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FfOm 10/17/2011 14.37 #033 P 001I002 <br /> .�-��Dn CERTIFICATE OF LlABlLITY tNSURANCE �ATE(MM/DplYVYY) <br /> ' io/i��zoii <br /> PROpUCER g63 . 33. 3131 FAX 863 . 533 . 7038 THIS CERTIFICATE 15 ISSUED AS A 1NATTER OF INFORMATION <br /> Gi bson & Wi rt , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTJFICAT'E <br /> 12S East Mai n Street HOLDER. 7HIS CERTIFtCATE DOES NO7 AMEND, EXTEND OR <br /> P.O. Drawer 59 <br /> ALTER THE CaVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Bartow, FL 33831 INSURERS AFFORDING COVERAGE NAiC # <br /> INSURED ]oe Goldsmith Construct�on Inc INSURERA gridgefield Employers Ins Co. 10701 <br /> 3248 Galloway Road INSURERB: <br /> Lakeland. FL 33809 INSURERC. <br /> iNSURER D: <br /> INSURER E <br /> OVE <br /> THE POLICtES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TNE INSURED NAMED ABOVE FOR THE POLICY PERIOD INpICATEO NOTWITHSTqN01NG <br /> ANY REQUIREMENT TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICFI THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN. THE tNSURANCE AFFORDED BY THE POLICfES DESCRIBED HEREIN !S SUBJECT TO ALl THE TERMS, EXCLUSIQNS AND CONdITIONS OF SUCH <br /> POl[CIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA�D CLAIMS. <br /> INSR D' TypE Oi INSUpANCE POLICY NUMBER ���CV EfFECT1VE POUCY EXWNATipN <br /> LIMITS <br /> 6ENERAI LIABIUTY EACH OCCURRENCE S <br /> COMMERCtAL GENERAL UABILITY DAMAGE 70 RENTEO s <br /> CLAIMS HWDE � OCCUR MEO EXP (My one persor.) g <br /> PERSONALBApVINJURY S <br /> 6ENERALAGGREGA7E 5 <br /> GEN'L AGGREGATE liNpT APPIIES PER: <br /> POLICY PR�_ PROOUCTS - COMPlOP AGG S <br /> JECT LOC <br /> AUTOMOBILE LIABIUTY <br /> ANY AUTO COMBINED SMIGLE LiMli <br /> (Ea acciden!) $ <br /> ALl OWNED AUTOS <br /> BODIIY INJURY $ <br /> SCHEDULEO AUTOS � ��� <br /> MIREO AUTQS <br /> NON•OWNED AUTOS BODILV INJURY � <br /> (Per acddent) <br /> PROPERTYDAMAGE E <br /> {Per 8tcident) <br /> GARAGE 11A81LITY AUTO ONtY - EA ACCIOENT S <br /> ANY AUTO <br /> OlHfRTHAN EAACC S <br /> AlfTO ONIV AGG S <br /> EXCESS/{lMERELIA L1A81UTY <br /> EACH OCCURRENCE s <br /> OCCUR � CUUMS MADE AGGREGATE <br /> S <br /> DEDUC71BlE <br /> s <br /> RETEN710N S <br /> S <br /> 0830-Q0793 07/O1/2011 07 O1/2012 $ <br /> WORKERS COMPENSATOM AND WC STATU- OTM- <br /> EMPIOYERS' LIABIUTY � <br /> /� ANY PROPRIETORIPARSNER�EXECUTIVE E.L. EACH ACCIDENT S SUO, OO <br /> OPFICER/MEMBER E%CLUDEO? <br /> �t yes. dettr�e unde� E l DISEASE - EA EMPLOYE S SOO � OO <br /> SPECU4L PROVIS�ONS below <br /> OTHER <br /> E.L. DISEASE • POLICY LIMIT ; SOO � OO <br /> DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES l EXCLUSIONS ADDED 6Y ENDORSEMENT I SPECIAL PROVISIONS <br /> T T <br /> SHOUlO ANY pF TNE ABpyE DE�RIBED POlIC1E3 BE CANCELLEO BEFORE THE <br /> EXPIRATION DATE THEREOf, 7ME ISSUING INSURER WILL EN�EAVpR TO MAIL <br /> lO DAYS WRITTEN NOTtCE TO THE CER71FICqTE HOL�R Np�pEO TO THE IEFT, <br /> �7 ty of Zephryh i 11 s 9UT AlLURE TO MAIL SUCM NOTICE SNALL IMPpSE NO OBUGATION OR LIABILfTY <br /> 5335 8th Street NV NIND UPON THE INSURE � NTS OR REPRESENTA71VE5. <br /> Zephryhi l l s, FL 33 S42 '� au wzeo err�seN a <br /> lP <br /> ACORD 25 (2001/08� FAX: 813. 780.0021 BACORD CORPORATION 1988 <br />