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<br />02/10/2004 TIc 11: 30 FAX S13 932 628i <br /> <br />ADCOCK-ADCOCK <br /> <br />IaJ 001 <br /> <br />ACIJREt CERTIFICATE OF LIABILITY INSURANCE I DATi (IIIlIIlOm'YY} <br />02/10/2004 <br />PIttJDUCe~ (813)933-6691 FAX (813)932-6287 THIS CERTIFICATE IS Issueo AS A MATTER OF INFORMATION <br />Adcock & Adcock Insurance Ag$ncy OHL Y AND CONFERS NO RIGHTS UPON THE CI!RTIFICATE <br /> HOLDER. THIS CERTIFlCAT~~ tgr AMEND. ~p OR <br />3IS W. Fletcher Ave. AL TEfl THE COV!RAGI! AFF THE POLIC S ELOW. <br />Tampa, FL 33612-)414 <br /> INSURERS AFFORDING COVERAGE NAIe # <br />INSURED INSVReR A: Southern-Owners Insurance Co. 10190 <br />Commercia' Systems of Tampa, Inc. INSURER II: Auto-Owners Insurance Co. 1898. <br />9810 U.S. Highway 92 East INSUReR c, Associated Industries <br />Taql&, Fl 33610 INSURliR 0: <br /> INSURER E: <br /> <br /> ES <br />THE POliCIES OF INSURANC! LISTED BELOW HAVE BEEN ISSU!O TO THE INSUREO NAMEO ABOVE FOR HiE POLlCY PERIOD INDICATED. NOTWITHSTANOIN' <br />ANY REQUIREMENT, TeAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR <br />MAY PERTAIN. TM! INSURANCE AFfORDeD BY THE POLlCliS OESCRIB~D H~REIN IS SUBJeCT TO ALL THE r~MS. EXCLUSIONS ANO CONDmoNS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUceD BY PAID ClAlMS. <br />rr -~-'" "'"~- ...,..,""""", pouev EXPlRA110H UMIT$ <br /> ~&RAL LlABIU'I'V 2058631203 04/07/2003 04/07/2004 IOACH oeeuMI!HOe $ 1.000.000 <br /> I ~D'AL GalERAl. LIABILITY DAMAG~ TO RENnD $ 100.000 <br /> I-::-:- CLAIMS MAOE m oecUF\ MEO EXP (Any one _n) $ 10.000 <br />A ~ Contractual liab. PeRSOt.IAl... AD\! INJURY $ 1.000.000 <br /> ~ GIHfRAL AGGREGATE $ 2,000,000 <br /> GEiN'L AGGREGATE LIMIT APPI,.IES PtiR' PROOUCT$ . eololPiOP AGG S 2 000,000 <br /> ~. POLICY n:8,: n LOC <br /> ~UTOM0811." LlABLITY 4227072900 06/01/2003 06/01/2004 COMIlINED SINGLE LIMIT <br /> lEa aCCIdent) S <br /> ..! ANV AUTO 500 ooe <br /> - ALL OWNEO AUTOS DODIl. Y INJURY <br /> (P<< p815on) S <br /> SCHEI:lIJLED AUTOS <br />8 X <br /> Ht~ED AUTOS BOOlL Y INJURY <br /> ~ $ <br /> ~ NOJ'l..oWNI!O AUTOS (per_Idem) <br /> t-- F'AOPIiiRTY OAI.IAGIi $ <br /> (Per accldentl <br /> RARAGe! LIABIUTY AUTO ONt Y , eAACClOeHT $ <br /> ANY AUTO OTHe~ THM! eAACe S <br /> "'UTO ONly, AGe> $ <br /> EXC~LIADILI1'Y 4227072901 04/07/2003 04/07/2004 EACli OCCUAAiNCe $ 1.000,O(H <br /> !loecu/\ 0 CLAIMS MADE AGGRkGATE $ 1. 000.001 <br />B $ <br /> ~ DEDUC'1181E S <br /> X RiTENl10N S 5 I 004l s <br /> WORKERS coroIIeNSATION AND 200333287& 06/01/2003 06/01/2004 X I we STATl)- I (~ <br /> I!.MI'I..OYER$' LWIIU'I'Y E.L. EACH ACCIDENT 1,000 00 <br />C l>NY PRQPRllITORJPA1UNERlEXECUTIVE $ <br />OI'FICl!I\IMEIw1BeR EXCLUOEOt e.L OISEA.$.. . lOA EMPLOYEe s 1. 000, 001 <br /> ~~M~~v\s~NS belOw E.\.. CIWMe -/'OLlCY LIMIT ~ 1.000 001 <br /> CI'I'MP <br />OI!SCIlIl"T1OH OF OPEltAT1OICS I LClCA'TIOHa fVE14ICLEBIEXCLUSION$ ADDEO 1IY INOORSliMiHT ISP~ PROVISIONS <br /> <br />to ........., I A""'-' <br />$HOUUlIWV Of' THI AeOVE DEBCRl8IiP /'OLlCIR BE CAHCa1.l.llD IUORE THE <br />IiXPlIU.TION DATE THEltSOl'. THE ISSUING INSUREIt WILL ENDSAYOR TO MAl. <br />...19- OAYS WRITTEN NOTICe TO T11l! cu:nrICATI tIOLDliR NAMED TO THE lEFT. <br />BUT fAlI.URE TO MAIL SUCH NOTICIi SJoIAU. tMrOSE NO oeUGATION OR LIADtUTY <br />OF AHV KIND UI'OH THE INSURER. IT$ AGI!NTlJ 011 fCEPRIil$&NTATMlS. <br />AUTHOIIZICI_AIiSEN1'ATlVE <br />James Randa", III C.I.C. <br /> <br />Zephyrhills Building Department <br />;335 Height Street <br />Zephyrhills, FL 33542 <br /> <br />ACORD 25 (2001108) <br /> <br />@ACORDCORPORAnON1M <br />