CERTIFICATE OF LIABILITY INSURANCE (8) CHART-1
DATE IMMIDDr%1yVY)
CERTIFICATE OF LIABILITY INSURANCE 0510112017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING fNSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
...............
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
certificate holder In lieu of such andorsernent(s).
.................
'6f'Vict�
:PRODUCER 941-484-0681 C_NT��
Gifford-Heiden Ins- NG/VG PHtaNE 9 44
111 E Venice Avenue 14 C,N ,Elaa
IL
Venice, FL 3d28ss_ Ict
Victor L. Garraus
WSIURERISi A�Fa1��LINGC(N EP RGE..._,._._._ - NAIC W
INSURER A:So uth ern-Owne rs Ins Co 10190
...............
INSURED James Chartler INSURER B:
6208 Van Dine Street
Englewood, Ft.34224 ..........
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:
............. REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, IFERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT INITH RESPECT TO WHICH THIS
CERTIF5CATE 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,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.............
LrR .v rl(PF 0 F I IN SU RA NCE L UB PO 1_1 CY NUM PE R POLICY
�NSD WVI In 0IMMAWLY)IJ LIMITS
—------------- ..........
"x COMMERCIAL GENERA
ENERAL LIABILITY
1,000,000,
c", 50,000
� x �20071294 05103�2017 0510312018
5,000
1,000,000
...........
1'000mo
X
'F 7 1,000mo
T11
------------------- —------- ...............
AuTOMOSR.E LIABILITY" 0 r'!BiN,E E I INA
A
3
EL
C
A,-
...............
4— ...................
UMBRELLA LIAB
EXCESS LIAR L
T E
A P 4
....................
—-----------------------
WORKERS COMPENSATION F
AND EMPLOYERS'LIABILITY
YN .. ........... .................
1, T-
L E,C!
E E ............
"';E EAcrV-1
.......... ...........
DESCRIPTION or OPERATIONS f LOCATIONS f VEHlCLFS (ACORD 101.Additional Remarks Schedule,maybe attached if more space is requirod)
(�ERTIRCATE HOLDER .......... C NCELLATION
....---—---
PR00001 .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PROOF OF COVERAGE***'***' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
........—------ .......
AUTHORIZED REPRESENTATIVE
FL
V
L ... .... ..............
ACORD 25(20161`03) 1988-2015 ACORD CO....RPORATION. All rights reserved,
The ACORD name and logo are registered marks of ACORD