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ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP 10 G~ DATE (MMlDDIYYYY) JTBPO-1 08/23/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance By Ken Brown, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 948117 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Maitland FL 32794-8117 Phone: 321-397-3870 Fax:321-397-3888 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Amerisure Mutual Ins. Co 23396 INSURER B: Amerisure Ins Company 19488 J T B Pool Contracting Inc. INSURER c: POBox 550 INSURER 0: Zephyrhills FL 33539-0550 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, LTR ~SRt POLICY NUMBER ~~Lf~1MMiD~D,yyt ULI\;Y LIMITS TYPE OF INSURANCE DATE (MM/DDIYY) GENERAL LIABILITY EACH OCCURRENCE $300,000 f-- A X COMMERCIAL GENERAL LIABILITY GL131439609 09/08/07 09/08/08 PREM~~s~a~uron~) $50,000 I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $300,000 GENERAL AGGREGATE $ 600,000 I-- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 600,000 ~ 'nPRO, nLOC Emp Ben. 1,000,000 POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT '-- (Ea accident) $ ANY AUTO I-- ALL OWNED AUTOS BODIL Y INJURY - (Per person) $ SCHEDULED AUTOS I-- HIRED AUTOS BODILY INJURY '-- (Per accident) $ NON,OWNED AUTOS - f-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ q 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 ITO~Y"~'~:i's I IV~R" B EMPLOYERS' LIABILITY WC131566609 09/08/07 09/08/08 $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ 100000 ~~~(;I~~s~~~VI~?~NS below E. L DISEASE, POLICY LIMIT $ 500000 OTHER ESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS :ax 813-780-0021 ERTIFICATE HOLDER City of Zephyrhi11s 5335 8th Street Zephyrhi11s, FL 34248 CANCELLATION ZBPHYRH 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR2ED SEN TW @ ACORD CORPORATION 1988 :ORD 25 (2001/08)