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05/20/2010 00:17 FAX 8137887133 STATE FARM t 01 <br /> Certificate of Insurance <br /> This certifies that • State Farm Fire and Casualty Company, Bloomington, Illinois <br /> s •in • State Farm General Insurance Company, Bloomington. wives <br /> a l ■ State Farm Fire and Casualty Company, Aurora. Ontario <br /> mnnue r p State Farm Florida Insurance Company, winter Maven, norsaa <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 it these policies is <br /> subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduce i by any paid claims. <br /> Policy Period Limits of L ability <br /> Policy Number Type of Insurance Effective Date I Expiration Date (at beginning of I rollcy period) <br /> Comprehensive BODILY INJURY AND <br /> Business Liability PROPERTY DAMAGE <br /> This insurance Include Products - Completed Operations <br /> — Contractual Liability Each Occurrence $ <br /> - Personal Injury <br /> Advertising Injury General Aggregate $ <br /> — Product- Completed $ <br /> Operations Aggregate <br /> Policy Period BODILY INJURY AND F ROPERTY DAMAGE <br /> Policy Number EXCESS LIABILITY Effective Date l Expiration Date (Combined Si,gle Limit) <br /> t <br /> 0 Umbrella Each Occurrence $ <br /> 0 Other I Aggregate $ <br /> 1 Policy Period <br /> Effective Date : Expiration Date Part I - Workers Comr ensation - Stahttory <br /> 9343F-F1127-21i• Workers' Compensation 03/22/10 $ 03/22/11 Part II - Employers Liability <br /> and Employers Liability Each Accident $ 100,000.00 <br /> Disease - Each Employee $ 100,000.00 <br /> Disease - Policy Limit $ 500,000.00 <br /> Policy Period Limits of I. lability <br /> Policy Number Type of Insurance Effective Date i Expiration Date (at beginning of l alicy period) <br /> • <br /> i • <br /> THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NM 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 Far n will try to mail a <br /> C' of Zephyrhills written notice to the certificate Colder 30 days <br /> City before cancellation. If we fail tc mail such notice, no <br /> 5335 8th Street before <br /> or liability will be imr osed on State Farm or <br /> Zephyrtulls, FL 33542 its agents or representatives. <br /> Signature of Autho R ep no , '— IL — " al <br /> INSUR ACCT 05120110 <br /> Title Data <br /> ELAINE RIEGLER <br /> Agent Name <br /> Telephone Number (813) 783-111410 <br /> Agent's Code Stamp <br /> Agent Code 2456 <br /> AFp <br /> Code 106399.10 0625009 2 <br />