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ACORQ CERTIFICATE OF LIABILITY INSURANCE FAX (813)282-9374 DATE (MMlDDIYYYY) 06/25/2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRO,?,.!J~I3).-:82-1965 Lassiter-Ware Insurance 5600 Mariner Street te 215 '1_"lpa, FL 33609 INSURED Hawkins Construction Inc. P. O. Box 1636 Tarpon Springs, FL 34688 INSURERS AFFORDING COVERAGE INSURER A: Ameri sure Insurance Company INSURERB: Amerisure Mutual Ins. CO. INSURER c: INSURER D: INSURER E: NAIC# 19488 23396 cnVFRAC;ES 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. ~$': ~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY GL2010976 07/01/2004 07/01/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 I-- 2,000,000 GENERAL AGGREGATE $ I-- 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ h POLICY [Xl ~~C?T n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I-- (Ea accident) $ ANY AUTO I-- ALL OWNED AUTOS BODILY INJURY I-- $ SCHEDULED AUTOS (Per person) I-- HIRED AUTOS BODILY INJURY I-- (Per accidenl) $ NON-OWNED AUTOS I-- I-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ tJ OCCUR o CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC2021538 07/01/2004 07/01/2005 X I WC STATU- I IOJ~' EMPLOYERS' LIABILITY 1,000,000 B ANY PROPRIETORlPARTNERlEXECUTNE E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E,L. DISEASE. EA EMPLOYEE $ 1,000,000 If yes, describe under $ 1,000,000 ._, SPECIAL PROVISIONS below E,L. DISEASE. POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS .icense Holder - John B. McCaugherty, Jr License # CG059737 R All Cities and Counties in State of Florida SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO L SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI AUTHORIZED AC?RD 25 (2001/08)