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9051
<br /> ,4c'Q CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYI�
<br /> 10/27/2011
<br /> THIS CERTIFICATE IS ISSUEb AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> gELOW. TIiIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEPI THE ISSUING INSURER(S), AUTHORIZED
<br /> :PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br /> ��JIPORTANT: If the certiflcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certiflcate holder in lieu of such endorsement(s).
<br /> PRODUCER N�E C Certficate Department
<br /> Commercial Lines -(813) 639-3000 aoN a .(g13) 639-3000 a� No : (813) 639-71 SO
<br /> Wells Fargo Insurance Services USA, Inc. Ap clw.certrequest@welisfargo.com
<br /> 2502 N. Rocky Point Drive, Suite 400 INSURER S AFFORDING COVERAGE NAIC �F
<br /> Tampa, FL 33607 �NSURERA: Nautilus Insurance Company 17370
<br /> �NSURED iNSUReR s: Great Divide Insurance Company 25224
<br /> Cross Environmental Services, Inc. �NSUrtertc:
<br /> P. O. Box 1299
<br /> INSURER D :
<br /> INSURER E :
<br /> Crystal Springs, FL 33524 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER• 3441799 REVISION NUMBER• See betow
<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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TNIS
<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 SNOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ��7R TYPE OF INSURANCE AD L S pOLICY NUAABER MM�/Dp EFF MM�/ � LIMITS
<br /> A GENERALLIABILITY ECP0150718013 11/1/2011 ��/1/2Q�2 �CHOCCURRENGE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY pREM SES Ea occurrence $ 100,000
<br /> CLAIMSMADE � OCCUR gl / PD Combined MED EXP (My one person) $ 5,000
<br /> X Max. Agg. Per Policy PERSONAL 8 ADV INJURY $ 1,000,000
<br /> um�c S�o,000,000 $5,000 Ded Per Claim
<br /> GENERALAGGREGATE $ 2,D00,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ 2,000,000
<br /> POLICY X PRa LOC g
<br /> AUTOMOBILE LIABILITY BAP150717913 11/1/2011 11/1/2012 EOM�B SINGLE LIMIT �,000,000
<br /> X ANY AUTO BODILY INJURY (Per person) $
<br /> ALL OWNED SCHEDULED
<br /> AUTOS AUTOS BODILY INJURY (Per acadent) $
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS Peracadent $
<br /> x Basic PIP - $1 $
<br /> A UMBRELLALIAB X occuR FFX150718113 11/1/2011 11/1/2012 �CHOCCURRENCE g �,000,000
<br /> X EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $ 1,000,000
<br /> DED x RETENTION $ 10,000 $
<br /> B AND EMPLOYERS' LIABI Y/ N WCA150903612 3/1 /2011 3/1 /2012 X WC STATU- OTH-
<br /> ANY PROPRIETOR/PARTNERIEXECUTIb'E
<br /> OFFICER/MEMBER EXCLUDED? � N! A E.L. EACH ACCIDENT $ 1.000,000
<br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,00O,OOD
<br /> If yes, desaibe under
<br /> DESCRIPTION OF OPERATIONS be�aw E.L. DISEASE - POLICY LIMIT $ 1,OD0,000
<br /> A Contractors PolluUon Liab ECP0150718013 11/1/2011 11l1/2012 g�,000 Each Pallution CondiGon/$2,OOO
<br /> $5,000 Ded. Each Claim Mold Limit $�,000,00a$z,000,000
<br /> w/$5,000 Ded.
<br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space Is requ(red)
<br /> RE:MM- The City of Zephyrhills is included as additional insured with respect to general liability.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES QE CANCELLED BEFORE
<br /> ��35 - 8th Street THE EXPiRAT10N DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> hyl'hllls, FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRE5ENTATIVE /'�
<br /> C�((tAM�
<br /> / ,C' �"•vT
<br /> The ACORD name and logo are registered marks of ACORD �O 1988 ACORD CORPORATION. All rights reserved.
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