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OLD DOMINION INSURED <br /> t INSURANCE COMPANY <br /> 4601 Touchton Road East, Ste. 3300 <br /> P.O. Box 16100, Jacksonville, FL 32245 -6100 <br /> Telephone: 1- 904 -642 -3000 / 1 -800- 226 -0875 <br /> CONTRACTORS POLICY DECLARATIONS <br /> Named Insured and Mailing Address <br /> SHERREL HEATING AND AIR <br /> CONDITIONING INC Policy Number: MPG75889 <br /> 9718 LINDA PLACE Account Number: CACG75889 <br /> TAMPA, FL 33610 <br /> Agent: BUHL INSURANCE AGENCY INC Producer Code: 090065003 <br /> AGENT PHONE : 813 876 0057 <br /> POLICYHOLDER INFORMATION <br /> Named Insureds Business: AIR COND SYSTEMS OR EQUIP- NO LPG <br /> Entity: CORPORATION <br /> Policy Term: 12 <br /> Effective: 12/27/09 (12:01 A.M. Standard Time at the address <br /> Expiration: 12/27/10 of the Named Insured stated above) <br /> In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide <br /> the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage, <br /> Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. <br /> BUSINESSOWNERS LIABILITY COVERAGE <br /> Liability & Medical Expenses - each occurrence LIMITS OF INSURANCE <br /> Personal and Advertising Injury Limit $ 3 0 0, 0 0 0 <br /> Products - Completed Operations A $ 300,000 <br /> Aggregate Limit $ 600,000 <br /> General Aggregate Limit <br /> $ 600,000 <br /> Fire Legal Liability - any one fire or explosion $ 500,000 <br /> Medical Expense Limit - per person <br /> $ 10,000 <br /> Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- <br /> ages reduces the amount of insurance we provide during the applicable annual period. Please refer to <br /> section D.4. of the Businessowners Liability Coverage Form. <br /> • <br /> For policies subject to premium audit: Annual Audit Applies. <br /> Commercial Inland Marine Coverage Part INCLUDED <br /> FL EMPAT FUND: 4.00 <br /> FL FIRE MARSHALL: $ .76 <br /> Estimated Annual Premium: S 857 <br /> FL RECOUPMENT: 30.59 <br /> TOTAL PREMIUM AND CHARGES S 892.35 <br /> Countersigned: 0 <br /> 64-5470 (7/07) 11/02/09 RENEW JC <br />