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From: Cindy McEwen At: Hillcrest Insurance FaxlD: 3523835899 To: City of Zephyrhills Date: 1/412005 0929 AM Page: 1 of 1 ACORD. CERTIFICA TE OF LIABILITY INSURANCE OP 10 1~ DATE (MM/DDIYYYY) BOLEN-l 01/04/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hillcrest Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 1364 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mount Dora FL 32756 Phone: 352-383-8164 Fax:352-383-5899 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Southern OWners Ins. Co. 10190 INSURER B- AutO-OWners 18988 Bolena construction, Inc. INSURER C FCCI Insurance Company 4459 Parkbreeze ct. INSURER D Orlando FL 32808-1043 INSURER E. 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 INSRC POLICY NUMBER .VL'\..f LIMITS LTR TYPE OF INSURANCE DATE (MMIODIYY) DATE (MMJODIYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - A X COMMERCiAl GENERAL LIABILITY 2057182603 03/07/04 03/07/05 UAMA'-'t: $ 100,000 PREMISES lEa occurence) l CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & flDV INJURY $1,000,000 f-- GENERAl AGGREGATE $2,000,000 f-- GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $2,000,000 II nPRO- n POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B -I 4179828600 12/18/04 12/18/05 (Ea accident) $ 1,000,000 X ANY AUTO - ALL OWNED AUTOS BODIL Y INJURY - (Per person) $ SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY - (Per accident) $ NON-OWNED AUTOS - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONL Y AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 B [J OCCUR D CLAIMS MADE 4179828601 03/07/04 03/07/05 AGGREGATE $1,000,000 $ ~ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X ITO'R'vtiMI'i'S I IOTH- ER C EMPLOYERS' LIABILITY 48366 02/02/04 02/02/05 EL EACH ACCIDENT $ 100,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under EL DISEASE - POLICY LIMIT $ 500,000 SPECiAl PROVISIONS below OTHER A Equipment Floater 2057182603 03/07/04 03/07/05 Leased 75,000 equipment DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Contractors/ Subcontract work Fax 1813-780-0021 CERTIFICATE HOLDER CITYZEP CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR city of Zephyrhills 5335 8th st. Zephyrhills FL 33542 ACORD 25 (2001/08)