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<br />A CORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 C9 DATE (MMlDDIYYYY) <br />BOLTI-J. 08/J.5/07 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> . , . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hockman Lackey Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3438 Colwell Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Tampa FL 336J.4 <br />Phone:8J.3-636-4000 Fax:8J.3-28J.-J.086 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: American Safety Risk Ret Grc up <br /> INSURER B: Hanover Insurance Company <br /> Boltin Pest Control, Inc. INSURER c: Bridgefield Employers Ins. Co <br /> Boltin Fumigatin, Inc. <br /> J.5534 US Hithwas 30J. INSURER D: <br /> Dade City F 33 23 <br /> INSURER E: <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 MAYBE ISSUED OR <br />MAY PERTAIN, 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,J~iJ~1f~E P~~~..,Y(~J'IRA~ ---- -_. <br />LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE MMlDDIYY LIMITS <br /> GENERAL UABILITY EACH OCCURRENCE $500,000 <br /> I-- UAMi\\3l:: ; YE" Kl::N I l::U <br />A ~ COMMERCIAL GENERAL LIABILITY TPGJ.042830 08/14/07 08/14/08 $J.OO,OOO <br />:::J CLAIMS MADE [!] OCCUR PREMISES Ea occurence) <br /> MED EXP (Anyone person) $5,000 <br /> I-- <br /> PERSONAL & ADV INJURY $J.,OOO,OOO <br /> I-- <br /> GENERAL AGGREGATE $J.,OOO,OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ J., 000,000 <br /> n .nPRO- n <br /> POLICY JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> - $ J., 000, 000 <br />B X ANY AUTO AZJ7936037 02/0J./07 02/01/08 (Ea accident) <br /> - <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - <br /> X HIRED AUTOS BODILY INJURY <br /> - $ <br /> X NON-OWNED AUTOS (Per accident) <br /> - <br /> - PROPERTY DAMAGE $ <br /> (Per acddent) <br /> GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ <br /> =1 ANY AUTO OTHER THAN EA ACe $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> :::J OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> $ <br /> R DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND X I TORY lIMITl3 I JUltI- <br /> ER <br />C EMPLOYERS' LIABILITY 0830-3293J. 0J./0J./07 0J./0J./08 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ J.OO, 000 <br /> OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ J.OO, 000 <br /> If yes, describe under $500,000 <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> i <br /> <br />CERTIFICATE HOLDER <br /> <br />Workers' Compensation <br />Compliance <br />J.3J.3 N. Tampa St., Ste 503 <br />Tampa FL 33602-3328 <br /> <br />CANCELLATION <br />DEP ARTM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUJ: EP.~E_~~NTATf.EE; .1_ <br />~ ~~'*It" - <br /> <br />ACORD 25 (2001/08) <br /> <br />@ ACORD CORPORATION 1988 <br />