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DATE ISSUED CONTRACT NO. <br /> April 6, 2009 I 3305032008 PREVIOUS NO. <br /> TPATE005022 <br /> THIS DECLARATION PAGE IS ATTACHED TO AND FORMS PART OF CERTIFICATE /COVER NOTE PROVISIONS <br /> ITEM /� <br /> CERTIFICATE 1 POLICY NUMBER : TCNR011740 <br /> Name m <br /> e <br /> of <br /> Assured <br /> s <br /> ur <br /> e <br /> d <br /> R J ALUMINUM & MASONRY <br /> ::: t Ov E E[ S; :.''.;t; P ',x.'i 'i .MO RRI <br /> 37912 7TH AVENUE E UDA <br /> ZEPHYRHILLS, FL 33541 > .«I 11RAN . MBAN '1 :J .:" I j�<'# ? :.-:; ::::`. >...:; <: <br /> : : A .,_.. . !;3:::: <br /> REF A; T;<::> �:::::::::: >�<. >::::�:: > >::::: <br /> O8 . l r OPANY 1€ SOLV NT:::: > .> .. <br /> : <br /> SK UR .::: <br /> 1 ASSURANCE RI <br /> 4 <br /> 0 <br /> 5N <br /> REO E <br /> O <br /> ST <br /> #160 <'1R1 ....:..::.::. :.;;:.;::...:;;:.. •:.•::.::;.;; :.;:: >::.::.;:.:.;:.:;;:;:: »::; .;;;;;:.: <br /> TAMPA, MP <br /> A <br /> FL <br /> 33609 6 <br /> 0 <br /> 9 <br /> Effective ... <br /> e Fr ... <br /> m 1 .... <br /> 2 2 :01 ,...... <br /> m .... <br /> Both ........ <br /> Days .... <br /> at <br /> Standard ... <br /> d a r <br /> Y d ... <br /> Time � ... <br /> ...... .....::::: ::: :..::.::.;::.;:::. <br /> .... . ........ TO ...... - g, - 201 p;::>:;:::>:;:::::.::::.;>::;>::::;:::::::>:::::;;::;:;:;:-:.::-;>:.;> ::; >:: >:.:. >:.;:.:::: :�;:.;:.:: <br /> April 6, 2009 <br /> NAME OF INSURERS AMOUNT OR PERCENT <br /> Acting upon your instruction, <br /> 3 we have <br /> effected the insurance with: <br /> >1111‹ <br /> UNDERWRITERS AT LLOYD'S, LONDON 100% ' <br /> LIMIT COVERAGE <br /> RATE PREMIUM <br /> $300,000 COMMERCIAL GENERAL LIABILITY SEE CL150 <br /> $525.00 <br /> 4 <br /> TOTAL BASE $525.00 <br /> SPECIAL CONDITIONS <br /> TERRORISM PREMIUM <br /> See SFE -01 (02/03) Schedule of Forms and Endorsements NO $65.00 <br /> SPECTI N <br /> 5 $65.00 <br /> TAX $31.25 <br /> FSLSO SERVICE FEE $.62 <br /> FHCF FEE $6.25 <br /> TOTAL $663.12 <br /> 6 Countersigned: TAPCO UNDERWRITERS, INC. <br /> CLEARWATER, FL <br /> In witness whereof this covernote has been signed at BURLINGTON, NC this 6 day of April 2009 <br /> NANCY25 FL <br /> SURPLUS LINES AGENT 13577 FEATHERSOUND DRIVE TAPCO UNDERWRITERS, INC <br /> VIRGINIA C. PHILLIPS PO BOX 17069 <br /> LICENSE# A206695 CLEARWATER, FLORIDA 33762 • <br /> Original by <br />