Laserfiche WebLink
12/05/2011 08:20 FAX 7278696477 Coolquest/dipatch �0003�0003 <br /> ' ° CERTIFICATE OF LIABILITY INSURANCE °�aEo� °°"""' <br /> / /aoii <br /> THIS CERTIFICATE IS ISSUED A3 A MATTER pF �NFORMATIOIV ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFlRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE �SSUING INSURER(S►, AUTHORIZED <br /> REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT If the oertificate holder is an ADDI1lONAL INSUREO, the policy(fes) must be endorsed. N SUBROGATION IS WAIVED, subject to <br /> the terms and conditio�s of the policy, certain policies may require an endorsemerrt. A statement on this cer0ificate dces not confer rights to the <br /> certificate holder in lieu of such endorsemeM(s). <br /> PRpOUCER 1-727-797-4190 CONTACT <br /> Arthur J. Gallagher Riak Management S�:vicea, Inc. � <br /> PHONE FAX <br /> A!C No : <br /> 4904 Eisenhower Hlvd., Ste 250 E <br /> AD ESS: <br /> Tampa, PL 33634 INSUR S AFFORDINGCOVERAGE ��p <br /> nvSURERw. TE���Y INS CO INC �42376 <br /> IMSURED <br /> Paychecka Plus, Inc. <br /> INSURER 8. <br /> INSI/RER C . <br /> 2920 Enterprise ROad #208 INBURERD. <br /> Clearwater, PL 33�63 �NSURERE <br /> INSUREA F . <br /> COVERAGES CERTIFICATE NUMBER: 2�3o94i3 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW HAVE BEEN ISSUED TO TNE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INOICATEO. NOTWITHSTANOING ANY REQUlREMENT, 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 POIICIES �ESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAIp CLAIMS. <br /> INSR TyPE OF INSURANCE L BR POUCY EFF � GOLKY E7fV <br /> LTR i POUCY NiJM�R <br /> GENERAI WB711TY ' UMITS <br /> I � EACH OCCURRcNCE 5 <br /> j COMMERCIA� GENERAL LIAB4iTY � MA ED <br /> PREMI E� � c Rence ' S <br /> CLAIMSMnDE � OCCUR I j I MEO E�Xp (q� o„e �,�„ ' S <br /> � PERSONAL & ADV INJURY S <br /> � ! GENERA�nGGREGATE ;S <br /> GEN1 AGGREGATE LIMIT AFPItES PER: � PRODUCTS - CAMP/OP AGG � 5 <br /> � 70UCY � �T LOC I S <br /> AUTOM081LE LIABfLITY j COMBINED 31NGLE LIMIT <br /> � � ' i Ea acdderK 5 <br /> � I ANV nUTO i BODILV INJURV (Pe/ p¢Bpn) $ <br /> ALL OWNED j —' SCHEOUIED <br /> � AUTOS � AUTOS BOOILY IWURV (Car accidern) S <br /> : NiREO AUTOS ; I��WNED I PROPERTY OAMAGE 5 <br /> —1 Per a ' ent <br /> � � S <br /> � � UMBRELLA LIAB i pCCUR � EACH OCCURR 5 <br /> � EXCESS LIAB CLAIMS-MADE I AGGREGATE S <br /> � I OEO RETENTION S S <br /> A i WORKERSCOMPENSAT(ON ThTC3266546 12/O1/12 X �STATU- ' OTH- <br /> ; AND EYPLOYER8' LIABI�ITY �� N 12 / O 1/ 1 T � <br /> ; ANYPROPRIETOR/PARTNER/EXECUTIVE i <br /> � OFFiCER/MEMBER EXCWDEO? � N I A i � i E.l. EACH ACCI� S 1, 000, 000 <br /> I(Mandatory in NH) i I E.L. OISEASE - EA EMP�OYE 5 1, 000, 000 <br /> ; If yes, desaibe under � <br /> � �ESCRIPTION OF OPERATIONS below I I � ! E.L. OISEASE • PpLICv LIMrt S 1, 000, 000 <br /> i I i <br /> I <br /> � � <br /> DESCRIP71pN pF OPERATtO1�E3 ! LOCATIONS I VENtClES (Attach ACORp 10t, Ady;t;onal Remarka ScMWde, if more spsce is requred) <br /> Joha Philie Sleetric, LLC ie an alteraate employez. Coverage ia provided ta contracted <br /> employeee of Paychecka Plus, Inc. aot aubcontract labor. <br /> John J. Philie is the Licenae Dolder. LicanaeltBR0015322. Exp Aug. 31, 2012 <br /> RE: Storr Office Eaviro�enta <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE <br /> City of Zephyrhills THE EXPIRATIpN DATE THEREOF, NOTICE WILL BE DEUVERED IN <br /> Ci ty Manager ACCORDANCE WITH THE POUCY PROYISIONS. <br /> 5335 8th Street w�Tr�pR�EOrtEV�seNTwnve <br /> 2ephyzhills, FL 33542 ` i\_ _�G �� <br /> � IISA �CJ���� <br /> O 1988-2010 ACORD CORPORATION. All rights reserved. <br />