|
11/15�'2011 14:23 8138644429 GULFCOASTUNDERWRITER PAGE 01/02
<br /> /�C` R Q" . OP !b: P(
<br /> �..�- CERTIFICATE t7F L�,ABILITY �NSURANC� DATE(MMIDDIYYYYJ
<br /> TNIS CERTIFICATE IS ISSUED AS A MATT�R OF INF�RMATIQM ONLY AND CpNF�RS NO RICyHT3 UPON THE C�RTIFIGATE HOI,D�R.� THf3
<br /> C�RTIFICATE DpE$ NOT AFFfRMATNE�Y dR NE�ATNELY AMENd, EXTEMQ OR AL7�li THE COVERAGE AFFOROEQ BY THE PpI.fC�Eg
<br /> BELOW. THI3 CERTIFICA7E OF INSURANC� p��g NOT CQNSTITU'TE A CdNTRACT BE7WEEN THE ISSUING INSUR�R(Sy, AUTHqRIZED
<br /> RERR�SEN7'ATIVE DR PROOUCER, AND TH� CERTIFICATE Hp�D�R,
<br /> IMPORTANT: If the certificate halder ig �q ADDITIONAL INSUFi�D, the poliCy(ie9) must be endorsed. If SUBROGATION 13 WAIV�p, subject to
<br /> the tsrms and Cpnditia� of the pellcy, CeRBpn policles may require an endorsemenk A statement on this �ert�f"roate docs not coMer nghts to the
<br /> Certificate holder in IiEu p{ such andorseme �.
<br /> PROOUC�q 813 �ONTi�T Rand Gra
<br /> Gulf Cpg� Underv�rlter5
<br /> 11073 Gauntryway B1vd. 673-864 PNq�E g73.q,�
<br /> Tampa, F� 33626 � �uc xo. 813�443-5$12
<br /> peter Condon (I�vel 40) �ss�_ .
<br /> PRO�u _, .FLORI-1
<br /> iNSUr�o Florlda Life#ime Impact Wlndaw �� s ��� � "�
<br /> and Door, Inc. rNSUt�RA:Ma Ins, Com an of FloNda 34932
<br /> 5734 West Idlewiid Avenue iNSUaeRe:Chartis Casual Com n
<br /> Tampa, FL33634 iNSUa�RC:
<br /> IN$(IR�R D :
<br /> �n►suR�R E ;
<br /> c ��� C�R77FICATE NUMBEI�: REViSION NUMBEa:
<br /> 7MIS Ig Tp C�RTIFY THAT THE PpLIClES OF INSURANCE LI3TE0 BELOW WAVE B�EN ISSUED TO THE INSUREQ NAMED ABOVE FOR THE POLICY PER�OD
<br /> INDfCAT�4. NOT'WITHS7ANDING ANY REQUIREMENT, T�RM OR CbNDITIQN pF I�NY CdNTRAGT OR pTHER DOCUMENT wrrH RESPECT Tb WHICH THIS
<br /> C�RTIFICATE MAY BE ISSUEO OR MAY PERTE►IN, THE INSUi4ANGE AFFOROE6 BY THE PpLICIES DESCRIBE� WEREIN IS SUBJECT Td ALL THF_ TERMS,
<br /> �XCLUSfONS AND GpNDITlONS OF SUCH PQLICIES. LIMITS SHdWN MAY Hq1lE BEEN REDUC�D 8Y PAID CLAIMS.
<br /> IN� pDp� SU
<br /> TYPEOFtN9uieAMCE ppV p pp�yp�p
<br /> GENERAL L,Iqg�� LIMIT'8
<br /> EACNOCGURFi�NC� S 'I�OIIO�OQ(
<br /> A X COMMERCIAL�ENERA�,�µyg���y I'-0OQ502458 03/31/17 03/31/12 pR Eeoxurrenee 3 1��0�(
<br /> CLAIMS-MADF � OCCUR MED IXP (Any one peraon} $ 5,QQ�
<br /> P�RSONAL.RADVINJUI2Y � 1.�,QQQ
<br /> OENERALAGGREGA'TE g 2,000,000
<br /> GEN'L AQpRE(�/{� �11'APPUES PER;
<br /> X POLICY PRO- �� PRObUC'r5 • COMwOP AGG 8 2,0OO,OQO
<br /> AUTOIi1C91LE LIABIU7Y a
<br /> GOMBMED SINGLE LMR
<br /> ANYAUT4 {�nn�dd9nty � ��,0�0
<br /> � ALL OWNED AU'r(ty BODILY IN,IURY (PM pqrqp�) 8
<br /> A x SCHEDUL�D AUT173 41 PC01109 11/09/71 17l09l12 BObILY INJURV (Per pedd9nt} g �
<br /> HIRED/1�7pg PROPERTYDAMA(�E �
<br /> (Pa aocldenq
<br /> NON-01NNF.p q�g ��� - No Ded. s 10��
<br /> A X�omp/Coll Ded 5D0 011P�01109 11/p9/11 ���as��a UM $ ��,�
<br /> uMert�w►u,ne occuR
<br /> EXCES3 u,aB �►CH OCCURR�NGE $
<br /> CLAIMS.MAD�
<br /> DEbUCTIBLF_
<br /> �C30RBOATE a
<br /> R �
<br /> WORKERSCOMpENSATION �
<br /> ANGEMPLOYERS'LLqB1uTy X wGBTATU- OTH.
<br /> B ANYpROPRIETQRlpp,�����71VE � CO57-75-0641 03f31177 � 43l31/12 �
<br /> OFFlCERIMEMB�R�(CLUbED7 NlA
<br /> fM�QrInNHy e.�.encynCCroEnn� s 500,00
<br /> 1f ox det+Glbe unGer F.L, oISEASF.. F,q EMPLbYE S SaQ,
<br /> � FERATI a
<br /> A G6rltenfS 100,000 Cp-060507A55-1 6.L, pISEABE -PbLlCY tlMlr $ 500 0
<br /> 03137M1 03/31/12 ped � 5•��n►ina�wal
<br /> A�qulpment 100,000 P-OObS02455�.i Ded 1,000 S
<br /> OESCqIPnpp� OF OpERAT10N& 1 LpCArpNS ! VEl11CLES Altneh ACqRO p� pebtlaaf�l Romerka 9chedulo, If moro zpaeo la raquirndy
<br /> Kenneth Goodmao Flafida Lir.�nse 3GC.19�14966$ F� �G'C-05$?.82. IVqichael Lane
<br /> lorlda 1.iC�nse CGC-0594E5. Cpmparly A Identity Recdvery SZ5,OQ0- Ded 3100.
<br /> ompany B; vehicle Schedu�e Attac{�ed,
<br /> C � �� C,4N�E
<br /> City of Zephyrhllls
<br /> Fax 873 -78�-�a2� ��ULD ANY OF TME A9p{/� p�R�gEp pOLIC1E$ H� CpNCE��Ep g�Fp}��
<br /> 5535 Sth St THE EXPIRATIpN DAT� TH�iLHOF, NOTICE Ulry�.�, �� DELIVER£D IN
<br /> ACCORDANCQ MryTN'�}�E PULICY PRbVI$IQN$,
<br /> Zephyrhllls, FL 33542
<br /> au�ntpR�o RFPRESENranvE
<br /> � �� � �
<br /> ACORD 25 (2008/p� � 7988-2Q09 ACORD CC1RpORATIdN. All rights reaerved,
<br /> � The ACORD name 811d logo are register'ed marks 4f �iCORp
<br />
|