RETENT�C I I i i � �
<br /> WORKERS COMPEN3ATION I I WC STATU- ! OTH�I '
<br /> i AN� EMPLOYERB' LIA0IUTY , ' � I � 70RY LIMITS 'i I ER ,.
<br /> YIN � i 1-.... -.��...-
<br /> ' ANY PROPRIETOR/PARTNERIEXECUTIVE I i �� I E.L. £ACH aCCloEtdT 1 y '
<br /> i OFFICER/MEMBeR EXCLUDED? �, N/ A I ,,, ' _„
<br /> (Mnneetory In NH� I E L. O�SEASE - EA EMpLOYEcI �
<br /> I II vom daau�De under ' � �
<br /> 06`SCRIPTI N OF OPEFiATtONS below � I E.L DI3EASE - POUGY LIMIT I S
<br /> � I
<br /> I �
<br /> I
<br /> D@3CRIDTION OF OPEfiATION9 ! LOCATIONS/ VEH1GlES {AN�C11 ACORD 107 nCaltlon�� Rern�rxa scneawe, R mure sprco Is rnqulroe�
<br /> GERTIFICATE HOL�DE�; __ � CANCEI.LATION '
<br /> SHOULO ANY OF THF A80VE DESCRIBE� POLICIES 8E CANCELLED B�FOR�"
<br /> City of Zephyrhills �E EXPIRATION �ATE TMER�OF, NOTICE WILL 6E DELIVERED :IN:
<br /> ACCOftDANCE WITFI THE POLICY PROYISlONB.
<br /> 5335 8 Street
<br /> AVTHOR�ED REPRESENTATIVE
<br /> Zephyrhills, FI 33542 � `���/
<br /> i �
<br /> � 1968-2014 ACORD CORPORATION. All rights resanaad',
<br /> - ---- -- .___- --_. ..�_ ,.....e,. _�_... ....., �,,,... _... _o...eto,�a ,..e.4. ni et`_f1Rf1
<br /> TOTAL P.�1
<br />
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