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06/16/2009 10:53 8139487225 JOHNSON AND HOGE INS PAGE 01/01 <br /> CERTIFICATE OF INSURANCE <br /> The company indicated below certifies that the insurance afforded by the policy or policies numbered and <br /> described below is in force as of the effective date of this certificate. This Certificate of Insurance <br /> does not amend, extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any <br /> policy numbered and described below. <br /> CERTIFICATE HOLDER: <br /> CITY OF ZEPHYRHILLS INSURED: <br /> 5335 BOTH ST KINSEY CENTRAL HEATING <br /> ZEPHYRHILLS, FL 33542 -4312 AND A /C, INC <br /> PO BOX 2209 <br /> ZEPHYRHILLS, FL 33539 - 2209 <br /> POLICY <br /> TYPE OF INSURANCE & ISSUING M CO. EFFO EXP. DATE * LIMITS A I <br /> LIABILITY 77- AC 707914-3001 01 - 29-09 01 -29-10 (*LIMITS AT INCEPTION) <br /> [X] Liability and NATIONWIDE Any One Occurrence $ 1,000,000 <br /> Medical Expense MUTUAL <br /> [X] Personal and INSURANCE CO. Any One Person /Org $ 1,000.000 <br /> Advertising Injury <br /> [X] Medical Expenses <br /> [X] Fire Legal ANY ONE PERSON S 5,000 <br /> Liability Any One Fire or Explosion S 100,000 <br /> General Aggregate* $ 2.000.000 <br /> [ ] Other Liability Prod /Comp Ops Aggregate* $ 1.000.000 <br /> AUTOMOBILE LIABILITY <br /> [ 3 BUSINESS AUTO <br /> Bodily Injury <br /> [ 1 Owned (Each Person) S <br /> [ ] Hired (Each Accident) 3 <br /> [ ] Non-Owned Property Damage <br /> (Each Accident) $ <br /> Combined Single Limit <br /> EXCESS LIABILITY <br /> Each Occurrence g <br /> [ ] Umbrella Form i Prod /Comp Ops /Disease <br /> Aggregate* ; <br /> f. ] Workers' STATUTORY LIMITS <br /> Compensation BODILY INJURY /ACCIDENT $ <br /> and Bodily Injury by Disease <br /> [ ] Employers' EACH EMPLOYEE S <br /> Liability Bodily Injury by Disease <br /> POLICY LIMIT , s <br /> DESCRIPTION OF OPERATIONS /LOCATIONS <br /> VEHICLES /RESTRICTIONS /SPECIAL ITEMS <br /> C \ 3 1:\C-k <br /> OM* <br /> Effective Date of Certificate: 06-16-2009 Authorized Re resentat v <br /> Date Certificate Issued: 06-16-2009 Co p i e • � - JOHNSON <br /> Countersigned at 216 CRYSTAL GROVE BLVD <br /> LUTZ. FL 33548 <br />