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01/15/2010 10:04 Family Insurance of Tampa Bay (FAX)813 319 1089 P.0011001 <br /> ACORN ® DATE (MMIDDIYY) CERTIFICATE OF LIABILITY INSURANCE 01/15/10 <br /> PRODUCER Family Insurance of Tampa Bay, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> 14020 N Florida Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> Tampa, FL 33613 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Phone (813)963 -2227 Fax (813)319 -9245 INSURERS AFFORDING COVERAGE NAIC <br /> INSURED POMBO'S CONTRACTING SERVICES INC INSURER A: American Vehicle <br /> INSURER B. <br /> 5004 Landsman Ave <br /> INSURER C. <br /> TAMPA, FL 33624 INSURER D: <br /> 813 INSURER E: <br /> COVERAGES . INSURER F: <br /> THE POLICIES OF INSURANCE LISTED 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 BYTHE 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 TYPE OF INSURANCE POLICY NUMBER L TE (MMDDMYI MI DATE LTR iNSRD E (MDD/YY)) LIMITS <br /> NSRD DATE <br /> GENERAL LIABILITY EACH OCCURRENCE I 1,000,000 <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 <br /> ® 02162009P_590795 02/16/09 02/16/10 PREMISES (Ea occurence) <br /> 00 CLAIMS MADE ❑ OCCUR MED EXP (Any one person) 5,000 <br /> A ❑ ❑ PERSONAL &ADVINJURY 1,000,000 <br /> ❑ GENERAL AGGREGATE 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> PRODUCTS - COMP /OP AGG 2,000,000 <br /> ® POLICY ❑ PROJECT ❑ LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ❑ ANY AUTO (Ea accident) <br /> ❑ ALL OWNED AUTOS BODILY INJURY <br /> ❑ ❑ SCHEDULED AUTOS (Per person) <br /> ❑ HIRED AUTOS BODILY INJURY <br /> ❑ NON OWNED AUTOS (Per accident) <br /> ❑ PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY- EA ACCIDENT <br /> ❑ ❑ ANY AUTO OTHER THAN EA ACC <br /> ❑ AUTO ONLY: AGG <br /> EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE <br /> ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE <br /> ❑ DEDUCTIBLE <br /> ❑ RETENTION $ <br /> WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- <br /> EMPLOYERS' LIABILITY TORY LIMITS ER <br /> ANY PROPRIETOR 1 PARTNER / EXECUTIVE E.L. EACH ACCIDENT <br /> OFFICER / MEMBER EXCLUDED? <br /> 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 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> City Of Zephyrhills Building Dept. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO <br /> 33335 8th St THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> Zephyrhills, Fl 33542 <br /> AUTHORIZED REPRESENTATIVE <br /> 813 - 780 - 0021 (;) <br /> ACORD 25 (2001/08) QF ® ACORD CORPORATION 1988 <br />