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From Paul Sram At: Roe Insurance, Inc. FaxID: 727 - 376 -2262 To: Jackie Date: 7/22/09 01:54 PM Page: 2 of 3 <br /> ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID PS DATE(MMI °Dnvvv) <br /> BIGGORI 07/22/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> • ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Greg Roe Insurance, Ing . • HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 9851 State Road 54 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> New Port Richey FL 34655 <br /> Phone:727- 376 -0030 Fax:727- 376 -2262 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A. mid continent Casualty Company 23418 <br /> INSURER B. Association Insurance Company 11240 <br /> Big Gorilla Framing, Inc. INSURER C <br /> Mike Raphael <br /> 6304 Spoonbill Dr. INSURER D <br /> New Port Richey FL 34652 <br /> INSURER E <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INK wuU L - POLICY NUMBER POLICYEl+ECTIVE POLICY CXPIRATION LIMITS <br /> LTR NSR(MOONY) C TYPE OF INSURANCE DATE (MOONY) DATE (MMIOD/YY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br /> A X COMMERCIAL GENERAL LIABILITY 04GL000734670 10/20/08 10/20/09 PREMISES (Ea ccu ence) _ $ 100000 _ <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) _ $ excluded <br /> PERSONAL & ADV INJURY $ 1000000 <br /> X includes XCU Cove GENERAL AGGREGATE $ 2000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2000000 <br /> 7 POLICY ^ PRJECO T [ LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> A X HIRED AUTOS 04GL000734670 10/20/08 10/20/09 BODILY INJURY <br /> X NON -OWNED AUTOS (Per accident) <br /> W $ <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY . AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> 7 OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WC, SIAIU- OM- <br /> WORKERS COMPENSATION AND X TORY LIMITS I ER <br /> B <br /> EMPLOYERS' LIABILITY WCV050155000 09/29/08 09/29/09 E.L. EACH ACCIDENT $ 500000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE $ 500000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 <br /> OTHER • <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> WORKERS COMPENSATION APPLIES TO FLORIDA OPERATIONS ONLY. <br /> *30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS NOTICE OF CANCELLATION FOR <br /> NON - PAYMENT OF PREMIUM <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITY OF ZEPHYRHILLS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * DAYS WRITTEN <br /> BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> FAX 813 -780 -0021 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8TH STREET <br /> ZEPHYRHILLS FL 33543 REPRESENTATIVES. <br /> AUTHO D REP SENT <br /> IVV� <br /> ACORD 25 (2001/08) © ACORD CORPORATION 1988 <br />