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Jan. 12. 2010 5:04PM STAHL & ASSOCIATES No. 6574 P. 1/1 <br /> A ° RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 1/12/2010 <br /> PRODUCER (727) 391 -9791 FAX: (727) 393 -5623 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Stahl &Associates Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 110 Carillon Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> St. Petersburg FL 33716 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURED INSURER A Amerisure Mutual Ins Co <br /> United Air Conditioning and Heating Inc. INSURER B Amerisure Insurance Co <br /> 13150 South Belcher Rd INSURER C <br /> INSURER D <br /> Largo FL 33773 INSURER E <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING <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 /> INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION YY <br /> LTR NSRD TYPE OF INSURANCE DATE (MMIDDIYY) DATE (MMIDDIYYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 <br /> DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 50 000 <br /> A CLAIMS MADE X OCCUR GL2040578 11/1/2009 11/1/2010 MED EXP Any one person) $ 10, 000 <br /> X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,000 <br /> X Blkt Add. Insured GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 <br /> X POLICY PRO- <br /> JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> X ANY AUTO CO accident) <br /> $ <br /> A ALL OWNED AUTOS CA2040576 11/1/2009 11/1/2010 BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON -OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC $ <br /> OTHER THAN <br /> AUTO ONLY. AGG $ <br /> EXCESS! UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR p1 CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> B WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y/N X TORY IIMITS FR <br /> ANY PROPRIETOR /PARTNER/EXECUTIVE E . EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) WC2041764 1/1/2010 1/1/2011 E . DISEASE - EA EMPLOYEE $ 500,000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS !LOCATIONS! VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> (813)780-0021 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City Of Zephryhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Zephryhills, FL 33540 <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> Kelly Petzold /GREEN �%— <br /> ACORD 25 (2008101) ©1988 -2009 ACORD CORPORATION. All rights reserved. <br /> INS025 (200501) The ACORD name and logo are registered marks of ACORD <br />