|
=��"'�'-05-�G�1� 1�'`"' F.i�=,��.�"F,p, I.J��IRANCE N_7E��C1` =13 �81. _,-,�:+E, � --.. c'�.
<br /> �.�c�c�►r�ri7, C�RTIF1Cp►�'E CIF LIAE31L1TY 1NSURANC� o�0�,�3, '
<br /> �......- �-�'- - ..
<br /> THIS C�R7I�ICA7� j8 18SUEl AS A MATTER OF INFOitM1ATi�ON �NLY AND CQNFEM�S NO RICsMTS UPt7N 7HE C�RTIFICIA'"F I�GI_UGR YM�
<br /> CEC1TIFtCA7E DQES NOT AFFIRMSTIVEt�f OR NE�a3'�V�+�Y AMEND, �XTEhID Cli� ALT�R TN� CQV�RACiE pRFORDECI �Y THE ��i.I�t�S ,
<br /> 9ELOV1'. Th91$ CEfiT1FICA'ff� t�F IN3URANCE �U�B P30T C;ON$TITUTE A CdF)TRACT BETWEEN TF�1E �SSUIlVG 1N.�c�R�Rl�a1� �U7���i2�D
<br /> R��R�,ENTATIVE 4R PRODUrER,AND TH�G8itvlf iCATE N(7LDER•
<br /> MI�ppR'!'ANY' 8F thr cerfJfi�h01d�r is 1n ADt31FIC�NAL INSURE.D, tne poticy(les) must ba endorsed. If SUBROGATlOM tS �hJAtVE[3.arsb{ect ta ' „
<br /> M
<br /> �e��.and co�aitC6are of the Poticy,certain poqcl�x rnay rdquire an endoraement A atatem�nt c,n thls certlflGate does not ca��r rtght���tha! , �
<br /> COrf3flC8t�s ha'�d���n fi+u Of suGh 9ndaPSemont S� ,M., r�cr �
<br /> �ooucwe $1�-636�4Q00 �►a,�• .. ----.. ..—_ F _— , „
<br /> iockman insurunce Ayency;ir�c. 813-281-10R on� ____., _, .,_�._._N�L._ _._._.._--.
<br /> t38 Colwei!Avenua � `�_ .�„ �
<br /> �mp6,FL 33b�4 Aoo'���s�- __ , ...+�._.�.._...Y ___.__,_�—.
<br /> 3oeklr+an�nsu�nc�A�enc�r��G. INOUR�)JhPrORDINQ COVEMGE�.^�_ _�_Nl�q �
<br /> ir+su a��:Hanover In�urance Com an '����� ,
<br /> _.,._L'L—M...�.
<br /> �uuseo �p�wcr Phase EleCtrlc�IS1C.V ._._._�_�-- INSURER9: �-- . __. _��_.-,.
<br /> �
<br /> Leszek K�eblssyn �NSV+ceN c�,�. . . . --.—• --; ' '
<br /> P.C?.@ox 3219 iNSUata o: _ ..�_, �_� . _�-__.
<br /> HQ�ld�y,FL 3�692 ' �
<br /> �NSURik e: �^-�_ �—�,.----- °�
<br /> .. ,_ �.`_�_�..�...
<br /> i
<br /> SURER F �
<br /> �'C�Y�FtAG��_ �ERTi ICAT�NUINSER: -- REViSIOk N MBE ; ,
<br /> THI$fS TO GER?iFY THAT THE POL�C�ES OP �NSUPAwCE I.tSTED BEt�Ow MAVE BEEN�S5UE0 =b TH�iN�SURE� NAMED ABt7L'E FS7R THE PO�iC'�' pF�taD;' ', •
<br /> INR�CATEO. NO'�tM7HS7ANDING AN�' REQUIFIEM�NX, TENM OR CflNDITION OF ANY COhiTRRC�� oR QTHER DOCUNEIdT'wlTli R�.SPECf T;7 tNHlCH Tt{I�
<br /> CER71F1CAY£ A�IA4' BE �55UED OR hAAy P�#iT�IN, THE iNSUftANCE AFFOflG£p �Y THE POUC�ES OESGRIeED HER��� i8 SU��CT �D kL'_ TME TERM$,
<br /> EXCLiJSION$�ND CC7NDlTIONS Of SUCN POltC1E8.LlM17S SH031JN PMY NAV�B��N REDUCE�BY RqID CLAIMS . �_�„.__V _____. ,"'
<br /> ��� TYPE OF INSUMq� yV--POLICV N M9�1 � Wf IM��ODfYY'1�T1�� �^ L',MITS_�w
<br /> ('�pA�{ALL1ABIlITY � � � I °aCMG'QC:IRRENGE I 3 ��
<br /> ''—� i LNJA1011M101 � i➢ut107/12 j 04107t13 �'����J �.�s _1�.,,;,_
<br /> A I aC CGMMERCIAI GENffR�.A�l.�IABI_trY I, i ` F P�`��5��`����``--�'
<br /> F_�~� CtAlMlS-k�DE �,A 1 OCGUR j I � tmEO FJt�4n5 a*�e p�,rc?^_.._r� � . �"
<br /> �---�� I I II PER30NRL 8 Afay li�'.iVRr I S '� �
<br /> � .w.�_�. .., i � �RAI A�GrtE�arE �� -.._..— ,' '1�
<br /> � --° � I I I PYROO't1CT$'C13MPPIOP AGIi I S '{^i pQ �: �
<br /> 3F,N'LAGGP.�IG�T£LiMf7"APPI.iESPEF' I I j , -.•-._�•�- --�_.�.3 —� -
<br /> �� � ��- INED SIN�LE IMI .,v��
<br /> -.�.���-� P4�I,ICY 1�,�i��^,�f I � LOC - I I�r�g ntY __��,.---__
<br /> I AUTGIIIOBII.6 U�L17Y � ' I
<br /> � r i � � i BGCI' LY!NJ�}Rl�Pvpn�deN %_ _..
<br /> I �M7Y AUTt) � � � � � „-�..-.��..
<br /> ALi.QWNEQ SCt1C0U'.ED � � BO�ILYlWUR�'(peracGaani1; �
<br /> 'AUTGIS �A1JT09 I � � PROP� TYOAAW E�.:b--... .,
<br /> � ��NON-OW1vGD � i i �{?ar acm�enU_ ----i-S , ,
<br /> M RGa AU708 � AU70£ — � ___
<br /> � �..�.--��
<br /> --- - '
<br /> UMYR6LLA LLiB !OCCUR � i��ACrI�CCURFiENC6 , �S ,__._.
<br /> AGGREGnT� ---�,.�S _ --
<br /> EXCiiS L1A0 �CLAI�.MAD�, I � � - --'---'-_� � , 4.�
<br /> R TION � � - -- -' y ATU. � OTW ^ �
<br /> NlORKL'M COYPEN3ATIGM i �
<br /> {AN��EMr601�f'iRt'4wpL,A'� YIN I ` J F.LIEACHI�CCIOGNT�$' .V r ,,
<br /> �o,av PROac+t�TORmnan:en�6wecu-r�vE r-1�r r r! � �
<br /> C�GiCCRMBMmEII CKGLUOEO7 �J I i � � DISEASE-tA EMP:O'"!EEj� __ ', t y,
<br /> �Y�ndr��Y M NFi} I '"
<br /> K p,tlrr�ri00 untlar � � I E 1. C�IBEA.��O_ICY�.t,tlT � �.
<br /> p RIFTiON F P FQATIDNS bac --r-�°"'�
<br /> , � � , I I
<br /> � ! ; ` _
<br /> Ip�lGAIP11dN OF OPERA7f0�1 LCYCAiION$I YENiCL�3(dtfeCh ACOp�1b�.AddiUauii R�m�rks SdteM�ia,H mon spa�e M nW�{+d1
<br /> Fsx: ei3-�5a-ao59
<br /> t �� ` ;"
<br /> � �;
<br /> �CERTIFICA'T!'N LqER CANC 1.LATIQN �_.. ----- ,. °
<br /> r �,, �
<br /> SERV PR
<br /> ! 5HOULD ANY OF TME A�CVE DESGRI�ED�OLICIES�E CANGE�.LFO lI�F�I�;t�.:fl'"
<br /> '*HE E7tPIpAT10N DAT� TIiE!lEOF, NQ"�iCE 1MLL 6E. DP.LAV[I�D'N'fix;k��:
<br /> �ry�p RCCOROANCE YVITFI THL POLICY PRQVi�1A1�. � ''C''
<br /> 11266 W Hil�sborough Ave --...-____- ; � :
<br /> Tampa,�L kurwo�o r�&PaG:ru�rATrve � ,, �.,
<br /> ;�►, �'�.�..,.� `' �
<br /> � .�:,�
<br /> �1938•2010 ACORq CORFPRA71Qhi. Ati rigbri rrss�r °,
<br /> ....,s„'e ron�nrrex► The ACtaRD name And togo are rogisterod marks of A�ORD
<br /> 'T`�J7R� P.�1
<br />
|