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f`� ° CERTIFICATE OF LIABILITY INSURANCE DA (PANT o0 1 PRODUCER Bauer & Associates THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 12210 US'Highway 301 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Dade City, FL 33525 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (352)567 -3702 Fax (352)523 -0434 INSURERS AFFORDING COVERAGE NAIC # INSURED WOZNIAK BUILDERS INC. INSURER A: SOUTHERN OWNERS INSURANCE PO BOX 326 INSURER s: DADE CITY, FL 33526 INSURER C: INSURER D: 1 INSURER E: COVERAGES INSURER F; THE POLICIES OF INSURANCE LISTED 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 ISSUEO OR ' MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TY O F INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMIT9 I TR INSRD DATE (MM/DD/YY1 DATE IMMIODIYYI GENERAL LIABILITY EACH OCCURRENCE 1 MIL *DAMAGE TO D COMMERCIAL GENERAL LIABILITY 20715654 01/19/09 01/19/10 PREMISES (EaEoccurence) 50,000 LJ ❑ CLAIMS MADE Q OCCUR MED EXP (Any one person) 5,000 A ❑ ❑ PERSONAL & ADV INJURY 1 MI L ❑ GENERAL AGGREGATE 2MIL GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG 2MIL _ 2 POUCY ❑ PROJECT ❑ LOC AUTOMOBILE UASIUTY COMBINED SINGLE LIMIT ❑ ANY AUTO 4672735000 03/19/08 03/19/10 _(Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY 100,000 A ❑ © SCHEDULED AUTOS (Per person) _ ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY 300,000 (Per accident) ❑ PROPERTY DAMAGE I 100,000 ❑ (Pov accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY AGG , EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ❑ 10 OCCUR fl CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RrrENTION $ WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- EMPLOYERS' LIABILITY TORY LIMITS FR ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT OFFICER / MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE If yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY UMT • OTHER A LICENSE & PERMIT BOND 66022954 1 09/14/08 _ 09/14/09 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS PLUMBING CONTRACTOR • CERTIFICATE HOLDER CANCELLATION SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF ZEPHYRHILLS SO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPT. THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 5335 8TH STREET a MIMED REPRESENTATIVE ZEPHYRHILLS , FL 33542 3/ 1 FAX @813 -780 -0021 1 / '7 /0 91 ACORD 25 (2001/08) OF ® RD CORPORATION 1888