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05/20/2010 00:17 FAX 8137887133 STATE FARM 102 <br /> Certificate of Insurance <br /> This certifies that • State Farm Fire and Casualty Company, Bloomington, Millais <br /> RAW MIMS <br /> 4 1 ■ State Farm General Insurance Company, abominator, Illinois <br /> • State Farm Fire and Casualty Company, Aurora, Ontario <br /> ,,, p State Farm Florida Insurance Company, Winter Haven, Florida <br /> ■ State Farm Lloyds, Dallas, Texas <br /> insures the following policyholder for the coverages indicated below: <br /> Policyholder JAMES 0 MORTON ELECTRIC CO INC <br /> Address of policyholder PO BOX 1537 36906 EILAND BLVD ZEPHYRHILLS, FL 33542 <br /> Location of operations <br /> Description of operations ELECTRIC WORK <br /> The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is <br /> subjectto all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduces I by any paid claims. <br /> Policy Period Limits of Liability <br /> Polley Number Type of Insurance Effective Date ; Expiration Date (at beginning of p alicy period) <br /> 98•BG•D576 - B C ompreh ensive 03/22/10 03/22/11 BODILY INJURY AND <br /> Business Liability PROPERTY DAMAGE <br /> This Insurance includes: Ti. Products - Completed Operations <br /> X Contractual Liability Each Occurrence $ 1,000,000.00 <br /> X Personal Injury <br /> X Advertising Injury General Aggregate $ 2,000,000.00 <br /> Product- Completed $ 2,000,000.00 <br /> Operations Aggregate <br /> Policy Period BODILY INJURY AND P kOPERTY DAMAGE <br /> Policy Number EXCESS LIABILITY Effective Date l Expiration Date , (Combined Single Limit) <br /> o Umbrella Each Occurrence $ <br /> o other Aggregate 5 <br /> Policy Period <br /> Effective Date Expiration Date Part I - Workers Comp tnsation - Statutory <br /> Workers' Compensation 'Part 1I - Employers Liability <br /> and Employers Liability Each Accident $ <br /> Disease - Each Employee $ <br /> Disease - Policy Limit $ <br /> Policy Period Limits of L ability <br /> Policy Number Type of Insurance Eflecdve Date Expiration Date (at beginning of r olicy period) <br /> THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NC R NEGATIVELY <br /> AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POUCY DESCRIBED HEREIN. <br /> Name and Address of Certification Holder If any of the described policies are canceled before <br /> their expiration date, State Fan l will try to mail a <br /> written notice to the certificate I polder 30 days <br /> City of Zephyrhills before cancellation. If we fail to mail such notice, no <br /> 5335 8th Street obligation or liability will be imp ased on State Farm or <br /> Zephyrhills, FL 33542 its agents or representatives. <br /> 7 , : �g� o./1 • <br /> Signature of Autho ' Rep = _ ', tiv 6� <br /> INSUR ACCT R <br /> I Title Date <br /> ELAINE RIEGLER <br /> Agent Name <br /> Telephone Number (813) 783 -8;00 <br /> 1 Agents Cade Stamp <br /> Agent Cate 2456 <br /> AFO cooe F611 <br /> rotass.ro o& Ares <br /> aware <br />