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r CA1E SSuED • CONTAACT NO. <br /> Pfrg ND. <br /> March 17, 2009 ART4462009 NEW <br /> THIS DECLARATION PAGE IS ATTACHED TO AND FORMS PART OF CERTIFICATE /COVER NOTE PROVISIONS <br /> ITEM CEMI CATS POLICY NUMBEA: ARTE020576 <br /> }� �,".,.-R, V -`fi ];.:',#e-:Sr . t'-; :4 3• •'#' a r, =7 - �•> . <br /> Name of Assured <br /> §:.'.'-' . -, , f , <br /> ssur ri- � � f � _ t � : <br /> ANDERSON PRESSURE CLEANING INC ` . { 4 " ,, g { Y 1 � 0 " _ £ ' <br /> sir <br /> 5104 MURRAY HILL DRIVE a �r f`, - <br /> TAMPA, FL 33615 ; ` s - M .,- , �� ..; . � <br /> 1 OTERO INSURANCE GROUP . . x "` `3 s <br /> 7520 W. WATERS AVE., #2 ¢ ' ` "_ 4 <br /> S <br /> r r <br /> rf _Z = h:,< -: max' - =' � � t�'m '_� "t:=:l - - :: -f = ?" `= -' - <br /> A ..:....: - -. <br /> TAMPA, FL 33615 W4r;_r _=- �. <br /> 2 Effectrme From 120tam Both Days at Standard Time : March 10, 2009 TO March 10, 2010 <br /> 1 Ac iirg upon your ins rust or, ` NAME OF INSURERS AMOUNT OR PERCENT <br /> 3 1 aha'r UNDERWRITERS AT LLOYD'S, LONDON 100% IIIM <br /> _fr the s. ar:ce r, the <br /> i 1111111 ' <br /> MUM <br /> i <br /> LIMIT COVERAGE RATE PREMIUM <br /> I <br /> $1,000,000 COMMERCIAL GENERAL LIABILITY SEE CL150 $1,180.00 <br /> 4' <br /> i <br /> TOTAL BASE $1,180.00 <br /> SPECIAL CONDITIONS <br /> TERRORISM PREMIUM <br /> POLICY FEE $35.00 <br /> INSPECTION $65.00 <br /> 5 See SFE -01 (02/03) Schedule of Forms and Endorsements TAX $R4.00 <br /> FStSOSERVCE FEE 51.28 <br /> FHCF FEE $12.80 <br /> TOTAL $1.358.08 - <br /> 6 Countersigned: TAPCO UNDERWRITERS, INC. <br /> CLEARWATER, FL <br /> In witness whereof this covernote has been signed at BURUNt3TON. NC this 17 da of March • 2009 T UNDERWRIT C <br /> • <br /> SURPLUS LINES AGENT 13577 FEATHERS DRIVE , <br /> BCAUTHR FL VIRGINIA C. PHILLIPS Po BOX 17069 <br /> 1 If'.FGIAFS A711RRQM PI Ab12WATFD RI Aeon .97a) �1/ <br />