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<br />From: Sandy Baltes At: Yates Insurance Agency FaxlD: (404) 633-1312 To: Pam Meehan <br /> <br />Date: 51612003 09:42 AM Page: 2 of 2 <br /> <br />. ACORDTU CERTIFICATE OF LIABILITY INSURANCE I DATI! (MM/DD/YYYY) <br />5/6/2003 <br />PRODUCER .. (404) 633-4321 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Yates Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIRCATE DOES NOT AMEND, EXTEND OR <br />p, O. Drawer 95806 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br />Atlanta, GA 30347 <br /> INSURERS AFFORDING COVERAGE NAIC# <br />INSURED S A Kennedy Inc INSURER A: Bituminous Casualty Co <br /> 4255 Trotters Way #1 iNSURER B: American International Specialty Lines <br /> Alpharetta, GA 30004 INSURER c: <br /> INSURER D: <br /> INSURER E: <br /> <br />SAKENNE-01 <br /> <br />BASA <br /> <br />COVERAGES <br /> <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PIiRTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I~.!l!' ~,~'?:~ POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> ~ERAL UABILITY EACH OCCURRENCE $ 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY CLP3156042B 12/31/2002 12/31/2003 ~REM;S'ES 'fE~~cc~~cei $ 100,OO~ <br /> CLAIMS MADE ~ OCCUR MED EX? (Anyone person) $ 10,OO~ <br /> I-- PERSONAL & ADV INJURY $ 1,OOO,OOll <br /> I-- GENERAL AGGREGATE $ 2,ooo,oOii <br /> GEI'L AGG~iGAi LIMIT AiPLlEi PER: PRODUCTS. COMP/OP AGG $ 2,OOO,OOC <br /> POLICY X ~~RT LOC <br /> AUTOMOBILE UABILITY COMBINED SINGLE LIMIT 1,OOO,00~ <br />A CAP3163982B 418/2003 12/31/2003 I.Ea accident) $ <br />- ANY AUTO <br /> X ALL OWNED AUTOS BODILY INJURY <br /> (Per person, $ <br /> - SCHEDULED AUTOS <br /> X HIRED AUTOS BODILY INJURY <br /> X IP.;w accident) $ <br /> - NON-DWNED AUTOS <br /> - PROPERTY DAMAGE $ <br /> (Per accldenC) <br /> ~AGE UABIUTY AUTO ONL l' . EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> iJESSlUMBRELLA UABlUTY EACH OCCURRENCE $ 5,OOO,Ooe <br />B X OCCUR C CLAIMS MADE BE2986172 12/31/2002 12/31/2003 AGGREGATE $ 5,OOO,Ooe <br /> Prod/Camp Ops Agg $ 5,00O,Ooe <br /> ~ DEDUCT'BLE $ <br /> X RETENTION $ 10,000 $ <br /> WORKERS COMPENSATION AND X I WC STATU. I OTH. <br /> TORY UMITS ER <br />A EMPLOYERS' UABILITY WC3156040 12/31/2002 12/31/2003 500,000 <br /> E.L. EACH ACCIDENT $ <br /> ,",NY PROPRIETOR/P ARTNER/EX.ECUT'VE 500,000 <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYI:E $ <br /> g~~'~L~W~vlk'?~~s below E.L. DISEASE. POLICY LIMIT $ 500,001l <br /> OTHER <br />DESCRIPTION OF OPERlITIONSI LOCAnONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAl. PROVISIONS <br />Project: Dollar Tree Store, 7749 Gall Blvd, Zephyrhills, FL 33541 <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />City. of Zephyrhills <br />5335 8th Street <br />Zephyrhills, FL 33541- <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF. THE ISSUING INSURER WIL1. ENDEAVOR TO MAIL 3~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAL1. <br />IMPOSE NO OBLIGATION OR UABlUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br /> <br />.-.- - -;:;~,(?.f:;~:""Y;-\1::=~"j~::/~;:i,. .,,,<":-~~~ . <br /> <br />ACORD 25 (2001/08) <br /> <br />@ ACORD CORPORATION 1988 <br />