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From: Amy Banchs At: Bouchard Insurance Inc FaxlD: To City of Zephyrhills Date: 2/26/2008 10:59 AM Page: 2 of 3 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 A4[ DATE (MMlDDIYYYY) EAGLE-l 02/26/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bouchard-Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-6090 Phone: 727-447-6481 Fax: 727-449-1267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Transport.ation Insurance CO INSURER B Valley Forge Insurance Co Eagle Roofing Contractors, Ine INSURER c: Mr Erie Sennott b.rican Casualty Co of a.aclng 3701 West Cherry Street INSURER D Transcontinental Znsuzanc:. Co Tampa FL 33607 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED Nl\MED 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 LTR NSR TYPE OF INSURANCE POLICY NUMBER D~';!~(MM/DDNYI "DATE' (MM/DONYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 - D X ~ COMMERCiAl GENERAl LIABILITY 2091487362 07/01/07 07/01/08 I~~"l: $ 100000 ~ CLAIMS MADE ~ OCCUR PREMISES (Ea occurence) - MED EXP (Anyone person) $ 5000 PERSONAL & I'DV INJURY $ 1000000 GENERAl AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMP/OP AGG $2000000 I [Xl PRO- nLOC POLICY X JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ~ $ 1000000 C ~ ANY AlITO C2082846198 07/01/07 07/01/08 (Ea aCCident) AlL OWNED AUTOS BODIL Y INJURY I-- $ SCHEDULED AlITOS (Per person) - ~ HIRED AlITOS BODIL Y INJURY $ ~ NON-OWNED AlITOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AlITO ONL Y . EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A gj .OCCUR 0 CLAIMS MI'DE CUP2082846265 07/01/07 07/01/08 AGGREGATE $ 1000000 $ 8 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND X IT~~tT~S I IUER B EMPLOYERS' LIABILITY WC2092172401 07/01/07 07/01/08 $ 500000 ANY PROPRIETORIPAATNERlEXEClITlVE EL EACH ACCIDENT OFFICERlMEMBER EXCLUDED? E l DISEASE - EA EMPLOYEE $ 500000 If yes, describe lJlder EL DISEASE - POLICY LIMIT $ 500000 SPECiAl PROVISIONS below OTHER D Rented Leased Equi C2048146410 07/01/07 07/01/08 L/R Equip 50000 D Installation Float C2048146410 07/01/07 07/01/08 Install F 20000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAl PROVISIONS CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY SUBJECT TO THE TERMS CONDITIONS AND EXCLUSIONS OF THE POLIVY FAX: 813-780-0021 CERTIFICATE HOLDER CANCELLATION CITYOFZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL CITY OF ZEPHYRHILLS PERMITTING DEPARTMENT 5335 8TH STREET ZEPHYRHILLS FL 33542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR P SENTA @ACORD CORPORATION 1988 ACORD 25 (2001/08)