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} 05/07/2009 20:41 FAX 8137887133 STATE FARM 1 02 <br /> 1• <br /> Certificate of Insurance <br /> MATS Mur <br /> This certifies that State Farm Fire and Casualty Company, Bloomington, Illinois <br /> State Farm General Insurance Company, Bloomington, Illinois <br /> State Farm Fire and Casualty Company, Aurora, Ontario <br /> f IMSYII / MC` State Farm Florida Insurance Company, venter Haven, Florida <br /> State Farm Lloyds, Dallas, Texas <br /> I 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 daims. <br /> Policy Period Limits of Liability <br /> Policy Number , Type of Insurance Effective Data i Expiration Date (at beginning of policy period) <br /> Comprehensive BODILY INJURY AND <br /> Business Liability __ ____ _ PROPERTY DAMAGE <br /> This Insurance includes: Products - Completed Operations <br /> = Contractual Liability Each Occurrence $ <br /> Personal Injury <br /> ,^ Advertising Injury General Aggregate $ <br /> — <br /> Product - Completed $ <br /> Operations Aggregate <br /> Policy Period BODILY INJURY AND PROPERTY DAMAGE <br /> Policy Number EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) <br /> Umbrella <br /> Each Occurrence $ <br /> Other Aggregate $ <br /> Policy Period <br /> Effective Date i Expiration Date Part I - Workers Compensation - Statutory <br /> Workers Compensation Part II - Employers Liability <br /> and Employers Liability Each Accident <br /> $ 100,000.00 <br /> • <br /> 98 - BB - F189 - 03/22/09 03/22/10 Disease -Each Employee $ 100,000.00 <br /> Disease - Policy Limit $ 500,000.00 <br /> Policy Period Limits of Liability <br /> Policy Number Type of Insurance Effective Date i 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 POLICY DESCRIBED HEREIN. <br /> Name and Address of Certification Holder If any of the described policies are canceled before <br /> ' CITY OF ZEPHYRHILLS their expiration date, State Famr by 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 /> , 813-at <br /> i Signature of Autho Representative Aai <br /> INS. ACCT. REP. O5/08/200t <br /> Title Date <br /> ELAINE RIEGLER <br /> Agent Nome <br /> Telepnone Number (813) 783 -8500 <br /> Ager>rs Cone Sump <br /> 1 Agent Code 2458 <br /> . 1 1001260 AFO Code F611 <br /> 108999.9 09.164009 <br />