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06/04/2009 15:30 3525679638 PASCO FARM BUREAU PAGE 01 <br /> CERTIFICATE OF INSURANCE <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION � ONLY AFFORDED BY THE UPON THE CERTIFICATE <br /> BELOW. HOLDER. <br /> CONFERS NO RIGHTS THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER COMPANIES AFFORDING COVERAGES: <br /> FLORIDA FARM BUREAU INSURANCE COMPANIES Company <br /> P.O. BOX 147030 Letter A: <br /> GAINESVILLE, FLORIDA 32614 F1oe Farm Bureau General Ins. Co. <br /> NAME AND ADDRESS OF INSURED: Company <br /> BAHR ' S ALUMINUM INC Letter B: <br /> 6440 FORT KING RD Florida Farm Bureau Casualty Ins. Co. <br /> ZEPHYRHILLS FL 033542 <br /> The policies of Insurance sated below have been issued to the Insured named above and are in lore at this time. Notwithstanding any requirement, term or condition of any contract or <br /> other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein Is subject to all the terms, exclusions and <br /> conditions of such policies, ALL LIMITS IN THOUSANDS <br /> CO. POLICY EFFECTIVE DATE POUCY EXPIRATION <br /> TYPE OF INSURANCE P OLICY NUMBER <br /> D D DATE (MCvtIDD)YY) <br /> �1"R General ApgrepAM $ 10 0 0 <br /> General Uabillty: a fade $ 3 <br /> ( Cornrnrndet General Liability operations <br /> 6 Advonless *Ty $ 500 <br /> _ <br /> (OcoummceForm) CPP 9522690 04/15/09 04/x5/7.0 <br /> A ch 0a ,enco $ 5 0 0 <br /> Cl L7 Owner's Contractor's Rae Dames (Ary one fire) $ 50 <br /> 0 Farmer's Personal Liability Medical Esparto (Any one person) $ 5 <br /> Combined Automobile LlaWllty: Single Unit $ <br /> 0 Any auto . <br /> BodOy Injury <br /> 0 All owned autos (Per Person) $ <br /> 0 Schedurrd autos Bodily Injury <br /> (Per Accident) <br /> ❑ Hired autos Property Cl Non•avvned autos Damage $ <br /> Fxcesq Llablllly: Occurrence � <br /> 0 Umbrella Form $ <br /> 0 Other than Umbrella loon $ $ $ _ <br /> Employers Liability: onxeel <br /> El Ferro Employers Lto Nry -'' `\� $ <br /> ` Mach wpm* <br /> o Farm Ertrployon'e Medical \, <br /> Other: WC840-0021343-2009 <br /> Workers Com•en - ation <br /> .i.• 01 01 2009 500 '000 $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES: / <br /> SHEET METAL WORK / <br /> J` <br /> '" . <br /> CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the Issuing company will endeavor to <br /> m 7.0 days written notice to the below named certificate holder, but failure to mall such notice shall impose no obligation or liability of any kind <br /> upon the co mpa n y. - 0 6 0 3 0 9 <br /> ADDRESS OF CERTIFICATE HOLDER: COUNTY CODE 51 DATE ISSUED / <br /> CI NAME AND OF ZEPH YRHILLS Serviced by, PASCO Court Farm Bureau <br /> 5335 I3TH STREET <br /> ZE»HVRHI LTA , FL335 JOHN W GRANT, I V <br /> AUTHORIZED REPRESENTATIVE <br /> 93.7492 (Rev. 5/93) <br />