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'4`°RO� CERTIFICATE OF LIABILITY INSU DATE(MMlDD/YYY1� <br /> RANCE 12�19�2�12 <br /> THIS CERTIFiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> 4ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> tEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certi£cate 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 /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT �F•FREY LIVENGOOD <br /> NAME: <br /> LIVENGOOD & ASSOCIATES, INC. PHONE (352) 686-0444 F'� �3sz� 686-2862 <br /> A/C No: <br /> 10519 SPRING HILL DRIVE E-MAi� .gINSURA6@TAMPABAY.RR.COM <br /> INSURE S AFFOR�ING COVERAGE NAIC# <br /> SPRING HILL FL 34608- iNSUReRn:BRIDGEFIELD <br /> INSURED SENICA AIR CONDITIONING INC. INSURER 8. <br /> 16640 SHADY HILI,S RD INSURERC. <br /> INSURER D. <br /> INSURER E. <br /> SPRING HILL FL 346�.0— INSURERF. <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 NOTIMTHSTANDING ANY REQUIREMENT, 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBR <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DDY� MM/LDDY/YWY LIMITS <br /> GENERAL LIA8ILITY � � � � EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY / / � � DAMAGE O RENT D <br /> PREMISES Ea occurtence S <br /> CLAIMSMADE � OCCUR � � � � MED EXP(My one person) $ <br /> � � � � PERSONAL&ADV INJURY $ <br /> � � � � GENERALAGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: � � � � PRODUCTS-COMP/OP AGG $ <br /> POLICY PRa LOC / / / / $ <br /> AUTOMOBILE LIABILI7Y / / / � COM8INED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO � � � � BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS � � � � BODILY INJURY(Per accident) $ <br /> HIRED AUTOS AO OONMED � � � � PROPERTY DAMAGE <br /> Per accident $ <br /> / / / / $ <br /> UMBRELLA LIAB OCCUR I I / / <br /> EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMSMADE � � / / <br /> AGGREGATE $ <br /> �ED RETENTION$ / / / / $ <br /> j� WORKERS COMPENSATION 30-30935 1/Ol/2013 1/Ol/2014 WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y�N }{ <br /> OFFIC R/MEIMB�R EXCLUDED ECUTIVE� N/A / � � � E.L.EACH ACCIDENT $ $OO OOO <br /> (Mandatory in NH <br /> Ifyes,describe under / / / � E.L.DISEASE-EA EMPLOYE $ 5�0 �0� <br /> DESCRIPTION OF OPERATIONS below � � � � E.L DISEASE-POLICY LIMIT $ 50O OOO <br /> � � � / <br /> � � / � <br /> DESCRIPTION OF OPER,4TIONS!LOCATIONS/VEHICLES (Attach ACORD 101 dditional Rem Schedule,if more space is required) <br /> Michael Boren Lic # CMC56953 ET11000770 ER13014209 <br /> A 10 DAY NOTICE OF CANCELLATION CAN BE SENT FOR NON-PAYMENT OF PREMIUM <br /> CERTIFICATE HOLDER CANCELLATION <br /> (B13) 7B0-0020 (813) 780-0005 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> CITY OF ZEPHRYHILLS <br /> 5335 8TH STREET AUTHORIZEDREPRESENTATIVE <br /> ZEPHYRHILLS FL 33540- �'� � � � <br /> ACORD 25(2010/05) OO 1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025�zo�oos�.oi The ACORD name and loqo are reqistered marks of ACORD <br />