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From:Diane Benoit FaxID: Page 2 of 3 Date:7/7/2009 02:56 PM Page:2 of 3 <br /> qCp R „ � DATE (MMIDD/YYYY) <br /> � CERTIFICATE OF LIABILITY INSURANCE P ID DI 07/07/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Bouchard - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> P 0 Box 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Clearwater FL 33758 -6090 <br /> Phone: 727-447-6481 Fax: 727-449-1267 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A $ridgefield Employers Ins co 10701 <br /> INSURER B <br /> Hunsberger Plumbing Co Inc <br /> Lauren Fuller INSURER C <br /> 111 Chapman Rd E INSURER D: <br /> Lutz FL 33549 <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 /> mlSK NUU L - POLICY EP•ECJIVE POLICY tXPIRAI I0N -- <br /> LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YYYY) DATE (MMIDD/YYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> PR EMIS IU KtI <br /> COMMERCIAL GENERAL LIABILITY occurence) <br /> (Ea occurence) $ <br /> CI AIMS MADF OCCI IR MFD FXP (Any one person) _ $ <br /> PERSONAL & ADV INJURY - $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ <br /> — 1 POLICY n PRO <br /> JECT LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON -OWNED AUTOS (Per accident) <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 /> OCCUR CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION X TORY LIMITS 1 ER <br /> AND EMPLOYERS' LIABILITY Y / N <br /> A PROPRIETOR/P EX TNER/E?ECUTIVE 083030810 01/01/09 01/01/10 E.L. EACH ACCIDENT $ 100000 <br /> MEMBER (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100000 <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 /> FAX: 813- 780 -0021 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> ZEPHRYH DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br /> CITY OF ZEPHRYHILLS <br /> 5335 8TH STREET REPRESENTATIVES. <br /> ZEPHYRHILLS FL 33542 AurH ° rrw TIVE <br /> ACORD 25 (2009/01) 988 -20 9 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />