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� <br /> I <br /> I <br /> �^� � TAYLO-2 OP ID:SD <br /> '`�`�„°RO� CERTIFICATE OF�I BILITY 1NSURANCE °"�,23,""'°�"' <br /> THi3 CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATiON O LY AND CONFERS NO RIGHT8 UPON THE CERTIFlCATE HOLDER THIS <br /> CERTIFlCATE DOES NOT AFFIRMATIVE�Y OR NEGATIVELY AME D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THI3 CERTIFlCATE OF INSURANCE DOES NOT CONS TE A CONTRACT BETWEEN THE ISSUING INSURER(S)� AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CER7IFlCATE HOLDE <br /> IMPORTANT: If the certiflcata holder is an ADDITIONAL INSURED, poliry(ies)must be endorsed. If SUBROGATION IS WAIVED�subJect to <br /> the terms and condJtions of ttw poUcy,certain policies may require endorseme�. A stabemeM on this certlHcaba does not confer rights to the <br /> certiNcata holder in Ileu of such endorseme s. <br /> PRODUCER A <br /> Williams-Hess Insurance "�� <br /> 1617 E Gary Road PHONE <br /> Lakeland•FL 33801 , — �� <br /> R.BRAN�EBERRY-A028698 <br /> nasu s aFwRaNO covEw►oe wuc s <br /> INSU�eA:H@rmila @ ins CO. <br /> INSURED Jack Franks c. ,NSUr�s:lnfln Insurance Grou 39497 <br /> dba Taylor ntal Cente ��,��:AGCS Marine Insurance Co <br /> � PO BOX 2636 <br /> Brandon,FL 33509 - !� INSURERD: <br /> INBURER E: <br /> RER : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD <br /> INDICATED. N0TIMTHSTANDING ANY REQUIREMENT,TERM OR COND ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY �E ISSUED OR MAY PERTAIN, THE INSURANCE AFF RDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMRS SHOWN MAY VE BEEN REDUCED BY PAID CIAIMS. <br /> � TYPE OP INSURANCE POLICY NUM MMID V� <br /> � <br /> OENERAL LJABILITY EACH OCCURRENCE t 1+�r� <br /> A X COMMERGAL CaENERAL UABILITY HGL543772-13 07/13/2013 07N3/Z014 pREMISES Ea acarrence � �,�� <br /> CWMSMADE �X OCxUR MED IXP(An7l�D��) i 1�OO <br /> a�RSOt��a nov iwuRr s ���.� <br /> GENERALAGGREGATE S 2.�+� <br /> GEN'L AGGREGATE UMIT APPUES PER: PRODI!(.'TS-COMP/OP AGG i II1CIUfI <br /> X POUCY PRO- �� S , <br /> AUTOMOBILE IJABILRY � BIN D i MI ��QQQ�OOO <br /> B arr nuro 509251507936001 10/28/2013 1 W29/2014 eoa�v iwuRr�wr�sa,) S <br /> �OOVSMIED X A�,HOESULEO BpqLY INJURY(Par acdderq) S <br /> A <br /> X HIREO AUTOS X A�IJTO�ED �R A � s <br /> p�p p� s 10,OOC <br /> uMg�y�,A upg ��R EACH OCCURRENCE S <br /> EXCESS W►B GAIMS-MADE AGGREGATE S <br /> DED RETENTION f � i <br /> WORKERS COMPENSATION WC STATU- TH- <br /> AND EMPLOYEits'W1&L11Y <br /> ANY PROPRIETORRARTNERIEXECUTIVE YQ N f A E.L EACN ACCIDENT S <br /> �Fl��EM������ EL DISEASE-EA EMPLOYE i <br /> (Manddoey In NiQ <br /> M y9s,desCAbe under E.L OISFJISE-POUCY L1MIT S <br /> DESCRIPTION OF OPERATIONS be�ow <br /> C Equlpmerrt Fioater MXI93021323 O7N312013 07/1312014 Bianket 2.��� <br /> Spectal Form UNSCHEDULED(B NICET) PropertY <br /> DESCRIPTION OF OPERA710NS 1 LOCA710N81 YEWCLEH(AWeh ACORD 101,Additlonal SeMduN,if ean W�e�Is re9�I <br /> I <br /> I <br /> . I <br /> i <br /> i <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> K-MART <br /> SHOULD ANY OF 7HE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE 7HEREOF, NOTICE VYILL BE DELIVERED IN <br /> K-Mart Corp Sears Holdings ACCORDANCE YY17H 7HE POLICY PROVISIONB. <br /> Corp <br /> #216 Zephyfiills �unww�o r�a�s�rr�rne <br /> 7422 Gali Blvd � .� � <br /> Zephyrhilis,FL 33541 ��•c�?��'�"�.� <br /> m 1988-2010 ACORD CORPORATION. All�Ighta reserved. <br /> ACORD 25(2010/05) The ACORD name and lo�o are registered marks of ACORD <br /> i <br /> � <br />