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JUN -24 -2009 09:14A FROM: MIKE PETERS STATE FA 727- 862 -4443 TO:18137800021 P.1 <br /> CERTIFICATE OF INSURANCE <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, Scarborough, Ontario <br /> ® STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida <br /> ❑ STATE FARM LLOYDS, Dallas, Texas <br /> insures the following policyholder for the coverages indicated below: <br /> Name of policyholder GUARANTEE ELECTRIC INC <br /> Address of policyholder 10645 Fawn Drive NEW PORT RICHEY, FL. 34654 <br /> Location of operations SAME AS ABOVE <br /> Description of operations Electrician <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 UABIUTY <br /> POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Does (at beginning of policy period) <br /> 98 BB C914 - v Comprehensive 10/27/2008 10/27/2009 BODILY INJURY AND <br /> Business Liability / PROPERTY DAMAGE <br /> This insurance includes: ® Products - Completed Operations <br /> ® Contractual Liability <br /> ® Underground Hazard Coverage Each Occurrence $ 1,000, 000 <br /> ® Personal Injury <br /> ® Advertising Injury General Aggregate $ 2,000,000 <br /> ❑ Explosion Hazard Coverage <br /> ❑ Collapse Hazard Coverage Products — Completed $ 2,000,000 <br /> ❑ Operations Aggregate <br /> 0 <br /> POUCY PERIOD BODILY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY Effective Date ' Expiration Dots (Combined Single Limit) <br /> ❑ Umbrella E Occurrence $ <br /> • <br /> ❑ Other i ggregate $ <br /> Part 1 STATUTORY <br /> • <br /> Part 2 BODILY INJURY <br /> 98 - TY - 0854 - 0 Workers' Compensation 10/27/2008 10/27/2009 <br /> and Employers Liability Each Accident $ 100000 <br /> Disease Each Employee $ 100000 <br /> Disease - Policy Limit $ 500000 <br /> POUCY PERIOD LIMITS OF UABILITY <br /> POLICY NUMBER TYPE OF INSURANCE <br /> 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 POLICY DESCRIBED HEREIN. <br /> If any of the described policies are canceled before <br /> its expiration date, State Farm will try to mail a written <br /> notice to the certificate holder <br /> Name and Address of Certificate Holder 30 days before cancellation. If however, we fail to <br /> mail such notice, no obligation or liability will be <br /> City of Zephryhills imposed on State Farm or its agents or <br /> 5335 8 Street representatives. <br /> Zephryhills, Fl. 33542 <br /> 1- 813 - 780 -0021 .)■.)%S) Qty <br /> Signatu Autrltrrzed Representative <br /> Agent 06/24/09 <br /> Title Date <br /> A sfAiie 1AiM ' IKE PETERS <br /> INSURANCE AGENCY, INC. <br /> A st1315 Little Rd <br /> 558 -964 e.3 04 -1999 Printed fn U.S.A. INsuaAN0 New Port Richey, FL 34654 <br /> OFF: (727) 862 -3516 <br /> FAX: (727) 862 -4443 <br />