181-Metropolitan Systems, Inc. Insurance Certif
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13721 c-t! J
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
2/11/2010
PRODUCER Commercial Lines - (727) 796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wells Fargo Insurance Services USA, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
311 Park Place Boulevard, Suite 400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ClealWater, FL 33759-3923 INSURERS AFFORDING COVERAGE NAIC#
INSURED Metropolitan Systems Inc. Etal INSURER A: Westfield Insurance Company 24112
3014 Horatio Street INSURER B: Zenith Insurance Company 13269
INSURER c:
INSURER D:
Tampa FL 33609 INSURER E:
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COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER P~1'f~ri~:68,wIE Pg~fJ(~~b~~N LIMITS
A ~NERAL LIABILITY CMM1686631 7/01/2009 7/0112010 EACH OCCURRENCE $ 1,000,000
~ 3MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 150,000
f-- CLAIMS MADE [8] OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2.000.000
n'L AGGREAE LIMIT APAS PER: PRODUCTS - COMP/OP AGG $ 2.000.000
PRO-
POLICY JECT LOC
A ~TOMOBILE LIABILITY CMM1686631 7/01/2009 7/01/2010 COMBINED SINGLE LIMIT $ 1,000,000
X ANY AUTO (Ea accident)
f--
f-- ALL OWNED AUTOS BODILY INJURY
$
X SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A 0ESS/UMBRELLA LIABILITY CMM1686631 7/01/2009 7/01/2010 EACH OCCURRENCE $ 4.000,000
X OCCUR 0 CLAIMS MADE AGGREGATE $ 4,000,000
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND Z831250618 3/01/2010 3/01/2011 X I WC STATU- I 10J~-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 1.000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1.000.000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1.000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTICICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
CERTIFICATE HOLDER
CANCELLATION Ten Day Notice for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
CITY OF SANFORD NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: CITY CLERK IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 1778 REPRESENTATIVES.
SANFORD FL 32711 AUTHORIZED REPRESENTATIVE 9(~-
ACORD 25 (2001/08) 1 of 2 1187647
@ ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (2001/08) 2 of 2
#S915260/M915043