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<br />Feb.21. 2008 <br /> <br />1: 51 PM <br /> <br />No. 5826 <br /> <br />P. 1/1 <br /> <br />ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) <br />TM 02/21/2008 <br />PRODUCER Phone (813) 988-1234 Fax: 813-988-0989 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ASSOCIATES AGENCY, INC. ONl Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />PO BOX 16190 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />11470 N. 53RD ST. 4' T"D AY A.., . ,w <br />TEMPLE TERRACE FL 33687 <br /> INSURERS AFFORDING COVERAGE NAIC# <br />Agency lIc# ROO1766 <br />INSURED INSURER A: SOUTHERN OWNERS INSURANCE CO. 10190 <br />R L MATHEWS QUALITY CONSTRUCTION INC INSURER B: AUTO OWNERS INSURANCE CO. 18988 <br />11728 N MARJORY AVENUE INSURER C: AMCOMP INSURANCE CO <br />TAMPA FL 33612-4146 <br /> INSURER D: <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 TOWHICH THIS CERTIFICATE MAY BE 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 />INSR AOO'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECnvE POLICY EXPIRATION LIMITS <br />LTR INSRO DATE IMMlDD/YYI DATE MMlDD/YV/ <br /> GENERAL LIABILIlY 20656305 08/03/07 08/03/08 EACH OCCURRENCE $ 300,000 <br /> X COMMERCIAL GENERAL LIABILITY =~~;~~~~:~~nce) $ 50,000 <br /> -.J CLAIMS MADE 0 OCCUR MED. EXP (Anyone person) $ 5,000 <br /> f--- <br />A PERSONAL & I'DV INJURY $ 300,000 <br /> f--- <br /> GENERAL AGGREGATE $ 300,000 <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG. $ <br /> I n PRO- nLOC <br /> POLICY JECT <br /> AUTOMOBILE LIAB/LIlY 4137093100 05/19/07 05/19/08 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea aCCident) $ 300,000 <br /> - <br /> ALL OWNED AUTOS BODIL Y INJURY <br /> t--- (Per person) $ <br /> SCHEDULED AUTOS <br />B ~ HIRED AUTOS <br /> BODIL Y INJURY <br /> X NON-OWNED AUTOS (Per aCCident) $ <br /> - <br /> - PROPERTY DAMAGE $ <br /> (Per aCCident) <br /> GARAGE LIABILIlY AUTO ONL Y - EA ACCIDENT $ <br /> R ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONL Y AGG $ <br /> EXCESS I UMBRELLA LIASILIlY EACH OCCURRENCE $ <br /> ~ OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> $ <br /> ==i DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND /WCSTATU. / I OTHER <br /> WCV 7048882 11/07/07 11/07/08 X TORY LIMITS <br /> EMPLOYERS' LIABILllY EL EACH ACCIDENT $ <br />C ANY PROPRIETORlPARTNERiEXECUTIVE 100,000 <br /> DFFICERlMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ 100,000 <br /> If ~I. "e.cribe under EL. DISEASE-POLICY LIMIT $ 500,000 <br /> SItECIAL PROVISIONS below <br /> OTHER: <br />DE SCRIPTION OF OPERA TIONS/LOCA 'nONSNEHICLES/EXCLL SIONS ADDED BY I NDORSEMENT/ SPECIAL PROVISIONS <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO <br />City of Zephyrhllls Building Depl. DO SO SHALL IMPOSE NO OBLIGATION OR L1ABILllY OF ANY KIND UPON THE INSURER. Irs <br />5335 8th street AGENTS OR REPRESENTATIVES <br />Zephyrhllls, FI 33542 AUTHORIZED REPRESENTATIVE ~~~ <br />Attention: 780-0021 Bill Owen <br /> <br />ACORD 25 (2001/08) <br /> <br />Certificate # <br /> <br />145598 <br /> <br />@ACORDCORPORATION1988 <br />