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01/15/2010 10:23 3525671159 PETERSON INS PAGE 01/02 <br /> ACORD <br /> , CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 01/15/2010 <br /> PRODUCER (352 5 67 - 9771 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Kyle Peterson Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 37837 Meridian Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Dade City FL 33525- INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A; SOUTHERN OWNERS INSURANCE <br /> EHRMAN SYSTEMS ENTERPRISES ,INC. DBA INSURER 8 INS. CO. <br /> ENVIRONMENTAL CONTRACTORS INSURER C: <br /> 10221 U.S. HWY 301 _ INSURER D: <br /> DADE CITY FL 33525- 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 ANY <br /> REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br /> THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br /> AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> I LT R INS TYPE OF INSURANCE POLICY NUMBER DATE 1 M/DD/YY) POLICY ATE (MM DNY) LIMITS <br /> LTR INSRDD'' <br /> A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 500, 000 <br /> X COMMERCIAL GENERAL LIABILITY PREM A s ( pE o m Mnoe $ 50,000 <br /> 1 CLAIMS MADE n OCCUR / / / / MED EXP (Any one person) S 5,000 <br /> PERSONAL & ADV INJURY $ 500,000 <br /> — _ 20593488 01/01 /2010 01/01/2011 GENERAL AGGREGATE $ 500,000 <br /> GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG S 500,000 <br /> i ( POLICY n JECT [1 LOC / / / / <br /> H AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMB <br /> ^ 8 500 , 000 <br /> _ — ANY AUTO (Ee accident) <br /> X ALL OWNED AUTOS 42 - 185 - 01/01/2010 01 /01 /2011 BODILY INJURY <br /> (Per person) $ <br /> _ SCHEDULED AUTOS <br /> HIRED AUTOS / / / / BODILY INJURY <br /> — S <br /> — <br /> NONAWNEDAUTOS <br /> (Per accident) <br /> / / / / PROPERTY DAMAGE S <br /> — (Per accident) <br /> GARAGE UABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO / / / / OTHER THAN EA ACC $ <br /> AUTO ONLY AGG $ <br /> EXCESS/UMBRELLA UABILITY / / / / EACH OCCURRENCE S <br /> 7 OCCUR n CLAIMS MADE AGGREGATE S <br /> $ <br /> —r . <br /> OEOUCTIBLE / 1 / / S <br /> RETENTION S $ <br /> WORKERS COMPINSATION AND / / / / 1 TOaY iVRS 1 _ lU <br /> EMPLOYERS' UABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED? / / / / E.L DISEASE - EA EMPLOYEE $ <br /> 11 yea, deSdbe under <br /> SPECIAL PROVISIONS Delon E.L DISEASE - POLICY LIMIT $ <br /> A OTHER INLAND MAARINE /PROP / / / / <br /> 20583488 01/01/2010 01/01/2011 <br /> / / / / <br /> DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADOED ST ENDORSEMENT/SPECIAL PROVISIONS <br /> LIC: CAC1814472; ER0013583 <br /> CERTIFICATE HOLDER _ CANCELLATION <br /> ( ) - (813) 780 -0021 SHOULD ANY OF 711E ABOVE DESCRIBED POLICIES BE CANCELLED WORE THE <br /> EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br /> CITY OF ZEPMYR $ILLS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON INC <br /> 5335 EIGHTH STREET INSURER, ITS AGENTS OR REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE � � PsdoLiZiSY\ <br /> ZEPHYRH LLS FL 33542- <br /> ACORD 25 (2001/08) 0 ACORD CORPORATION 1988 <br /> 1NS025 (0108).oe Page 1 of 2 <br />