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Jan 08 2010 4:59PM HP LRSERJET FRX p.1 <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID VII DATE(MMIDO/TYYY) <br /> FUQUA - 01/08/10 <br /> PRODUCER THIS CERTIFICATE I8 ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> WH Ewing , Blackwelder 6 Duce HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1330 Havendale Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Winter Haven FL 33881 <br /> Phone : 863 293 - 2838 Fax: 8 63 - 299 - 6723 INSURERS AFFORDING COVERAGE NAIL it <br /> INSURED INSURER A: Owners Insurance Co, 32700 <br /> INSURER 8: Auto Owners Insurance Co . <br /> �'lSt3tsa Electric , Inc s Blvd. INSURER D: <br /> MSURER C: <br /> Y2�4I11 g�ees Garden <br /> Winter Haven FL 33884 <br /> INSURER E: <br /> COVERAGES <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 MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> Wail Ao oti, - - POLICY EFFECTIVE <br /> POLICY EXPNM <br /> LTR INERD TYPE OF INSURANCE POLICY NUMBER D ATE ( MM10O/YT ) DATE ( LIMITS <br /> GENERAL LUEIUTY • EACH OCCURRENCE $ 1 , 000 , 000 <br /> A X COMMERCIAL GENERALLIABILTTY 72686687 -09 08/08/09 08/08/10 PREMSES(fac "'ocolaan. $300,000 <br /> I CLAIMS MADE I OCCUR MED EXP (Any one person) s 10 , 00 0 <br /> PERSONAL &ADV INJURY 3 1, 000, 000 <br /> GENERAL AGGREGATE S 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 <br /> 7 POLICY JECT n LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> B ANY AUTO 4464551001 08/22/09 08/22/10 (E° end) $1000000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> X SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON -OWNED AUTOS (Per oxidant) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE UABHLITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC i <br /> OTHER THAN <br /> AUTO ONLY: AGG 8 <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 85,000,000 <br /> OCCUR OCCUR n CLAIMS MADE 4691007100 08/08/09 08/08/10 AGGREGATE s 5,000,000 <br /> $ <br /> id DEDUCTIBLE $ <br /> RETENTION E 10 , 00 0 y <br /> WORKERS COMPENSATION AND VYC STAI S ER <br /> �OIH <br /> TORY LRMIT <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTNE E.L. EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED? <br /> EL. DISEASE - EA EMPLOYEE $ <br /> If yyMse,� describe under <br /> SPECIAL PROVISIONS be El. DISEASE - POLICY LIMIT $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Fax: 813 - 780 -0021 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYZEP SNOULD ANYOF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE 188111/40 INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> City of Zephyzhills NOTICE 70111E CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL <br /> Building Department IMPOSE NO OBLIGATION OR LIAI R.ITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8th Street <br /> Zophyrhills FL 33542 REPRESENTATIVES. <br /> A��r4IAl�',6Q A268620 <br /> ACORD 26 (2001108) ACORD CORPORATION 1986 <br /> • <br />