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From Megan Manning At: Lykes Insurance FaxID: 813 - 249 -8607 To: Insurance Certificate Date: 10/13/2009 04:25 PM Page: 1 of 2 <br /> DATE (MWDD/ YYY) <br /> OP ID M4 <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE TREEL -1 10/13/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Lykes Insurance , Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 400 N. Tampa St . , Suite 2200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Tampa FL 33602 <br /> Phone: 813- 223 -3911 Fax: 813- 221 -1857 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A. Auto- Owners Insurance 18988 <br /> INSURER B <br /> Treelawn Builders INSURER C <br /> PO Box 506 INSURER D <br /> Brookesville FL 34605 <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 /> WI K AUU L POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDM/) DATE (MMIDD/YY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> UAMAGt IU KtN ItU <br /> A X COMMERCIAL GENERAL LIABILITY 20662768 01/28/09 01/28/10 PREMISES (Ea occurence) $ 50,000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 <br /> PERSONAL 8ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 <br /> POLICY PRO LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> A ANY AUTO 4201981100 02/10/09 02/10/10 (Ea accident) $ 500,000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> X SCHEDULED AUTOS (Per person) $ <br /> X HIRED AUTOS BODILY INJURY <br /> X NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> — <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY. AGG $ <br /> EXCESS /UMBRELLA LIABILIT EACH OCCURRENCE $ 3,000,000 <br /> A 7 OCCUR CLAIMS MADE 4201981101 01/28/09 01/28/10 AGGREGATE $ 3,000,000 <br /> DEDUCTIBLE <br /> X RETENTION $ 10,000 $ <br /> WC SIAIU- UIH- <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> ZEPH533 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> City of Zephyrhills IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 5335 8th Street <br /> Zephryhills FL 33542 /`Q^/ REPRESENTATIVES. <br /> � —� <br /> ACORD 25 (2001 /08) ©ACORD CORPORATION 1988 <br />