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10/13/2006 03:28 8638750703 BIG_DADDYS PAGE 02/03 <br /> Crerm warv.4e "Jaen•1A6I1e,A.AI At argon Inx►ancw Swrvlewe FANID: 6153- 284l2 To: Et 19 Daddy's MH - Christy Date: 4/2/09 11:10 AM Page. 1 of I <br /> AC ORD CERTIFICATE OF LIABILITY INSURANCE OPIO 391 DATE`MWDON'''") <br /> ENTER -1 04/02/09 <br /> PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION <br /> BIS/GREEN INSURANCE BLRVICLI'S ONLY ANO CONFERS NO RI0)HTS UPON THE CERTIFICATE <br /> "COTS Insurance Inc" HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1500 6th Street NW ALTER THE COVERAGE AFFORDED BY THE POuc1E8 BELOW. <br /> Winter Haven FL 33881 <br /> Phone:863- 294 -4241 Fax:863- 294 -4243 INSURER3AFFOROIN000VERAGE NAICl1 <br /> INSURE!) INNSER n The Burlington Ins co FJC <br /> wsuREP s: <br /> Big Daddy's Mobile Haase Set Up iN�RER c <br /> Service, LLC 'Tackle peterson <br /> 621 Avenue A East- Wabneta POURER D: <br /> Winter Maven FL 33980 <br /> INSURER E: <br /> • <br /> COVERAGES <br /> THE POLICIES CF IP URWNCE LISTED BELOW HAVE SEEN ISSLED TO THE INELRED NAACO MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REOUREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Writ RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIIE) IEAEIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDTIONS OF SUCH <br /> POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED Sri PAID CLAIMS, wy <br /> L,TR ! TYPE OF FISURANC6 POLICY NUMBER �r "r 1 DA7E r (MMP70f1 Yw Laws <br /> GENERAL WORRY EACH OCQMPENCE 11,000,000 <br /> ]L <br /> r IVTiC <br /> 2,. ca✓AEERCIALGENERAL U m ABU. 2649003199 07/21/08 07/21/09 PREMIS (En 160,000 <br /> . �J aAIMS MADE © occup MED EXP )lyy one Pelson) 1 5 , 000 _ <br /> PERSONAL A ADV (NARY $1,000,0(10 <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEML AGGREGATE LIIM PGR PS : PRODUCTS. COM P AGO $ Included <br /> 7 OL <br /> PICE n JECY n LOC • <br /> AUTOMOBILE UABILI TY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO CEe AccHlontI <br /> ALL OWNED AUTOS SODILY INJURY <br /> SCHEDULED AUTOS (Per Omen) 1 <br /> _... HIRED AAOS <br /> BOOBY IN.A.11Y - <br /> NON•ONMEDAUTOS (PereeeMeN) 3 <br /> PROPERTY DAMAGE 3' <br /> (Per Accident) <br /> GARAGE LABLITY AUTO MY - EA ACCIDENT 1 <br /> - 1] ANY ALPO OTHER THAN EA ACC 3 <br /> AUTOON.Y: nes <br /> EXCESSRAIBRELLA UABILITY EACH OCCttIRENCE Y 1 <br /> nc0LR CLAIM$ AOOREGAYE 1 <br /> .R DEDUCTIBLE 1 <br /> MORTON 3 1 <br /> WORKERS COMPRI$ATION AND ITOT LfIMR6 I 1OER <br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT t <br /> MY PROPRIETORIPARTNER/E)EQTIVE <br /> OFFICEPNHEMBER EXCI.UDEOT L.L. DISEASE - EA EMPLOYEE $ <br /> If y�l, Oa1W IAIIef <br /> SPECIAL crI <br /> PRI wISItXNS WAY E.L. mew- POLICY LINT _ 1 <br /> OTHER <br /> • • • • - ••..: r LOCATI •' r VENICLES s EXCLUSIONS 400E0 BY = " • _..., 'NT / SPECIAL PROVISIONS <br /> JecKle Peterson Installer License # IR0000537 <br /> Aggregate Limits shown may have been reduced by paid claims.. <br /> CERTIFICATE HOLDER CANCELLATION <br /> CI9!YOFS <br /> 11404A0 ANY OF THE A90VE DESCIVIEO POLICIES BE mecum BEFORE THE EXPIRATION <br /> DATE TIEREOF. THE ISe*NG INSURER WILL ENDEAVOR TO MAIL 3.0 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEST, BUT FAILURE TO 00 *0 SHALL <br /> City of Eephyrbilis WORE NO OILS/MON OR LIABILITY OF ANY KIND UPON THE INl.JR9f, ITN AGENT1 DR <br /> 5335 Stb St. _ <br /> Eephprhizls FL 33542 " °NNT"T <br /> AUT <br /> ACORO 2512001JOi) e ACORO CORPORATION 1988 <br />