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05/07/2009 20:41 FAX 8137887133 STATE FARM el 01 <br /> Certificate of Insurance <br /> • This certifies that State Farm Fire and Casualty Company, Bloomington, Illinois <br /> ..•r MIMI State Farm General Insurance Company, Bloomington, Illinois <br /> State Farm Fire and Casualty Company, Aurora, Ontario <br /> 'asuman% State Farm Florida Insurance Company, Water Haven, Florida <br /> State Farm Lloyds, Dallas. Texas <br /> insures the following policyholder for the coverages indicated below: <br /> Policyholder JAMES 0 MORTON ELECTRIC CO INC <br /> Address of policyholder PO BOX 1537 36906 EILAND BLVD ZEPHYRHILLS FL 33542 <br /> Location of operations <br /> Description of operations ELECTRICAL WORK <br /> The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is <br /> subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. <br /> Policy Period Umits-of Liability <br /> Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period) <br /> 98 BB H244 0 B Comprehensive 03122/2009 03/22/2010 BODILY INJURY AND <br /> Business Liability PROPERTY DAMAGE <br /> This insurance includes_ Products - Completed Operations <br /> Contractual Liability Each Occurrence $ 1,000,000.00 <br /> Personal Injury <br /> Advertising Injury General Aggregate g 2,000,000.00 <br /> Product - Completed $ 2,000,000.00 <br /> Operations Aggregate <br /> ' Policy Period BODILY INJURY AND PROPERTY DAMAGE <br /> Policy Number EXCESS LIABILITY Effective Date Expiation Date (Combined Single Limit) <br /> ❑ Umbrella <br /> Each Occurrence S <br /> ❑ Other <br /> . Aggregate $ <br /> Policy Period <br /> Effective Date : Expiration Date Part I - Workers Compensation - Statutory <br /> Workers' Compensation Part II - Employers Liability <br /> and Employers Liability Each Accident $ 100,000.00 <br /> 98 03/22109 03/22/10 Disease - Each Employee 5 100,000.00 <br /> Disease - Policy Limit S 500,000.00 <br /> Policy Period Limits of Liability <br /> Policy Number Type of Insurance Effective Date : Expiration Date (at beginning of policy period) <br /> THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY <br /> AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POUCY DESCRIBED HEREIN. <br /> Name and Address of Certification Holder <br /> If any of the described polices are canceled before <br /> CITY OF ZEPHYRHILLS their expiration date, State Farm will try to mail a <br /> 5335 8TH ST. written notice to the certificate holder 30 days <br /> ZEPHYRHILLS, FL. 33542 before cancellation. If we fail to mail such notice, no <br /> obligation or liability will be imposed on State Farm or <br /> its agents or representatives. <br /> A- _ , • 'L• <br /> Signature of Au orized R •resentative ' <br /> INS. ACCT. REP. 05/08/2001 <br /> Title Date <br /> ELAINE RIEGLER <br /> Agent Name <br /> Telephone Number (813) 783.8500 <br /> s <br /> : t <br /> Agents Code stamp <br /> Agent Code 2456 <br /> AFO code F611 <br /> 1001250 <br /> mmau LL4.16.a709 <br />