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!_;:,o , 2 :-_ -1_,"1 '"? E^4 : PETERSON INS PACT 132/c'3 <br /> �- <br /> A CRD. CERTIFICATE OF LIABILITY INSURANCE DATE (MNIODlYY1 ^f) <br /> 04/29/2009 , <br /> I'RO ( 352) 567 -9771 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Cy Pdtergor. Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND 4A <br /> 37 Meridian Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> D City _ L 34525- INSURERS AFFORDING COVERAGE <br /> NAIC # INSURED INSCREft INSURANCE CO. <br /> D ELECTRIC, INC . IN SURER ®. SOUTHERN OWNERS _ CO <br /> INS . CO _ <br /> MR. ROBERT DOUGLAS INSURERC:AUTO OWNERS INS <br /> 36425 COVINGTON RD. INSURER D: <br /> DADE CITY 33525- INSURER E. <br /> COVERAGES -- <br /> THE POLICIES OF INSURANCE I.ISTE:D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FUR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY <br /> REQUIREMENT, TERM OR CONDIT OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br /> THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BXCLUS:ONS ANO CONDITIONS OF SUCH POLICIES. <br /> AGGREGATE LIMITS $HUWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> IN5RI ,ADD . POLICY EFFECTIVE POLICY EXPIRATION <br /> LIMITS <br /> LIR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM 0OITY) PATE (MMIDOEYI) _ -- <br /> A of %ERAL LIABILITY 2D54303D 02/24/2009 02/14/2010 EACH OCCURRENCE s 1,000,000 <br /> 1'A^'+ — 50,000 <br /> i ©CGt-0MEACIAL GENERAL LIABILITY I � PREMISES Ed o a:uhehdC f <br /> . ___, , CLAIMS MADE / QGCUR / / / / MED EXP (Any vie peson) S <br /> 5,000 <br /> J PERSONAL & AP/ INJURY S 1,000,000 <br /> / / / / GENERAL AGGREGATE s 2,000,000 <br /> TEEN I_APGREC.ATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG 8 2,000,000 <br /> X POLICY 3 LOC <br /> / / / / <br /> AUTOMOBILE LAMM/ 1 / / 4 / / COMBINED SINGLE LIMIT <br /> (Ea &CCiaenti & <br /> I ANY AUTO — — <br /> At. L VANED AUTOS / / / / BODILY INJURY <br /> — (Per person) S <br /> SCHEDILED ALTOS <br /> HIRED AUTOS / / / / BOCILY INJURY S <br /> i (Der 9CCiaent) <br /> NON -OWN _O AUTOS 'V <br /> I <br /> _ <br /> II / / I / / PRIIPERTf DAMAGE 5 <br /> I } — — - --------- <br /> tAPAGE LIABILITY <br /> (PNr accident) <br /> AUTOONLY- EF.ACCIDENT $ <br /> 1 —.— ANY AVTO / / / / OTHER THAN _ EA ACC 5 <br /> AUTO ONLY: AGG E <br /> — <br /> —fi <br /> EXGEBSrUM$RELLA LIABILITY / / / / I L EACH OCC'UIIRFNCE< 1 <br /> 1 OCCUR n ;LAIMSMACE . I AGGREGATE <br /> CT0UCTl6LE / / / / + <br /> ' _ FRETEN'ICN S T sE --..-- <br /> B WORK.ERSCOMPENSATIONANO 2C531B49 _ * 02/01/2009 D2/01/2010 TORYLMAtTS ° A <br /> CM_ <br /> LIABILITY ., <br /> 00 0 000 <br /> ANY wROaRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCID $ , <br /> OFFIC'ERrMEMSER EXCLUDED? / / / 1 E.L. DISEASE - EA EMPLOYEE 3 1,000,000 <br /> If yos, describe under I ~— <br /> SPEC PROVISIONS Felt* E.L. OISFJA$E - VOL ICY LIMIT $ 1,000,000 <br /> IOaR / / / / <br /> / / / / — <br /> / / <br /> ()ESCR OF OPERATIONSl LOCAT1ONSNEHICL E?E &EXCLV$IVNSAODEC BY EN60RFEMENTISPECIAL PROVISIONS <br /> �cbert E Douglas, Li Genoa # ECC +)02552 / / <br /> 1 <br /> CERTIFICATE HOLDER CANCELLATION <br /> ( - ( - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORt THE <br /> EXPIRATION DATE THERNOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 30 DAYS WRITTEN N0T7CE TO THE CERTIFICATE HOLDER NAM80 TO THE LEFT, BUT <br /> CITY OF ZEPHYRMILLS FAILURE TO CO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br /> BUILD DEP ?RTM E1tiT INSURER ITS AGENTS OR REPRESENTATIVES. <br /> 533 EIGHTH 3T AU THORJZEDREPRESENTA <br /> ZEPH7'TU - IL LS <br /> FL 33542 - v <br /> 1 v 1 � � /W <br /> ACOR.L) 25 (2001/08) i ACOR0 CORPORATION 1988 <br /> INR(".9K :nvw:rs: Page1 C42 <br />